Is Fat And Muscle Removed During Blepharoplasty (Eyelid) Surgery?

Q: Dr. Eppley, Can you tell looking at a person if the fat is herniated prior to surgery and is the entire fat pads removed in bilateral upper lid surgery? Also, you mention a strip of muscle excised…is it removed from inner to outer corner of the eyes or is this just done for blepharospasm?

A: Photos are generally very helpful to determine if one has herniated eyelid fat. Most herniated fat generally occurs in the lower eyelids and less so in the upper eyelids. The lower eyelids have three distinct fat pockets that often herniate and are removed. The upper eyelid, however, has only two fat pockets that may be treated as the lateral compartment of the upper eyelid contains the lacrimal gland which should not be removed. It may be tucked back up with sutures if needed. The concept of removing the entire fad pads is not done either in the upper or lower eyelids as creating a ‘skeletonized’ and more aged looking eye area is possible with too much fat removal.

A strip of orbicularis muscle is often removed in upper and lower blepharoplasty surgery. It is done in the upper eyelid to help create more of an upper eyelid fold and is done on the lower eyelids to get rid of fullness below the lashline, often called an orbicularis roll. The condition of blepharoplasm is treated with Botox injections, not muscle removal.

Dr. Barry Eppley

Indianapolis, Indiana