Two Upper Eyelid Lift Questions-Thank You?

If a patient desires only skin (no muscle or fat removed) to be removed in an upper eyelid lift, can this be done on the patient's request understanding that aesthetically, it may not be totally at the top level? Or, does some amount of fat and muscle need to be removed regardless? Thank you!

Doctor Answers 19

Skin Only Upper Eyelid Surgery

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    Skin only upper eyelid surgery gives most if not all of the benefits of a conventional bleph, depending upon preoperative anatomy.

Upper eyelid lift and skin removal

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The upper blepharoplasty procedure can involve removal of skin, fat, and muscle.  Muscle is removed only when the eyelids are very heavy.  Medial orbital fat is removed only when it is herniated and protruding.  Sometimes a skin only upper blepharoplasty is all that is necessary to improve the look of the upper lids.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Upper Blepharoplasty

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The eyes are the primary facial feature that communicates tiredness or exhaustion (and, likewise, energy and vitality). Your cheeks and your neck don't really reflect whether or not you've had a good night's rest. But miss a night of sleep and your eyes will make it obvious to everyone.

Aesthetic plastic surgery of the eyelids can produce a dramatic rejuvenating effect, literally taking years off of a person's appearance. Interestingly, many patients find that following eyelid surgery friends will say 'You look great!', but they usually cannot pinpoint exactly why.

Excessive or 'redundant' upper eyelid skin is a very typical aging change that leads people to seek eyelid surgery. In many patients, this surgery can be performed under light sedation with local anesthesia as an outpatient office procedure. In a few cases, protruding fat behind the eyelids is also removed. As with most facial aging changes, no two people present with exactly the same eyelid concerns. Surgical treatment is therefore individualized to the needs of each individual patient.

My approach to upper eyelid surgery is to be conservative with skin excision, and to reserve excision of fat for patients with significant fat excess. In my opinion, aggressive removal of upper eyelid skin and fat is a 'skeletonizing' procedure which risks making eyes appear more deep-set and aged, rather than younger. In fact, in many patients I perform structural fat grafting (using the patient's own fat, from the abdomen or hips) to help restore soft tissue volume around the eyes.

The next time you flip through Vogue or Allure (guys, just grab one at the checkout stand) take a close look at the eyes of the models. In most of them, women in their teens and twenties, you will see only a sliver of the upper eyelid, if it is visible at all. In many, the upper lid is completely obscured by soft tissue fullness between the brow and eyelashes, which I sometimes refer to as the 'brow roll'. Perusing the fashion magazines provides quick confirmation that the youthful upper lid is not a skeletonized upper lid.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Can you only remove skin with an upper lid blepharoplasty?

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Absolutely! Skin alone can be removed. People have different opinions as to what is beautiful. Some patients do not want deep set eyes, which would occur with removal of both muscle and fat in most cases. 

Find a plastic surgeon that will fulfill your goals. Take a look at Bruce Jenner's eyes. His upper lids were over resected, in my opinion. It appears that too much muscle and fat was removed. This certainly isn't acceptable for most males. Women appear to appreciate deeper set upper eyelids than men. But, we are here to make the patients happy, not ourselves, providing we stay within certain normal parameters.

Upper eyelift

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There is no problem with removing just skin in an upper eyelift (blepharoplasty). If you have need of fat removal this can or cannot be addressed and the decesion is between you and your surgeon . The operation can be limited to simple skin removal and nothing problem.

Upper eyelid lift

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If you are clear about your goal and only wants skin removal, then that's what you should have, as long as you understand your options. The patient should always have the rights to say yes or no and make final decision since it's your body. Understand that because this surgery is elective, some surgeons will decline performing your surgery because what they like to do and what you allow them to do is different. Not all upper blepharoplasty is the same. Some patients, only skin removal is need, while others may benefit with muscle and/or fat contouring. Most surgeons would like to perform surgery that he or she believes will give the patients best aesthetic outcome. However, you may not agree with it and you certainly have the right to say no. Find a plastic surgeon that will listen to you and provide you with a solution that matches you goal.

Stewart Wang, MD, FACS
Los Angeles Plastic Surgeon
4.6 out of 5 stars 28 reviews

If a patient desires only skin (no muscle or fat removed) to be removed in an upper eyelid lift, can this be done on the patient

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 Yes, of course.  If after the aesthetic ramifications are explained to the patient...that patient wishes less to be done and therefore less of an aesthetic result, their wishes should be honored.  I do make exceptions for this as long as the treatment or surgery does improve the patient aesthetically and not the reverse (I would decline to do the surgery at that point).

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

Upper blepharoplasty

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It is a discussion you need to have with your surgeon.  Removing fat or muscle is actually not recommended as it tends to hollow the eyelids but in some instances (especially medial eyelid fat pad) it is done.  See an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Removal of skin only can help

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Skin removal is probably the most important component of the procedure.  During a consultation, your surgeon can explain to you what the removal and skin could achieve.  The removal of fat and muscle may cause more swelling and bruising, but they could potentially improve your final result enough so that adding them to your procedure would be worth it.

Shim Ching, MD
Honolulu Plastic Surgeon
4.6 out of 5 stars 51 reviews

Upper eyelid surgery

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Hi! Thank you for your question!

I am Dr. Speron, a proud member of both the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgeons (ASAPS).  I am also certified with the American Board of Plastic Surgery.

Yes, a skin only blepharoplasty can be performed. 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.

The surgical steps are tailored to each individual patient. I advise that you discuss with your surgeon the best method for the results that you desire.
I have provided a direct link below for additional information as well as a lot of before and after pictures.
If you have any further questions, please feel free to call us at 847.696.9900 for a private consultation.
Best of luck and have a great day!
Dr. Speron

Sam Speron, MD
Chicago Plastic Surgeon

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.