2 Questions: Upper Eyelid Lift-Blepharoplasty? Thanks Much!

Is there less of a risk to cause eye damage (I.e. nerve, blink rate, etc) for a sugeon to just remove "only" skin without disturbing muscle and fat and keeping the muscle and fat as is, in tact? I realize it may not bring the total optimal cosmetic look, yet I never would want to risk eye damage due to compromising and/or interference with any muscle and fat. Also, can a patient request "skin" removal only if they desire, again, knowing it may not be the total optimal look? Thank you again.

Doctor Answers 12

To Do or Not To Do Skin Only Eyelid Lift?

Thank you for your 2 interesting upper eyelid lift blepharoplasty questions. Nerve damage and blinking following upper eyelid blepharoplasty is uncommon when performed by a well trained plastic surgeon. If you have protruding fat and significant excess upper eyelid muscle and it is not addressed at the time of surgery, you may become disappointed with your post operative results. Obviously, removing only upper eyelid skin is the safest, but it may not give you the optimal results that you are doing the plastic surgery for in the first place. I hope that this helps you with your decision.


New York Plastic Surgeon
5.0 out of 5 stars 23 reviews

Upper blepharoplasty to only remove skin

Patients can request that only skin is removed during their upper blepharoplasty and that the fat and muscle are left alone.  Fat is removed in most but not all patients when there is excess puffiness noted in the upper eyelid area.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Blepharoplasty Questions

Generally the 2 parts to an upper eyelid blepharoplasty (eyelid lift) are removal of excess skin and removal of any excess fat.  To reach the fat, which is in a deeper plane, the surgeon must cut through muscle.  Therefore, fat removal requires a more invasive, yet very standard approach.  In fact, the complications from this surgery are extremely rare.  However, you can always request that your surgeon just remove the extra skin and leave the fat alone.  Interestingly, this may not detract from your cosmetic result that much, as the youthful eyelid is fuller than the aged eyelid.

Richard G. Schwartz, MD
West Palm Beach Plastic Surgeon
5.0 out of 5 stars 30 reviews

2 Questions: Upper Eyelid Lift-Blepharoplasty? Thanks Much!

 Yes, removing skin only is less invasive and as such carries less risk...although the risk of Upper Eyelid Surgery IMHO is very low to begin with. Yes, you can always request a more conservative approach with Eyelid Surgery or any Plastic Surgery procedure.  

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Skin only blepharoplasty

You can request any thing you want, even if it is not in your best interest.   Sound like you have an irrational fear of injury to your eye with a blepharoplasty.  Just pick a great surgeon and tell him/her what result you are anticipating.  If you insist on 'skin only' you will, most likely, not like the result.

Talmage Raine MD FACS


Talmage J. Raine, MD, FACS
Chicago Plastic Surgeon
4.6 out of 5 stars 9 reviews

Eyelid surgery

Dear anon,

  • Each surgeon has their own technique, and if you like their before and afters, then you should choose that surgeon
  • I typically do not remove muscle unless there is a good reason to, I like leaving the upper eyelid full
  • The skin only removal, I would discuss this with your surgeon, you can request it, but if he/she has other reasons, then you may need to find another

Best regards,

Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 74 reviews

Upper lid blepharoplasty

The upper eyelid should be preserved as much as possible. I have seen alto of overtreated eyes in my career. I will commonly excise a small amount of skin and maybe a tiny strip of muscle if that much to sharpen the crease in someone whose crease is notwell defined. I rarely take our central fat and usually take out fat medially) closer to the nose.  I think keeping the full upper lid is a sign of youth.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

The bottom line is that no surgery is perfectly safe.

The risk of going blind from eyelid surgery appears to be about one in 30,000 cases.  The risk of eyelid surgery affecting the blink rate is much, much higher.  This might even be true with a skin only blepharoplasty.  Eyelid surgeons you seen may advise you to have surgery their way-trust me.  What you should not do is make a surgeon do something they are not comfortable with.  If the surgeon tells you that you need skin, muscle and fat removed, do not make that surgeon do a "skin only" bleph.  Additionally, you may never find a comfort zone for having eyelid surgery.  If you are not comfortable, please listen to your feelings.  Eyelid surgery is virtually always elective.  Find a surgeon who makes you comfortable and makes sense to you. 

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Blepharoplasty risks

Although, I will agree with others on this forum that the risk of upper blepharoplasty is relatively low, as an Oculoplastic surgeon, we tend to see more of the adverse outcomes after blepharoplasty, as patients tend to seek out the "eyelid specialists". And for the most part, I have abandoned removing muscle and fat from upper eyelid blepharoplasty, [with the exception of the nasal fat pad along the upper eyelid] because of this risk. In addition, volume preservation is extremely important from an aesthetic standpoint, not just a functional one.

I would say that decreased blink rate and or excursion is more commonly the reason of post blepharoplasty dry eye as compared to removal of too much skin.

So, is it likely that you will develop dry eye if muscle is removed? I will agree that the answer is "no". But it will be even less likely, if no muscle is removed.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

2 Questions: Upper Eyelid Lift-Blepharoplasty? Thanks Much!

Some patients do require removal of a small strip of muscle and some fat (in addition to excess skin) for the best result. The risk of doing so is minimal in experienced hands and typically removing some muscle and fat does not create any additional risk. If you're concerned about this, please discuss with your surgeon to determine the best approach for you. They will make solid recommendations and be able to put your mind at ease. I hope this information is helpful.

Stephen Weber MD, FACS

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

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.