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

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.

Upper blepharoplasty removes the excess or " hooding ' of skin. Often the inner portion of the upper eyelid is puffy due to excess fat and can be removed at the same time. Removal of muscle or strip of muscle can also be performed to tighten and define the crease.

It is important not to remove too much fat of the upper eyelid and cause an aged hollowed out look of the patient. Each patient undergoing surgical rejuvenation of the upper eyelids is evaluated to meet their needs determined by the plastic surgeon.

Blepharoplasty of the upper eyelids is a very effective procedure to remove excess skin and fat above the eye.  During the procedure, the excess skin and a small amount of fat is removed carefully from each upper eyelid.  Usually a small strip of muscle is removed to decrease the bulkiness of the upper eyelid.  If only skin is removed, then some bagginess of the upper eyelid may remain.  When meeting with a board certified facial plastic surgeon, he or she will be able to determine the best procedure for you.
 

There are different techniques to address upper eyelid rejuvenation. Your surgeon will review your individual findings and recommend which technique is best for you. Skin is removed but muscle and fat manipulation will be dictated by your presentation. The upper lid has 2 fat compartments which create a fullness adjacent to the nose. I limit fat and muscle resection in the upper lid as I feel a youthful upper lid has a characteristic fullness.

Ask your surgeon at the time of your consultation which technique will be used. Look at pre and post operative photos to confirm you share your surgeons aesthetic sense.

I hope this was helpful.

The nature of the surgery is tailored to each patient's needs.  Usually skin is removed with often a small amount of fat removal in the inner corner of the lid.  The scars often fade quickly and are beautifully tucked into the natural lid crease.

Upper blepharoplasty involves removal of
the eyelid skin, removal or tightening of the underlying orbicularis muscle,
and removal or shaping of some orbital fat. Key to good surgery is preserving
the natural looking appearance of the eyelids. This requires varying degree of
surgery and shaping of the upper eyelid, including each of these anatomical
layers depending on a person’s individual face, ethnicity and gender. Removal
of excessive skin and soft tissues can result in an unnatural appearance and troublesome
dry eyes. In addition removal of excessive orbital fat can change a person’s
appearance by hollowing out the upper eyelid rather than rejuvenating one’s
appearance the upper eyelid is more aged, this is sometimes termed skeletonized
appearance upper eyelid. Often to get the best results, removal of soft tissues
is not sufficient, additional procedures such as skin resurfacing, the use of
botulinum toxin, correction of droopy upper eyelid (ptosis), fat transfer
amongst others will all have a role in natural rejuvenation. 

Hello,

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

Blepharoplasty technique depends on the result you need.  If you only have excess skin then only skin needs to be removed although usually some of the muscle is also removed.  If you have excess "bags" of fat then some of the fat can be removed as well.

The classic upper blepharoplasty involves skin removal, limited muscle removal, and fat removal or contouring.  When I perform upper blepharoplasty I  tailor the procedure to the patient's goals and their anatomy.   For example,  patient's with thin or skeletonized looking upper eyelids to begin with certainly don't have any fat removal done during the procedure. 

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.

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