Is muscle around eyes excised during blepharoplasty?

I am planing to have upper and lower blepharoplasty to remove eye bags and extra skin on upper lids. Is any muscle around eyes affected, excised or partially excised during the operation? I am doing eye exercises daily to improve my vision (bates method) and want to continue doing so.

Doctor Answers 13

Sparing Eye Muscles During Blepharoplasty

I spare the eye muscles rather than excise them during blepharoplasty, but this depends on patient anatomy and need. Sometimes the muscles have grown so lax that they drag the eyelid downward. Minimal excision and/or tightening may help. It's a minimally invasive surgery and recovery time tends to be quick, with return to normal activities within a few days. I hope this helps.

Eyelid muscle resection during eyelid surgery

Thank you for your question. During lower eyelid surgery there are techniques that divide the orbicularis muscle along its lateral aspect to gain access to the orbital septum and fat pads. This muscle division is then repaired during the closure. Another lower eyelid surgery technique removes the fat without dividing the muscle but instead the muscle fibers are separated to access the fat that may not be completely accessible through transconjunctival approach. In the upper eyelid a narrow strip 1-2 mm of orbicularis muscle is removed in some techniques to help define the upper eyelid sulcus and to access the fat pads. Other techniques simply separate the muscle without removing any in order to access the fat pads. In general the thin muscle resection of the upper eyelid does not affect movement. In the lower lid there can be a loss of tone of the muscle and although this typically recovers it can contribute to lateral scleral show, lid laxity and changing the shape of the eye/aperture. Discuss your concerns with your surgeon in regards to the effect the surgery may have on your muscle exercises.

Removing muscle in blepharoplasty surgery

In most cases, it is possible to achieve excellent aesthetic results without removing lower eyelid surgery.  Re-suspending the orbicularis muscle is a preferred technique, and usually results in a much better post operative result because muscle function is preserved.  This is also true in upper eyelid surgery, but sometimes a small strip of muscle can be removed to enhance the upper eyelid crease.  This can however result in some difficulty in closing  the upper eyelid.

J. Kevin Duplechain, MD, FACS
Lafayette Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Is muscle excised with the blepharoplasty procedure?

  On a few occasions, we do excise a small strip of orbicularis oculi muscle when needed. This is for performed for patients who desire  a deeper upper eyelid fold  when patient's have very hooded and thick upper eyelids.  Removing a small strip of muscle is not performed on patient  who have dry eyes. For many examples are more information, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

Is muscle around eyes excised during blepharoplasty?

Hello Qning,There are some techniques where the muscle around the eye is partially excised in blepharoplasty.  I am not a fan of those techniques as more conservative approaches with the muscle lead to more predictable and more aesthetic results in my opinion.  Regardless of the technique chosen, the overall function of the eye muscle is not really affected by excising or not excising.  I'd recommend you consult with a facial plastic surgeon to go over your options and learn what is best for you.I hope this helps and good luck. 

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews


This is a controversial topic.  The consensus among surgeons who currently perform large numbers of eyelid surgeries is that conservative excision or no excision at all is the preferred practice.  Over-excision can lead to a hollowed out eye and in extreme cases lead to difficulty with eyelid closure.  My advice is to seek the expertise of an experienced eyelid surgeon!Best of luck!

Jeffrey B. Wise, MD, FACS
Wayne Facial Plastic Surgeon
4.9 out of 5 stars 124 reviews

Is muscle around eyes excised during blepharoplasty?

It is best NOT to remove any eyelid muscle during blepharoplasty.  Removing muscle adds risk to the procedure in terms of eyelid closure, etc. 

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 58 reviews

Blepharoplasty and orbicularis muscle

Typically in the upper eyelids, some orbicularis fibers which encircle the lids are partially removed along with overlying skin. This allows accurate fixation of the crease and prevents bunching of the muscle in the lid crease area. The amount removed depends upon the surgical technique, and the anatomy and preferences of the patient. Generally, less removal is better for a natural appearance and normal function of the eyelids.  In the lower lids, little or no removal of muscle is preferred as the orbicularis muscle preserves a youthful pretarsal area and maintains a preseptal support in front of the fat pads. A transconjunctival approach to the fat pads in the lower lid avoids an external incision and is preferred when the lower lid anatomy is otherwise normal (no ectropion or entropion).  The extraocular muscles (muscles that provide motility for the eyeballs) are not disturbed by blepharoplasty. To assure good healing of the eyelids, however, you should avoid "palming" and "massaging" the eyes as suggested by the Bates method while you are in the perioperative period. Such hand to eye contact can cause postoperative bleeding and bruising, and damage the delicate eyelid tissues. Be sure to disclose to your surgeon the extent of your exercises. Best wishes.

Sara A. Kaltreider, MD
Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

Eyelid muscle excision during blepharoplasty

Great questionThe orbicularis oculi is the muscle involved in closing your eyelids.  It used to be removed during an upper blepharoplasty.  As the surgery has evolved, the trend is to preserve it as it gives the upper eyelid fullness and prevents the eyelid from looking hollow and possibly having lagophthalmos (or incomplete closure of the eyes). Hopes this helps

Is muscle around eyes excised during blepharoplasty?

Depends on the case, yes, muscle excision is occasionally done but as techniques evolve we have gone ot more of a muscle preserving technique, but if done these excisions will not effect your vision.Good luck!!

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.9 out of 5 stars 62 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.