Can Bleparoplasty Be Successful with Just Removal of the Skin Without Removing Fat or Muscle?

I'm will have blepharoplasty. I'm told this can involve removal of 1) Skin 2) Fat and/or 3) Muscle. Fortunately, insurance will pay for this, but only the removal of the "skin". The surgeon said I can pay out of pocket for the sculpturing of the fat pads. I don't want to be frugal money-wise if this operation is best served with both, (fat/skin removal) yet if only the "skin" removal will suffice, and not look incomplete, (I.e. 50% undone), I'd do just the "skin" removal this is common practice

Doctor Answers 9

Fat removal with skin

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I think you should have it all done if it needs to be doen.I do not charge my patients extra to remove excess fat if it is present.It takes but a few minutes to do this.

Fort Myers Plastic Surgeon
4.9 out of 5 stars 70 reviews

Skin Excision with Blepharoplasty

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As mentioned, skin is the most important component of the blepharoplasty procedure.  By removing skin you can improve the vision and the appearance to a significant degree.  There is debate over muscle and fat excision.  Many surgeons have gotten away from fat removal in blepharoplasty to avoid the ‘hollow’ look and instead are adding fat to volumize the face and orbit.


Jill Hessler, MD
Palo Alto Facial Plastic Surgeon
4.9 out of 5 stars 32 reviews

Removal of Skin, Muscle and/or Fat in Blepharoplasty

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You did not say whether you were having an upper or lower Blepharoplasty, but, since part will be paid by insurance, I assume it is the upper lids. You also did not say anything about your age. In the upper eyelids, there has been a debate for many years about whether to take muscle as well as skin. Most surgeons today take at least some muscle. In the lower eyelids, most surgeons have stopped removing fat and, instead, only reposition it. Many of us have also stopped removing the fat in the upper eyelids when doing blepharoplasty for aging since this frequently causes a sunken appearance. Instead, we are adding fat frequently. If, however, you are quite young and have significant extra fat, then you may be a candidate for fat removal. You need to discuss what removing the fat would do specifically for you and what the result would be without it.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Upper Lid Blepharoplasty Options and Outcomes

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Success of a blepharoplasty procedure depends on if you are assessing functional or cosmetic outcomes, the latter of which is ultimately associated with patient expectations. From a functional standpoint, insurance companies will only recognize skin removal since this is generally adequate for improving a visual field deficit. In some patients, this may be all that is necessary for cosmetic improvement as well. Muscle removal if done at all is generally more conservatively than it has been in the past but may be done to sculpt out or fixate the position of the crease. Removal of fat also tends to be more conservative and if done at all typically only involves the area in the inner corner of the eye. Your surgeon should be able to point this area out to you and whether contouring this area would help with the cosmetic outcome. If this is noted and you feel it would be bothersome if not corrected, consider factors such as downtime and ultimate cost savings by having it done with the functional procedure rather than separately.

Pamela Henderson, MD
Phoenix Facial Plastic Surgeon
4.8 out of 5 stars 20 reviews


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Without seeing you in person, it is difficult to say what you need, but in general for herniated fat some is usually removed as well.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Can Bleparoplasty Be Successful with Just Removal of the Skin Without Removing Fat or Muscle?

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 Yes, this is quite common in Upper Eyelid Surgery where there may exist excess skin or fat.  Removing part of the muscle is doen in cvases whgere the eyes appear shallow and the desire is to deepen the upper eyelid crease.  Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Can Bleparoplasty Be Successful with Just Removal of the Skin Without Removing Fat or Muscle?

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As my colleagues have pointed out there are many methods to perform an upper eyelid surgery. The proper technique requires an examination of your eyes and an assessment of the underlying problems that need to be corrected. Removal of skin only will improve the upper eyelid appearance and get rid of the extra skin that impairs your vision. Determining whether you need removal or muscle and/ or fat would require an in person examination. I hope this information is helpful.

Stephen Weber MD, FACS

Eyelid surgery for skin alone

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Actually the trend in upper eyelid rejuvenation is away from muscle resection, and skin removal might be all that is needed. You have to rely on your surgeon's judgement, and your goals. If you are interested, vision impaired by hooding skin might look just fine after blepharoplasty with skin only. If fat reduction can improve the result, yet is not what you really wan,t then consider the cost. We can't imagine that either way your surgeon will leave you looking poorly.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

What is Essential in Upper Eyelid Blepharoplasty

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An upper eyelid Blepharoplasty can include removal of skin, muscle, and fat.  However, techniques have evolved away from removal of muscle because it tends to lead to a more "hollowed out" look which is less aesthetically appealing.  From a functional standpoint, removal of skin is the essential ingredient in removal of upper eyelid hooding.  Removal of fat is almost always cosmetic and may or may not be performed in an insurance Blepharoplasty depending on the judgment and preference of the Surgeon.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 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.