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

Eyelid Surgery Blepharoplasty Seattle WA

The Eyelid Surgery

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 lift and a lower eyelid lift can be performed independently or together.

Improving The Appearance

Cosmetic blepharoplasty or eyelid rejuvenation is done to improve the appearance of the upper or lower eyelids. The primary goal of upper lid lift is to remove mostly excess skin and a little fat, whereas the goal of the lower lid surgery is to remove mostly excess fat and a little skin. The fat in the lower eyelids is a genetic trait and is referred to by many as “Puffiness”. Excess skin on the upper lids creates the “Tired” look. Typically, patients will say that they look tired and older than they feel when they look in the mirror.

Blepharoplasty: Upper and Lower Eyelid Reductions in Washington State

With the aging process, the eyelid skin tends to relax, and become “hooded”, and the fat around the lower eye tends to protrude and accumulate around the eyes, resulting in a “puffy” appearance.

The Incision

The incision for an Upper Lid procedure is made following the natural eyelid crease. After the precise measurement of fat and excess skin is removed, the incision is closed with dissolvable sutures. The Lower Lid procedure involves two parts; for excess fat / puffiness, the incision is made on the inside of the lower lids and the fat is removed. If there is excess skin on the outside portion of their lower lids, Dr. Portuese removes a small pinch of skin just below the eyelash line. This incision is typically closed with a tissue glue adhesive and the incision is nearly unnoticeable about four weeks following the procedure.

With respect to the lower lids surgery, the incision for the fat pad removal is done on the inside from the subconjunctival approach. There are three fat pads on the lowers and a small portion of this fat is removed to get rid of the tired look. Most patients over 50 years of age will need a small pinch of excess lower eyelid skin. If this is the case, this is a conservative 2-3 mm pinch that is taken directly at the subciliary line directly below the eyelashes and is covered by the lower curl of the eyelashes themselves. This incision, when necessary, is closed with Histocryl tissue adhesive that will fall off in 7 – 10 days after surgery. When patients awaken in the recovery room, the eyelids are relatively numb.

Recovery Phase

However, most patients experience some form of mild burning and headache, which is mild in the first few hours in the postoperative recovery phase. Some patients experience a headache after the first few hours of the surgery, but that usually subsides with some mild pain relievers. The recovery at the Seattle Blepharoplasty Center typically takes about an hour to an hour-and-a-half. At that time, the patient can be discharged to home with their caregiver.


Dr. Portuese will examine the upper and lower eyelids during the consultation. He will also take photographs of the eyelids and computer imaging can be performed at the eyelid consultation. The computer imaging is a communication tool ( not a guarantee of how patients will look ), but it gives an idea of what to expect. This is also an opportunity for patients to discuss expectations from the procedure ( eyelid rejuvenation. )


During the consultation, Dr. Portuese will review before and after photos of real patients from Washington State, Portland and surrounding areas. Board certified facial surgeon Dr. William Portuese will also review the visual field obstruction test if it is performed prior to the examination by an ophthalmologist. If there is a significant visual field obstruction, usually over 30′ in primary gaze, a patient’s insurance may cover a portion of the surgery. This will be determined by the visual field obstruction test.

Dr. William Portuese will review the visual field obstruction test, will take pictures, and will submit a physical examination, all for preauthorization with the patient’s medical insurance prior to any insurance-related blepharoplasty work being done.

The Upper and Lower Blepharoplasty can be performed alone, or in conjunction with additional cosmetic surgery such as a Facelift or Rhinoplasty – Nose Job. If you’d like to learn more about the benefits of upper lid surgery, please don’t hesitate to contact our surgical office today for more details.

Complications of a blepharoplasty

Irregularities of the skin are the most common occurrence after this procedure. Patients can get little white heads, which need to be opened up, along the incision line on the upper lids. Sometimes these can actually turn into small pimples and have to be drained.

Postoperative Appointments

Examination of the upper and/or lower eyelids is performed and the incisions are cleaned by Dr. Portuese. He will make sure that all tissues on the upper and lower lids are healing quite well. He will make sure that your vision is intact. The upper and lower eyelids tend to be quite swollen, puffy, and bruised. At this point, about 7 – 10 days, patients can start applying makeup to their eyelids if they desire so that they can get back out into their work environment.

Other Procedures

Blepharoplasty can be done by itself or in conjunction with other facial procedures, such as a facelift or rhinoplasty.

Useful Links

Top Questions about Facial Rejuvenation
Guide to Eyelid Rejuvenation

Patient Testimonial
B Thompson
5/5 stars

I have suffered for years with puffy eyes. My business requires face to face meetings and outside sales. Everyday I would receive at least one comment on ‘how tired’ I looked. They thought it was a sympathy comment like ‘you poor tired thing’, however it stung every time I heard it. I’m a little on the queasy side when it comes to medical procedures, so I kept putting off the inevitable .. I finally had enough and decided to look into blepharoplasty. Dr. Portuese came highly recommended from one of my colleagues and I’m so glad I chose him to perform the procedure. Dr Portuese and his staff was amazing, they put my mind at ease, explained the procedure, recovery and gave me the confidence that I needed. I had the eyelift, what a success! I wish I would of done it sooner! It has been 6 months and I haven’t had one person comment on ‘how tired I look”. I look great, feel great and so happy with the results. Thanks Dr. Portuese! You guys are the best!

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