Can an eyelid surgery be done without touching the orbital septum?

Some of the answers state that passing through the orbital septum to repositioning or removing fat can lead to internal bleeding that can cause blindness. Can it be done without going through the orbital septum?

Doctor Answers 8

Eyelid Surgery

Thank you for your question. Yes. Transconjunctival blepharoplasty removes fatty tissue simply by using a laser on the interior part of the lower eyelid. It avoids an external incision and instead make an incision inside the eyelid itself to gain access to the lower eyelid fat bags. This is a common and safe procedure. I suggest that you move forward and consult with a board certified facial plastic surgeon.

Best wishes,


Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 96 reviews

Can eyelid surgery be done without touching the orbital septum

Unfortunately, the orbital fat that is causing the puffiness in the lower layers is encased in the orbital septum which must be opened up to be able to remove the protruding fat deposits. Bleeding is extremely rare in experienced surgeon's hands. Even if that were bleeding present, an experienced surgeon knows how to control it. We have never seen blindness in over 25 years performing eyelid surgery. Make appointments with three of the busiest eyelid surgeons in your local area

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Orbital septum question

Yes - the combination of transconjunctival fat removal and a pinch blepharoplasty (to treat the excess skin) is a method that does not violate the orbital septum.

Fortunately, the risk of blindness following blepharoplasty is very, very small indeed.

For more information about the risks of eyelid surgery, have a detailed discussion with your local plastic surgeon or oculoplastic surgeon 

Lower blepharoplasty technique

For lower blepharoplasty, the septum is NOT cut if done through conjunctival approach but it is cut via skin approach. It does not lead to increased bleeding, so the septum itself isn't important. The approach is much more important. See following link and video.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 62 reviews

Can an eyelid surgery be done without touching the orbital septum?

You may be a bit overconcerned regarding the risk of blindness. Your chance of dying on the way to or from surgery is many times higher and yet you are still going to do it. But yes, surgery can be done without touching the orbital septum, we do it all the time. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

There is skin only blepharoplasty that does not violate the septum or orbicularis oculi muscle.

This may or may not be right for you.  No surgeon can promise you that you won't have this rare complication.  My advice to you is to not have eyelid surgery.  It is okay to admit that it is just not for you.  Although the incidence of this complication is very low, still it could happen.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Blepharoplasty: Can an eyelid surgery be done without touching the orbital septum?

Blepharoplasty is a surgery to improve the eyelids by addressing excess skin, herniating fat, or asymmetry. 

With an accurate diagnosis of the problem, the best treatment can be performed. Patients with redundant skin can see improvement with a skin only blepharoplasty. This would keep the septum intact and avoid issues concerning internal bleeding. Patients with herniating fat or hanging lacrimal gland may need a surgery that goes through the orbital septum with the risk of internal bleeding. Fat grafting is emerging as an adjunct to select patients to rejuvenate the eye without going through the septum. I recommend consulting with your surgeon to determine your specific issues and the appropriate techniques to address them for a safe and happy outcome. Safety comes first. 

Victor Chung, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Skin only blepharoplasty

Thanks for sharing your question. I can appreciate your concern.

Yes. skin only blepharoplasty is an option. However, if herniating fat is part of the eyelid anatomy, this would not be addressed with the skin only surgery. 

Finally, make sure that you have a consultation with a board certified plastic surgeon.

Wishing you the best in your journey

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.