Upper blepharoplasty: upper eyelid surgery to remove excess skin or fat

When upper blepharoplasty is indicated

The indication for this surgery rests on the clinical assessment of the patient and on the presence of a number of anatomical changes affecting the function or the appearance of the eyelid. The most usual are:

• Excess skin forming folds over the upper eyelid.
• Loss of the natural eyelid crease as the tissue drops.
• A feeling of heaviness in the eyes at the end of the day.
• Visual fatigue from a restricted opening of the eye.
• Difficulty applying make-up to the mobile part of the eyelid.
• A build-up of fat at the inner corner of the eyelid.
• A reduced field of vision in the upper region.

Although many people come for aesthetic reasons, there are also clear medical reasons for this surgery. Upper blepharoplasty can improve quality of life in patients with restricted peripheral vision, functional discomfort or irritation from the constant rubbing of excess skin.

Assessment before treatment

Before an upper blepharoplasty is scheduled, the patient must undergo a complete medical assessment, which includes:

• A review of the general medical history.
• Assessment of the anatomy of the face and the eyelids.
• Analysis of the position of the brows and the quality of the skin.
• Examination of the levator muscle of the eyelid.
• An ophthalmic assessment where there are functional symptoms.

At this consultation it is determined whether there is also ptosis of the eyelid (drooping from muscle weakness), which may require additional treatment. Any eye conditions that could affect the surgery, such as severe dry eye or diseases of the cornea, are also ruled out.

It is essential to adapt the surgical technique to each patient. That is why, at the Instituto de Cirugía Plástica del Mediterráneo, the procedure is designed individually, taking into account not only the excess skin or fat but also the facial proportions and the symmetry of the eyes.

How upper blepharoplasty is carried out

Upper eyelid surgery is usually carried out under local anaesthetic, with or without sedation, as a day case. That means the patient can go home the same day as the operation.

The main steps of the technique are:

• Precise marking of the excess skin to be removed, with the patient sitting up.
• Applying local anaesthetic to the eyelid region.
• Making an incision along the natural crease of the eyelid.
• Careful removal of the excess skin and, where necessary, of the orbicularis muscle.
• Removing or redistributing the fat at the inner corner of the eyelid.
• Fine suturing with stitches removed after 5 to 7 days.

The incision is perfectly concealed in the eyelid crease, so once healed it is not visible with the eye open. The procedure takes approximately 40 to 60 minutes per eyelid.

During surgery the anatomy of the eyelid is respected as far as possible, avoiding over-correction that could alter the facial expression or make it difficult to close the eye.

The benefits of upper blepharoplasty

The benefits of this operation, when correctly indicated, are many and evident:

• An aesthetic improvement to the eyes, which look more open and rejuvenated.
• Restoration of the natural crease of the eyelid.
• Removal of folds that make applying make-up difficult.
• Less of that feeling of heaviness in the eyes.
• Correction of the visual restriction caused by excess skin.
• Greater symmetry between the two eyes.

The results last for years, although they are subject to the natural progress of ageing. Most patients experience a significant improvement in their facial expression, keeping their own identity and with no external sign of surgery.

What is removed and what is kept: skin, muscle and fat

Upper blepharoplasty has a reputation for being “taking away the skin that is left over”, and that simplification falls short. There are three layers in the eyelid that can be adjusted — skin, orbicularis muscle and fat — and the result depends on how much each one is touched.

• Skin. The excess that falls over the crease is removed, marked with the patient sitting up and the eye open, always leaving the margin needed for the eyelid to close comfortably.
• Orbicularis muscle. We routinely remove a narrow, measured strip. It is what makes the eyelid less bulky: when only skin is taken from a thick eyelid, the crease stays soft and poorly defined; removing that strip leaves the crease clean and opens the eyes more sharply.
• Fat. Conservative removal, above all of the medial pad — the one nearest the nose — which is usually the one that shows. The central fat is left alone: emptying the eyelid ages the eyes rather than rejuvenating them.

The question that really matters is not whether the muscle is touched but how much. And there is a particularly elegant piece of work on that, because it used each patient as their own control: in 22 people operated on both eyelids, one had skin removed alone and the other skin plus a wide strip of muscle, and the result was assessed by the patient, the surgeon and an independent panel, blinded.

Aesthetically the two sides came out equivalent, and the eyelids with the wider resection had more lazy closure and more sensation of dryness during recovery — discomforts that usually settle on their own as the eyelid beds in. The practical reading is the one we apply: the strip is removed because it refines the eyelid, not because more is better. That study sets the ceiling, and that is why the resection is narrow and matched to the thickness of each eyelid, never a wide band as a matter of routine.

What really improves afterwards

It is worth ending with what there is to gain, which tends to get buried under lists of risks. A prospective study of 348 patients who had upper eyelid surgery measured the result with the FACE-Q questionnaire, the validated tool for this kind of surgery, and found significant improvement in every domain assessed: satisfaction with the eyes, with the appearance of the face as a whole and with the result, and also in psychological function and social function. Adverse effects were minimal and improved over time.

In other words: what changes is not only how the eyelid looks but how the person who had the surgery feels and relates to others. Which is, almost always, the real reason for the consultation.

Recovery after surgery

Recovery after an upper blepharoplasty is usually quick and well tolerated. The initial aftercare includes:

• Applying cold locally during the first 48 hours.
• Sleeping with the head raised to reduce swelling.
• Avoiding strenuous physical exertion and sun exposure.
• Cleaning the area carefully with saline or recommended products.
• Avoiding make-up until the stitches come out. It can be resumed once they are removed (5-7 days).

Swelling or bruising in the first few days is normal. These signs fade gradually and do not affect the final result. Patients can resume social and working activities within 7 to 10 days, depending on how quickly each one recovers.

The scar goes through an initial phase of redness that fades with time. By six months it is usually imperceptible. In some cases scar creams or laser may be recommended to speed up the maturing of the tissue.

Risks and uncommon complications

Although upper blepharoplasty is safe surgery, like any operation it can carry certain risks. The less common complications include:

• Bruising after surgery.
• Local infection.
• A visible or asymmetrical scar.
• Over-correction with difficulty closing the eye.
• Temporary dry eye.
• Asymmetry of the eyelid crease.

Choosing an experienced surgeon and following the aftercare instructions strictly significantly reduce the likelihood of these complications.

At the Instituto de Cirugía Plástica del Mediterráneo we follow patients closely after surgery, with scheduled clinical checks to ensure a proper recovery and a stable result.

Natural results, adapted to the face

The key to success in an upper blepharoplasty lies not only in removing skin but in understanding the relationship between the structure of the eyelid, the expression of the eyes and facial harmony. Priority therefore goes to:

• Avoiding excessive removal of tissue.
• Keeping the natural volume where necessary.
• Preserving facial symmetry.
• Respecting the proportions of the face.

Every patient has a unique anatomy, and the aesthetic goals can vary according to sex, age and facial identity. That is why the procedure has to be adapted to the face individually, and not follow generic surgical patterns.

---

Upper blepharoplasty is an effective, safe and lasting solution for correcting excess skin and fat in the upper eyelid. Its benefits go beyond appearance, since it can improve visual function and quality of life. The success of the procedure depends on a proper medical assessment, a precise technique and planning centred on the patient.

If you are considering this operation, the first step is a specialist consultation. At the Instituto de Cirugía Plástica del Mediterráneo you will find an experienced medical team who will advise you professionally and honestly, adapting every treatment to your real needs and always respecting your facial identity.