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The Facial Plastic Surgery Center
Dr William Portuese - Board Certified Facial Plastic Surgeon

Facial Surgery Procedures


Eyelid surgery, often known as blepharoplasty, is another common facial operation.
In order to cure dermatochalasis (aging-related alterations in the periorbital tissues) and blepharochalasis, excessive eyelid skin and/or orbital fat are removed during blepharoplasty (excessive papery thin skin).

Visually unappealing alterations known as “droopy eyelids,” “tired eyes,” or “bags under the eyes” may result from the influence of gravity on periorbital structures, diminished strength in periorbital muscles, UV damage, and changes in skin composition.
Lower blepharoplasty is traditionally performed with a subciliary incision with a raised skin and muscle flap, herniated medial, middle, and lateral fat detection, and repair.

The simplest blepharoplasty is the skin pinch procedure.
This method avoids a bulky skin-muscle flap that could lead to unsettling vertical traction and swelling in the periorbital tissues by just excising extra skin through a subciliary approach.

In order to prevent nerve damage and lessen scarring, the pinch blepharoplasty of the lower lid also avoids piercing the orbicularis muscle and the orbital septum.

More thin, wrinkled skin can be safely removed using this method while yet maintaining a pleasing position for the eyelids.
Upper and lower lid blepharoplasties are frequently carried out while the patient is under moderate sedation or local anesthesia.
Notably, blepharoplasty is also used to treat the condition known as lid ptosis, which has a variety of origins.

Attenuation of the levator palpebrae superioris is the most typical cause.

Browlifts and Forehead Lifts

A significant portion of a facial cosmetic surgery practice also involves forehead lifts or browlifts.
In terms of the traditional method, which involves removing extra skin and repositioning the forehead skin upward, this treatment is rather simple.

If the frontal hairline is low, the incisions are made along a coronal line within the hair-bearing scalp.
For individuals with a high hairline, a trichial or trichophytic incision is used.

The majority of women who adopt these two strategies are female.
A third option for males is a midbrowlift, which involves making an incision in a deep brow furrow and removing a fusiform ellipse of skin.

Rarely is a direct browlift performed, where the incision is placed at the upper edge of the brows.
If a patient has considerable brow ptosis that is causing a mechanical visual field defect, functional brow surgery is more frequently performed using mid- or direct browlifts, both of which may leave a noticeable scar.
The most recent method is endoscopic surgery, in which a number of tiny incisions are made behind the hairline and an endoscope is used to view the procedure as the forehead skin is elevated.
The surgeon can redrape and fix the skin more cephalad by releasing soft tissue from the arcus marginalis and temporal line of fusion with the endoscope inserted beneath the forehead flap.

The outcomes are less striking, but it is a superb strategy for the younger patient who wants less pronounced and more natural alterations.

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