Would like to know the risks of muscle impact/removal in upper blepharoplasty

Thank you for your time. Would you tell me the risks of having the muscle impacted and/or removed in upper blepharoplasty? Also, is it more risky than simple skin only removal?

Doctor Answers 9

Muscle injury post bleph

This is rare.some surgeons will remove a small segment of the orbiucularis muscle when they do their upper ;lid blephs but this does not impair the functioning of the upper lid.


Fort Myers Plastic Surgeon
4.8 out of 5 stars 56 reviews

Would like to know the risks of muscle impact/removal in upper blepharoplasty

I personally remove a small strip of orbicularis muscle on all of my upper blepharoplasties. The size of the excision will vary depending on the patient. In over 29 years of performing this operation, I have never had any problems with a hollowed out look or ptosis (droopy eyelid). The removal of this small strip allows easy access to the underlying fat pads. Now, if too much fat is removed from the two existing fat pads of the upper lid, then you may get the hollowed out look which is very unattractive. I encourage you to search out a surgeon certified by the ABPS. Look at many , many photos of before and after. I encourage all patients to speak to other patients who have had similar procedures so hat they can judge for themselves. Good luck on your journey.

When is too much muscle too much?

I do not routinely remove muscle from the upper eyelid as there are occasions whereby the patient is already hollowed in that region.  In that case, removing a strip of skin will further hollow the upper eyelid and actually age the appearance further.  If the patient is not hollowed, then the surgeon can take a conservative strip of muscle enough to "de-bulk" the upper eyelid.
You should consult with a board certified Facial Plastic Surgeon to get an accurate assessment.
Good luck.

Roberto E. Garcia, MD, FACS
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

Muscle removal during upper blepharoplasty

This is an excellent question, as there are many misconceptions about the differences in removal of skin or skin/muscle together during upper blepharoplasty surgery.

My opinion is that there is minimal difference in recovery or added risk to removing a small amount of orbicularis muscle during surgery. For me, the decision of which tissue to remove is purely aesthetic. If a patient has bulky upper eyelids, I usually remove some muscle to help reduce bulkiness in the eyelid. If a patient has thin, hollow upper eyelids, I usually leave all the orbicularis muscle to help minimize the hollowing that can result from tissue removal. 

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 147 reviews

Would like to know the risks of muscle impact/removal in upper blepharoplasty

There is a slim risk of ptosis of the upper eyelid if too much muscle is removed. Best to discuss with your surgeon... 

Techniques in upper eyelid blepharoplasty

In an upper eyelid blepharoplasty a 2  - 3 mm strip of orbicularis muscle may be removed.  This is helpful when the muscle is hypertrophied and thickened.  It is not always necessary and it a matter of judgement whether or not this needs to be performed.  There are no absolutes in plastic surgery.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 16 reviews

What is the effect of muscle removal during upper eyelid lift?

Muscle removal (usually a thin strip only) is done in certain upper blepharoplasty operations to "debulk" the upper lid - it is not necessary in everyone
If a muscle strip is removed, the remaining muscle heals together (as an internal scar) and does not have any real long term impact on upper eyelid function. 
From an aesthetic or cosmetic perspective, as long as the right decision is made for the right person, the outcome of upper blepharoplasty should be excellent

I hope this helps - good luck!

Muscle excision in upper eyelid blehparoplasty

Studies have shown that there is no cosmetic difference when muscle is excised or left intact.  For people with very dry eyes, there is a possibility of a worsening of the dry eye if a lot of muscle is excised.  But for most people this will not cause a dry eye.  It is usually just what the surgeon prefers.   

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 25 reviews

There are pros and cons with both procedures.

Steve Fagien, an oculoplastic surgeon in Boca Raton Florida is a big proponent of skin only blepharoplasty.  The advantage of the skin only approach is that it leaves the orbicularis oculi muscle intact.  This is actually a great thing because this muscle is what closes the eyelid.  On the other hand, by not cutting the orbicularis oculi means that no ptosis correction is possible through the front of the eyelid or even anchor belpharoplasty which is needed to correct lash ptosis.

Cutting the orbicularis oclui muscle does contribute to dry eye and for individuals with a tendency for dry eye, this can be very problematic.

Which approach is right for you?  This needs to be carefully assessed by your surgeon with a detailed consultation.  If you are spending less than 5 minutes with a potential surgeon, you are probably in the wrong office.

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