Upper blepharoplasty: Skin incision is placed in the natural crease of the eyelids to remove excess skin and fat, while orbicularis oculi muscle is typically spared. Fat is also minimally removed to avoid a “hollow-eyes” appearance. Lateral canthus is elevated with non-absorbable sutures, as it normally lies 2mm higher than medial canthus. Lower blepharoplasty: Skin incision is placed 2mm under the lower lid margin to remove excess skin and fat that cause tiring and saggy appearance. In almost every patient over 35, tightening of the lower lid must be performed to avoid scleral show.