Is an upper blepharoplasty (eyelid surgery) a feminizing procedure?
Publication date: 1/2026
Yes, an upper blepharoplasty is considered a feminizing procedure when it is used to increase “eyelid show” and raise the lid crease to feminine anatomical distances. While often categorized as cosmetic rejuvenation, in the context of Gender-Affirming Care, it is a reconstructive tool used to align masculine orbital features with a feminine presentation.
The Role of Blepharoplasty in Gender-Affirming Care
A frequent point of contention during insurance authorization for gender-affirming care is whether an upper blepharoplasty (eyelid surgery) constitutes a medically necessary feminizing procedure or a form of cosmetic rejuvenation. While often conflated with aging interventions, in the context of Facial Feminization Surgery (FFS), upper blepharoplasty is a strategic tool used to address specific gender-indicating markers of the upper face. For the appropriate candidate, Dr. Mittermiller, an experienced facial feminization surgeon, considers upper blepharoplasty an effective feminizing procedure.
Quantitative Anatomical Differences in Eyelid Appearance
To understand why eyelid surgery is feminizing, one must look at the anatomical differences between masculine and feminine eyelids. Research suggests that the “gender” of the eye is defined by specific soft tissue metrics such as the amount of eyelid show, which refers to the distance between the eyelashes and the eyelid crease. “In the occidental upper lid, the crease is typically 7 to 8 mm above the lid margin in men and 10 to 12 mm above the lid margin in women.”1 Multiple additional publications endorse this measurable difference between the two genders2, 3 and also note that “increased tarsal platform show [is] generally considered feminine and aesthetically desirable.” 4
Qualitative Differences in Eyelid Appearance
In addition to precise, quantitative differences, many surgeons recognize a qualitative difference between masculine and feminine eyelids. In an article from The Wall Street Journal about blepharoplasty, Dr. Flora Levin, a Connecticut-based oculoplastic surgeon, and Dr. Melissa Doft, a plastic surgeon on Manhattan’s Upper East Side, shared their opinions. The relevant excerpt from the article is included below.
Surgeons shouldn’t, however, treat male and female eyelids the same, cautions Levin. Typically, “men have a straight brow, thicker skin, a fuller upper lid, more prominent fat pads and less space above the lashes, so when you take out too much skin, you’re giving them more lid, which is feminizing,” said Levin. A more-hooded male lid is often considered masculine.5
Summary of Upper Blepharoplasty in FFS
Achieving a natural and aesthetically pleasing appearance around the eyes is a nuanced aspect of facial feminization surgery. This frequently involves shaping the bones around the eye, but it can involve adjusting the soft tissues for a natural, feminine appearance. Upper blepharoplasty (eyelid surgery) in this context is reconstructive, not cosmetic, as it treats the secondary sex characteristics of the eyelids.
Blepharoplasty with Dr. Mittermiller
Dr. Mittermiller has extensive experience performing Feminizing Facial Surgery (FFS) and performs procedures such as upper blepharoplasty as part of comprehensive facial feminization when it is indicated. Dr. Mittermiller’s goal is to help each patient achieve an appearance that is natural, feminine, and reflects one’s truest self.
Dr. Mittermiller is a plastic surgeon with specialty training in craniofacial surgery and facial feminization surgery. He is primarily located in Los Angeles, California and serves the broader Southern California area.
Contact us today to schedule a consultation.
Citations
- Sam Most, Mobley SR, Larrabee WF, Jr. (2005) Anatomy of the eyelids. Facial Plast Surg Clin North Am 13 (4):487–492, v. doi:10.1016/j.fsc.2005.06.003 https://pubmed.ncbi.nlm.nih.gov/16253835/
- Sedgh J (2018) The Aesthetics of the Upper Face and Brow: Male and Female Differences. Facial Plast Surg 34 (2):114–118. doi:10.1055/s-0038-1636935 https://pubmed.ncbi.nlm.nih.gov/29631279/
- Farhadian JA, Bloom BS, Brauer JA (2015) Male Aesthetics: A Review of Facial Anatomy and Pertinent Clinical Implications. J Drugs Dermatol 14 (9):1029–1034 https://pubmed.ncbi.nlm.nih.gov/26355624/
- Luong HN, Liu AS, Sharaf BA, Bite U, Wagner LH (2025) Effect of Facial Feminization Surgery (FFS) on Eyelid Anatomic Features. Facial Plast Surg 41 (3):307–312. doi:10.1055/a-2315-7612 https://pubmed.ncbi.nlm.nih.gov/38677276/
- Valdesolo F (2025) An Eyelid Lift in Your 30s? Why Younger Women Are Getting ‘Blephs’. The Wall Street Journal, 1/1/2026 https://www.wsj.com/style/beauty/blepharoplasty-eyelid-lift-cosmetic-surgery-cc865580