This woman in her mid 50s was starting to develop some extra skin in her eyelids. She had previously had trauma to this area, and had a plate on the orbital bone that you could feel. She did not really have any extra fat. She came to our Scottsdale office, and Dr. Nachbar performed a four-eyelid blepharoplasty / eyelid lift without removing any fat from the eyelids. However, there was some thickened muscle, so a small amount of hypertrophic muscle was removed along with the eyelid skin. No canthopexy or canthoplasty was needed. She is shown three months later, and you can see the natural improvement in both the upper and lower eyelids.