DR WILLIAM PORTUESE | 1101 MADISON ST #1280 SEATTLE, WASHINGTON 98104 | (206) 624-6200
Dr William Portuese - Board Certified Facial Plastic Surgeon in Seattle WA

Complete Guide To Blepharoplasty© copywrited William Portuese MD, 2007/8



The eyelids are probably one of the most defining characteristics of facial expression. Patients’ friends tell them that they look tired all the time, but yet they feel great. For that reason, eyelid and/or blepharoplasty surgery is performed. Blepharoplasty is also referred to as having one’s eyelids done and can be performed for both cosmetic reasons and functional reasons. Performed to make the eyelids look more well rested on the upper lids and to remove the puffiness and bags on the lower lids. Excess skin and fat is removed on both the upper and lower lids. There are three components that make up the eyelids; skin, muscle, and fat. Fat bulging creates a puffiness look on the lower lids as well as the upper lids. Excess skin can fold over on the upper lids, touching the eyelashes, creating visual obstruction when severe enough. On rare occasions, excess muscle on the upper lids can also be an issue and sometimes needs to be conservatively trimmed for cosmetic purposes. All three of these components must look good in a symmetrical fashion and allow for proper blink reflex and closure of the eyelids. An upper eyelid blepharoplasty and a lower eyelid blepharoplasty can be performed independently or together.

There are two kinds of blepharoplasties performed. There is the upper blepharoplasty for excess skin on the upper eyelids. The lower eyelid blepharoplasty is done with the primary goal of removing excess bags and sometimes trimming a little bit of skin at the lash line.

Many times, there are also preexisting asymmetries where one eyebrow and eyelid and orbital socket is lower than the opposite side. This is all taken into account when a blepharoplasty is performed. The goal of upper eyelid blepharoplasty is to reshape and sculpt the upper lids so that they look more well rested and the goal of lower eyelid blepharoplasty is to remove the excess bags on the lower lids to give a refreshed look.

The blepharoplasty operation is performed on people usually in their 40s or 50s when they eyelids start to sag or become puffy underneath. Other things that can cause puffiness on the lower lids are allergies, genetic predisposition, salt intake, fluid, and hormonal changes. Dark circles and lower eyelid pigmentation are not changed with lower eyelid surgery. The shadows that are created from the lower eyelid fat bags are improved when the preexisting fat is removed from the lower lids. A conservative pinch of lower lid skin taken at the eyelash line can also help with lower eyelid skin laxity.


Washington Ambulatory Surgery Center Association Washington State Medical Association American Academy of Facial Plastic and Reconstructive Surgery Real Self