The tone and shape of eyelids can loosen and sag with time. Surgical repair of this condition can give the eyes a more youthful look by removing excess skin and bulging fat from the upper and/or lower eyelids. In the upper eyelids, excess skin can result in a tired appearance or can result in difficulty seeing the top segment of your visual field. As a result, some forms of blepharoplasty surgery are considered cosmetic while in others it is medically necessary to allow the patient to see better and covered by the health insurance. Lower eyelid blepharoplasty is almost always a cosmetic procedure to improve the shape, contour, and appearance of loose skin, bulging fat, and irregular shape.