Blepharoplasty (Eyelid Surgery) in Seattle Washington

Blepharoplasty (Eyelid Surgery) FAQ
Facial Plastic Surgeon in Seattle Dr. Portuese

Q: What is a blepharoplasty?
A: A blepharoplasty is an operation that removes excess skin and fat that occurs on both the upper and lower eyelids. The lower eyelid surgery is always considered cosmetic and a majority of the time the upper eyelid surgery is also cosmetic. However, when the upper eyelid skin is touching the eyelashes and obstructing approximately 30% of the visual field, this may be covered under the patient's medical insurance.

Q: What is an upper blepharoplasty?
A: An upper blepharoplasty is a rejuvenation procedure of the upper eyelids. An incision is placed in the upper eyelid crease and excess skin and fat is removed. Occasionally, a small strip of redundant orbicularis occuli muscle is also taken to further deepen the upper lid crease when necessary. The upper lid incision is closed with absorbable stitches, which dissolve in five to seven days after the surgery.

Q: What is a lower blepharoplasty?
A: Lower eyelid surgery is also known as a lower blepharoplasty, which is done primarily for excess bags and puffiness underneath the lower lids. The invisible incision for the lower eyelid surgery is placed on the inside of the lower lid, which is called the conjunctiva of the inside of the eyelid. When needed, if there is extra skin on the lower lids, a small incision is placed at the lash line. This incision is directly below the eyelashes and a small pinch of skin, approximately 2 to 3 mm, is taken. The incision is closed with Histocryl tissue glue. There are no stitches in the lower lids.

Q: How long does a blepharoplasty last?
A: A blepharoplasty, when done for cosmetic surgery purposes, lasts approximately 10 to 15 years before the patient needs to have it redone.

Q: What kind of anesthesia is used for an upper and lower lid blepharoplasty?
A: Typically, both upper and lower blepharoplasty surgeries are done under a general anesthesia, lasting approximately one hour. The upper lids and lower lids each take approximately 30 minutes to perform. Anesthesia is administered by our board certified physician anesthesiologists from Swedish Medical Center on First Hill in Seattle, Washington.

Q: Are there any bandages placed on the outside of the eyelids after a blepharoplasty?
A: There are no bandages placed on the eyelids after blepharoplasty surgery. Cool compresses can be used, but avoid ice because we do not want patients to be frost-bitten after their surgery. Patients are discharged to home from the Seattle Facial Plastic Surgery Center.

Q: Can a rhinoplasty be performed at the same time as blepharoplasty?
A: Yes. Many times a cosmetic rhinoplasty can be performed at the same time as an upper and/or lower eyelid blepharoplasty. Cosmetic eyelid surgery is always paid for by the patient and is not submitted to insurance. Any medically related vision problems or disorders such as visual field obstruction are billed to the patient's medical insurance for reimbursement when medically necessary.

Q: Can a blepharoplasty and a facelift be completed at the same time?
A: Yes. In many cases, patients who undergo a blepharoplasty have a facelift done simultaneously. These two procedures can be done concurrently and is done quite frequently in our outpatient surgery center.

Q: What is the average age that a blepharoplasty surgery is performed?
A: Most blepharoplasty surgeries are performed for people in their mid 40s to early 50s who are starting to see the facial and eyelid changes of aging including sagging upper eyelids with excess skin and puffiness and bags underneath the eyelids.

Q: How long must I refrain from exercise after my upper and lower lid blepharoplasty surgery?
A: For any type of eyelid surgery, including a blepharoplasty, it is important not to exercise for two weeks following the surgery. Patients should keep activities to a minimum and the heart rate low so that they do not experience any swelling around their eyelids in the postoperative phase.

Q: How long will the swelling last after my upper and lower lid blepharoplasty surgery?
A: Typically, the majority of the swelling subsides after the first two weeks following a blepharoplasty. Most of the bruising and swelling subsides by the 10th to 14th day after the surgery. We encourage patients to refrain from work or social activities for a minimum of two weeks if they do not want others to notice that they have had surgery.

Q: What type of stitches are used on an upper blepharoplasty surgery?
A: After the surgery is completed, there are very fine dissolvable stitches that are placed on the upper eyelids that close the incision. These sutures dissolve in 7 to 10 days after the surgery and do not need to be removed.

Q: What type of stitches are used on a lower blepharoplasty surgery?
A: There are no sutures placed for a lower blepharoplasty. The incision on the inside of the lower lid closes naturally on its own since it is a very small incision. If needed, the external incision at the latch line is closed with a Histocryl tissue adhesive. This glue flakes off at approximately 7 to 10 days after the surgery.

Q: Will I be able to see after either an upper or lower blepharoplasty surgery?
A: Yes. Patients are able to see after their surgery. However, we do not recommend driving for the first few days after the surgery since vision can be slightly blurry. The white part of the eye known as the sclera can also become swollen and can make for difficult reading in the first few days after the surgery. Patients also express the fact that their eyes are quite tired in the first two weeks of the postoperative phase.

Q: Is blepharoplasty an outpatient surgery?
A: Yes. Patients are discharged to home from the Seattle Facial Plastic Surgery Center. Out-of-town patients stay in one of the local area hotels for the first night. There are four hotels conveniently located within one block of the office. Patients do not need to stay overnight in the hospital unless there are some other medically-related conditions.

Q: How is the puffiness taken away from my lower lids?
A: The puffiness is caused by diet-resistant fat. It is also called orbital fat on the lower lids. This fat is teased out through very tiny incisions on the inside of the lower lids and removed. If needed, a very small conservative portion of skin is removed from the lower lids on the outside through an incision right at the lash line. Skin removal is not performed on all patients.

Q: How is the upper blepharoplasty surgery performed?
A: An incision is made in the upper eyelid crease and excess skin is removed in a conservative fashion so that patients are still able to close their eyes. If needed, a small strip of the orbicularis occuli muscle can be removed to deepen the crease. There are two diet-resistant fat pads on the upper lids in the orbital septum. A portion of this is also removed to improve the puffiness look on the upper lids.

Q: I have dry eyes and would like to have a blepharoplasty.
A: If patients have dry eyes, they need to first have a Schirmer's test done by an ophthalmologist to document the extent of dryness. Sometimes the dryness can be addressed preoperatively through eye drops and punctal plugs. Once the amount of dryness is documented, upper &/or lower blepharoplasty can be performed. There is a very small risk, less than 5%, that dry eyes can become more dry after a blepharoplasty surgery.

Q: Is there financing available for my eyelid surgery?
A: Yes. Our office takes VISA and MasterCard and third party financing options are available through Care Credit.

Q: How do I know if my medical insurance will cover my upper eyelid surgery?
A: Our office will preauthorize any upper blepharoplasty surgery if 30% of visual field is obstructed as documented on a visual field obstruction test. The visual field obstruction test is done by an ophthalmologist. Pictures of the patient’s eyelids, visual field obstruction test, and medical documentation will be sent to the patient’s insurance company for preauthorization prior to the surgery. Cosmetic eyelid surgery is not medically necessary and is not covered under the patient’s medical insurance plan.

Q: Do you ever perform a forehead lift with an upper or lower blepharoplasty?
A: Yes. Many times patients have low eyebrows with very puffy upper lids and excess skin on the upper lids as well. Often, Dr. Portuese will do an upper blepharoplasty at the same time as a forehead lift to further balance the upper 1/3 of the face and facial aesthetics. Please see our before and after photo gallery under blepharoplasty and forehead lift for examples of this.

Q: I have very deep set eyes and would still like to perform a blepharoplasty.
A: If the patient has very deep set eyes, during an upper blepharoplasty, care is taken to not accentuate the deepening of the crease. Typically, there will only be skin removal in order to address the excess skin on the upper lids. If the lower lids are deep set, there usually is nothing that can be done other than just a simple skin incision at the lash line on the lower lids to remove excess skin.

Q: I have very prominent eyes and wonder if I could have a blepharoplasty.
A: Very prominent eyes typically have a lot of fat bulging on both the upper and lower lids. An upper and lower blepharoplasty can be performed for this condition to make the eyes look less prominent and more natural.

Q: What is the goal of upper eyelid blepharoplasty surgery?
A: The goal of upper eyelid blepharoplasty surgery is to primarily remove excess skin and a small amount of puffiness on the upper lids on the medial portion closest to the nose.

Q: What is the goal of lower eyelid blepharoplasty surgery?
A: The goal of lower blepharoplasty is to primarily remove the excess bags on the lower lids and the secondary goal is to remove a small amount of skin if there are excess wrinkles.

Q: How much does an upper lid blepharoplasty or lower lid blepharoplasty cost?
A: Typical cost for a cosmetic upper or lower blepharoplasty is in the $3,000 range depending upon the complexity.

Q: How much does both an upper and lower eyelid blepharoplasty cost?
A: Typically, the cost for a cosmetic upper and lower blepharoplasty is in the $4,500 range.

Q: What do I need to do to prepare for my eyelid surgery?
A: Our office policy is to avoid aspirin, ibuprofen, vitamin E, and all herbal products for two weeks prior to the surgery. This is to prevent any bleeding around the eyes during the time of the surgery or in the immediate postoperative healing period. Women of childbearing age need to make sure they are not pregnant before undergoing elective cosmetic surgery.

Q: Is the pain severe after upper and lower lid blepharoplasty surgery?
A: No. There is mild-to-moderate discomfort the first day or two after a blepharoplasty. Many patients just take Tylenol for the entire postoperative course and do not find it painful. Some patients take two pain pills the first night to help them sleep. Many patients may experience a headache in the first day or two after the surgery. Tylenol is taken as needed for minor discomfort for the remainder of the week.

Q: Who performs my anesthesia for a blepharoplasty?
A: Board certified physician anesthesiologists from Swedish Medical Center perform the anesthesia in our Medicare-certified ambulatory surgery center.

Q: Where is the blepharoplasty performed?
A: All blepharoplasties are performed at the Seattle Facial Plastic Surgery Center, our Medicare-certified ambulatory surgery center located adjacent to Swedish Medical Center complex on First Hill in Seattle, Washington.

Q: If I am traveling from out of town to have my blepharoplasty, how long do I need to spend in town before I can go home?
A: Typically, Dr. Portuese likes patients in town for at least one week after their eyelid surgery so that he is able to check on the healing progress. In an ideal situation, he also likes to see patients back at approximately three weeks, two months, and six months after the surgery to check on the postoperative healing.

Q: How long do I need to take off work after my eyelid surgery?
A: Most patients take approximately one to two weeks off from their work environment. The bruising and swelling around the eyes can last upwards of two weeks. Patients who are able to work from home can certainly do computer, phone work, and book work, but may not feel comfortable venturing out of the house until all of the bruising and swelling is gone, unless they use sunglasses. Most patients refrain from any social or physical activities for two weeks.

Q: Do I need to take a pregnancy test prior to my eyelid surgery?
A: It is a very good idea to have a pregnancy test done within a few days prior to any surgery including blepharoplasty surgery. The anesthesiologists who perform anesthesia in our surgery center do not wish to have women who are pregnant put to sleep under anesthesia for cosmetic surgery.

Q: Is there any other blood work I will need to have prior to having my eyelid surgery?
A: This depends upon your medical conditions. If you are taking a diuretic, a potassium level will need to be performed within the week before the surgery. Men 45 and over and women 55 and over will need a recent EKG performed within six months prior to the date of the surgery to make sure that there are no heart issues. Patients who have high blood pressure need to be taking their current medications to make sure that their blood pressure is under control prior to the surgery.

Q: What about nausea and vomiting after my blepharoplasty surgery?
A: There are two sources of nausea and vomiting after having had blepharoplasty surgery. The first is from the actual anesthetic itself, which can last approximately 12 hours in the postoperative phase. After that, nausea and vomiting can be related to taking pain medicine and narcotics. We ask patients to taper off their pain medicine and to just take Tylenol to eliminate the nausea and vomiting. We also prescribe some anti-nausea pills that are taken an hour before the surgery to help with the postoperative nausea and vomiting.

Q: Why do I need to have a preoperative visit for my blepharoplasty surgery?
A: All patients have a preoperative appointment with one of our nurses. For out-of-town patients, this can be done over the phone. Pictures of the eyelids are taken, a thorough health history is reviewed, and all medications are recorded. At this time, about three weeks prior to surgery, all needed laboratory or medical testing is performed.

Q: When can I wear contacts after blepharoplasty surgery?
A: No. Contacts just need to be taken out the day of the surgery and for approximately 10 days in the postoperative healing period

Q: When can a patient wear eyelid makeup after a blepharoplasty surgery?
A: Patients are able to wear eyelid makeup approximately one week after the surgery to cover any bruising and swelling that may exist. The makeup can be applied both on the upper and lower lids to camouflage bruising and swelling approximately one week after the surgery. The Histocryl glue on the lower lids and the dissolvable stitches on the upper lids take approximately 7 – 10 days to dissolve. Once that is gone, makeup can then be applied.

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For an eyelid surgery in Seattle Washington, contact facial plastic surgeon William Portuese. View before and after photos of eyelid surgery.