Emulsion formation by homogenization is commonly used in food production and research to increase product stability and to design colloidal structures. High-energy methods such as high-pressure homogenizers and rotor–stator mixers are the two most common techniques. However, to what extent does the research community understand the emulsion formation taking place in these devices? This contribution attempts to answer this question through critically reviewing the scientific literature, starting with the hydrodynamics of homogenizers and continuing by reviewing drop breakup and coalescence. It is concluded that although research in this field has been ongoing for a century and has provided a substantial amount of empirical correlations and scaling laws, the fundamental understanding is still limited, especially in the case of emulsions with a high-volume fraction of the disperse phase, as seen in many food applications. These limitations in the current understanding are also used to provide future perspectives and suggest directions for further investigation.