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Cosmetic periorbital and eyelid surgery is a commonly performed procedure in facial plastic surgery. Understanding the biomechanics of periorbital anatomy and its role in aesthetic surgery is essential for achieving optimal outcomes. This review explores the biomechanical processes involved in periorbital age changes and analyzes the impact of cosmetic surgery approaches on these processes. By maintaining the initial mechanical equilibrium of the brows, eyelids, septal fat, and blepharoplasty folds, periorbital and eyelid cosmetic surgery can effectively rejuvenate the appearance. Disruption of this equilibrium can lead to the migration of anatomic components, resulting in signs of aging. Surgeons, by applying biomechanical concepts, can tailor the forces exerted upon the different structures to manifest the patient’s aesthetic aspirations. The key to success in periorbital and eyelid cosmetic surgery lies in re-establishing a dynamic mechanical equilibrium within the periorbital framework.