Blepharoplasty of Upper Eyelids. Is fat and muscle removed or just skin?

Do most surgeons remove fat and muscle in the upper eye lids during blepharoplasty? Or is just the excess skin removed?

Doctor Answers 37

Each eyelid surgery should be tailored to your unique needs.

Dear Cerro

Classically upper blepharoplasty involved removal of skin, muscle, and fat.  However, it is the details that separate a beautiful upper blepharoplasty from a butchery.  Generally surgeons go wrong with these surgeries by removing too much of everything.  Skeletonizing an eyelid only makes the eye look like it had surgery.  It does not make for a rejuvenated look.  It is not enough to make someone look different.  It is essential to make them look better.  Often this is best done by being conservative.  Upper eyelid surgery cannot elevate the brow.  A common mistake that is made in upper blepharoplasty is to ignore a heavy brow when what is needed is a forehead procedure rather than upper eyelid surgery.  It is important that the surgeon place the crease of the upper eyelid (which will be were the lowest eyelid incision is made) at the right height.  It is all too common that these are made a 10 mm and they then heal to 12 mm because this is what text books advise.  Upper eyelid surgery is a sculpting and draping procedure not a cutting and removing procedure.  Commonly fat does not need to be excised or only excised in a limited fashion helping to preserve upper eyelid fold volume.  Weakness in the levator aponeurosis, the tendon insertion of the muscle that raises the eyelid is often ignored.  Blepharoplasty is an excellent opportunity to reinforce a weak tendon insertion that is causing a fall in the position of the eyelid margin.  However, many eyelid surgeons lack the training, skill, and experience to expertly expose the levator tendon and tighten it as part of their eyelid surgery.  Finally, for many patients laxity of the skin on the eyelid platform, the part of the eyelid between the eyelashes and the upper eyelid crease, is ignored.  By carefully tailoring surgery, it is possible to firm and tighten this skin by expertly anchoring it to the upper eyelid levator tendon.  This can be a very important detail that helps create a brighter looking eye.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Natural Looking Upper Blepharoplasty

Many patients come to me for correction of overly-aggresive blepharoplasty surgery where too much skin and or fat has been removed. Hollow eyes age the face and can give people a very bizarre look. be sure to view many, many before and after photos to be certain you and your surgeon share the same aesthetic sensibilities.  Once you find a plastic surgeon who has demonstrated he or he can provide the results you want, check their background, raining, education, facilities  and staff thoroughy.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

It depends!

In an upper eyelid blepharoplasty, skin is almost always removed.  The muscle and fat may be thinned judiciously as necessary.  It really depends on what your specific goals and concerns are, so try and be as specific as possible with your surgeon in describing what bothers you.  A lot of it also depends on how you are made, for example, if you already have a very hollow eyelid, than fat excision would not necessarily be a good idea. However, if you had lots of fatty prolapse, then fat scupting may be necessary.  So it really depends on how you are made, and what you want! 

Good luck


Jasmine Mohadjer M.D.

Oculoplastic Surgeon

Tampa Bay, FL

Jasmine Mohadjer, MD
Tampa Oculoplastic Surgeon
5.0 out of 5 stars 2 reviews

Blepharoplasty of Upper Eyelids. Is fat and muscle removed or just skin?

In my practice, I find that fat removal is often necessary in older patients. In younger patients, typically skin alone needs to be removed. Obviously, the surgical steps are tailored to each individual patient.

Maurice M. Khosh, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

Upper Blepharoplasty


Mostly skin is removed. Sometimes a small amount of fat, but rarely muscle. Thank you, and I hope this helps answer your question.


Dr. Nassif

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 47 reviews

Upper blepharoplasty surgery involves removing excess skin, and sometimes muscle and fat.

Most of my patients that undergo upper blepharoplasty have excess skin and hooding of their upper eyelids. The goal of upper blepharoplasty is to rejuvenate the upper eyelids, recreate youthful eyelid creases, and maintain an unoperated appearance.

Unless thare is unsightly bulging of the "medial fat pads" near your nose, I rarely remove orbital fat during upper blepharoplasty. Removing orbital fat may increase your risk of complications, and may lead to orbital hollowing. The majority of my blepharoplasty patients require only excision of excess skin, and a muscle strip to help define the eyelid crease.

I hope this is helpful for you.

Regards from NJ.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 418 reviews

Upper Eyelid Surgery with Skin, Muscle, and Fat Modification

Upper eyelid surgery to rejuvenate the eyes is tailored to suit the needs of each particular patient. Generally, excess skin is removed. Occasionally, excess fat is removed. Sometimes eyelid muscle is tightened too. Lastly, the specific tissue modification on one eye may be different in the other eye due to inherent asymmetry present in most patients. Eyelid plastic surgeons will explain what will occur during your procedure. Best of luck.

Dr. Chaboki


Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Blepharoplasty Focuses On Rejuvenation Not Radical Excision

How an upper blepharoplasty is performed should be based on what the patient needs, not a standard operation for everyone. Blepharoplasty most certainly removes upper eyelid skin, the only variable is what is done with the fat. Is the fat removed, left completely alone, or transposed to a different location? That will depend on the patient's individual anatomy, aesthetic goals and their age. Today's blepharoplasty techniques are based on more preservation of natural eyelid structures such as fat and muscle rather than the radical excision of the past. 

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Upper Lid Blepharoplasty: What's Involved

Upper Eyelid Blepharoplasty is primarily a procedure performed to remove excess skin from the upper eyelid crease, like removing a pleat from a trouser leg. There are certain circumstances where I remove medial (inner) upper eyelid fat, but I I almost never remove central fat.  Likewise, I never remove upper eyelid muscle.  The reason for preserving central upper lid fat and muscle is to avoid a "hollowed out look", which is characteristic of a poorly performed Blepharoplasty and actually makes a patient look older. A certain amount of fullness is required between the upper lid crease and the eyebrow in order to preserve a youthful look.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 93 reviews

Blepharoplasty Technique

Good question.  There is not a one-size-fits-all procedure for belpharoplasty.  Your surgeon should customize the procedure for your particular anatomy.  A combination of fat excision, replacement or repositioning and excess skin removal is usually performed.  If you post pictures, we may be able to give you more specific advice.


Good luck.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

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