[Aesthetic blepharoplasty]

Suzanne Noël, a pioneer of aesthetic surgery in Europe, first published her results with cosmetic blepharoplasty in 1926, in a book entitled: "The social role of aesthetic surgery". Paul Tessier further expanded the range and surgical possibilities of blepharoplasty by incorporating lateral canthopexies and underlying the importance of the craniofacial skeleton. Other authors in the 20th century brought their own technical refinements to this operation, such as the transconjunctival route, and various fat preserving modifications as well as lipostructure. The aim of this paper was to review the surgical approach to blepharoplasty, according to both historical and currently used protocols (including data gathered by questionnaires sent to eight French and foreign plastic surgical teams). A new perspective is proposed regarding the analysis of different morphological and ageing subtypes. The indication for individual surgical techniques stems from an accurate analysis of each patient according to anatomical categories. Pre-operative records before any orbito-palpebral surgery should include a full orthoptic and ophthalmological assessment, as well as high-quality medical photographs. An increasing emphasis has developed recently upon the use of autologous fat harvested locally (septofat advancement), or from a distant site (lipostructure).