Full Incision Blepharoplasty — Excess Skin and Fat Removal

How It Works

With age, the upper eyelid skin loses elasticity, orbital fat herniates forward, and the orbicularis oculi muscle becomes lax. As a result, the eyelids feel heavy, partially hooding the palpebral fissure and giving the eyes a tired, sad appearance. Full-incision blepharoplasty addresses all three issues: excising a pre-measured strip of excess skin, removing or repositioning herniated fat (avoiding over-resection to prevent a hollowed look), and creating a defined crease by anchoring the skin-muscle flap to the levator aponeurosis at an optimal height.

When Is a Full Incision Needed Instead of a Mini-Incision or Non-Incisional Double Eyelid Procedure?

A full-incision approach is indicated when skin laxity extends across both the inner and outer corners of the eyes, when eyelid fat is prominent, or for individuals aged 35–40 and older presenting with marked periorbital aging. Suture methods and mini-incisions cannot adequately remove substantial excess skin and fat, often leading to suboptimal or short-lived results. Conversely, younger patients with thin eyelid skin do not require a full-incision technique.

Full-Incision Blepharoplasty Is Not 'Eye Enlargement'

The primary goal is to achieve lighter eyelids, a defined and symmetrical crease, and naturally opened eyes; the anatomical size of the palpebral fissure remains unchanged. Creating an excessively high crease or over-excising skin leads to an unnatural, operated appearance that is difficult to revise. Therefore, our surgeons prioritize conservative excision while preserving the natural eyelid-to-eyebrow proportion. Prior to surgery, the surgeon must rule out brow ptosis (which requires a brow lift first) and true blepharoptosis (which requires levator muscle repair)—performing blepharoplasty alone in these cases will only make the eyes appear heavier.

Potential Risks to Consider

The incision line within the crease remains pink for 1–3 months; asymmetry; creases placed too high or too low; over-resection of skin or fat leading to a hollowed appearance or lagophthalmos (difficulty fully closing the eyes during sleep); prolonged swelling and bruising; temporary dry eye symptoms; and rarely, hematoma or infection. Most minor asymmetries resolve spontaneously once swelling fully subsides after 3–6 months.

The BonBoz Approach

Our plastic surgeons conduct thorough in-person consultations, measuring excess skin with pinch tests, evaluating fat distribution, performing brow and levator function assessments, and simulating the desired eyelid crease. We employ a tissue-preserving surgical philosophy: removing only the necessary amount of skin, repositioning fat rather than aggressive excision, and using intradermal suturing for fine, minimal scarring. The consulting surgeon is the operating surgeon; incision lines, skin excision margins, expected downtime, and potential risks are thoroughly explained before you make your decision.