Are fat and muscle removed during upper eyelid surgery?

I’m constantly told I look tired all the time. Seems like upper eyelid surgery would be a good option for me. What’s typically involved? Do doctors remove fat and muscle during surgery? Or do they only remove the skin.


F, 52, New York

Tags:woman age 45-54 upper eyelids excess skin fat muscle

  Hi, I have performed many Brow Lifts and Eyelid Surgeries over the past 30 years.  During consultations with potential upper Blepharoplasty patients that are female, the surgeon should stand behind the patients as they look into a mirror and elevate the eyebrows into their proper aesthetic position.  When this is done there are three possible outcomes that decide what should be considered, Brow Lift, Upper Eyelid Surgery (blepharoplasty), or a combination of both.  If the eyebrows are placed into the proper aesthetic position and:

1. All the excess upper eyelid fullness is gone when the brows are elevated to their proper aesthetic position.  This means all the laxity is due to the low eyebrows and a Brow Lift is recommended alone.  Should upper eyelid skin be removed in this scenario, the eyebrows will be pulled down further as the incision is closed, which should be avoided.

2. None of the upper eyelid fullness is reduced.  This means that the eyebrows are in the proper aesthetic position and all the fullness is due to excess upper eyelid skin and an Upper eyelid surgery alone is recommended.

3. The most common in women over 50 years of age is when the brows are lifted, some but not all of the upper eyelid fullness is removed.  This means the eyebrows are low and there is excess upper eyelid skin.  For complete upper eyelid rejuvenation both a Brow Lift and upper eyelid surgery is required.  If only a Brow Lift is performed some but not all of the upper eyelid fullness is reduced.  If an upper eyelid surgery alone is considered, only the remaining amount of excess upper eyelid fullness shown with this maneuver can be removed.  If more is removed, the eyebrows will be pulled downward.  

When an upper Blepharoplasty is being performed excess skin and fat can be removed as well as a thin strip of muscle (when the eyelid crease is superficial and needs to be deepened).  An experienced Blepharoplasty Surgeon knows what tissue layers are appropriate to remove and by how much in each individual patient in order to create an natural looking result.

Hope this helps.

Depending on the design of the surgery for the individual characteristics of the patient, upper eyelid surgery usually involves removal of skin, muscle, and/or fat, and reshaping of the eyelid to a more youthful appearance.  Since every face is different, the surgery plan should be customized and discussed with each patient individually.

Sometimes it is only necessary to remove excess skin during eyelid surgery (blepharoplasty).  Sometimes, though, there is too much muscle and a sliver of muscle may be removed as well.  This is where a consult with a surgeon is so very important.

You can read about eyelid surgery on my website

You are most welcome to see me for a consultation -- it is free.  Call 212 570 6080.

Elliot W.Jacobs,MD,FACS

 Before an upper blepharoplasty is performed a proper assessment will determine  what tissue and how much tissue needs to remove. For some people only skin  is removed. For others is more strip of muscle and pockets of fat are also removed to achieve a fresh brighter appearance to your eyes. 

It depends! Depending on your goals and anatomy, your board certified plastic surgeon will carefully assess whether skin, skin and muscle, or skin muscle and fat are necessary to excise. In most cases, I will perform skin-only blepharoplasty, in the office, under local anesthesia for folks with excess skin alone. If there is bulging factor a double-eyelid is desired, I consider excision or repositioning of fat too.