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

Blepharoplasty (Eyelid Surgery) FAQ

#1 How are droopy upper eyelids fixed?The primary goal of an upper eyelid blepharoplasty is to remove excess skin creating the tired or hooded look. The blepharoplasty procedure for the upper eyelids includes removal of skin and fat from the upper lids to create a rejuvenated look. The incision is located in the upper eyelid crease. An upper eyelid blepharoplasty procedure is usually performed under a brief general anesthetic as an outpatient surgical procedure. Anticipate 2 weeks of bruising and swelling after the procedure.

#2 How much does eyelid surgery cost?
The cost of upper and lower eyelid surgery is more than just the cost of only the upper eyelids or only the lower eyelid surgery. The fees for an upper and lower blepharoplasty are determined by the amount of time in the operating room, the time under anesthesia by an anesthesiologist, and the surgeon’s fees for performing the procedure. The fees for both upper and lower eyelid surgery are located on our website.

#3 Recovery time for eyelid surgery?
Due to gravity, the lower lids tend to bruise and swell more than the upper lids. When patients perform both upper and lower eyelid surgery, it usually requires 2 weeks of some degree of bruising and swelling to subside, but it can be quite variable depending upon the patient. We ask that patients refrain from strenuous activity and exercise for at least 2 weeks after the procedure. Full healing after an eyelid procedure takes 3 months.

#4 Are there any stitches placed in the eyelids?
In our practice, there are no stitches placed in the lower lids. The fat is removed through a trans-conjunctival approach from the inside of the eyelid. If there is excess skin, a small incision pinch technique is placed on the outside of the eyelids. This incision is closed with tissue glue. The upper Blepharoplasty incision is closed with sutures that are dissolvable and fall out/ dissolve in approximately one week.

#5 Asymmetrical eyelids, what to do about them?
Everyone has some degree of asymmetry on their eyelids, but some patients have more asymmetry than others. When performing eyelid surgery, asymmetrical surgery is frequently performed to adjust them to look more symmetrical. Some patients have more fat/ puffiness on one side of the eyelids or the other, so more fat is taken out of the puffy side than on the less puffy side. Some patients have excess skin on one side , usually due to the brow position, so at more skin is taken out of one side than the other to make them more symmetrical. When the eyebrows are significantly asymmetric, an eyebrow lift is required.

#6 What are the requirements to have medical insurance pay for an upper blepharoplasty?
Medical insurance will never pay for a cosmetic procedure on either the upper or lower eyelids. When there is significant excess skin on the upper lids touching the eyelashes creating a significant visual field obstruction, a medical insurance company may consider that a medical necessity and pay for the surgery. Chart notes, visual field obstruction tests, and photographs are all required to be submitted for pre-authorization to the patient’s medical insurance to determine medical necessity. Excess hooded skin is removed through an incision on the upper eyelid known as a blepharoplasty procedure.

#7 Browlift versus eyelid lift?
A browlift procedure is performed when patients have very low eyebrows. The brow lift procedure can also adjust asymmetrical eyebrows by lifting one more than the other when needed. The brow lift procedure can adjust the muscles of the forehead such as the frontalis and the corrugator complex which helps with with forehead wrinkles. An eyelid lift involves making an incision in the upper eyelid to remove the hooded excess skin on the upper eyelids to rejuvenate them. Eyelid surgery is performed when the eyebrows are in adequate position and there is excess hooded skin present.

#8 What is the recovery time after a blepharoplasty procedure?
In our practice, we tell patients to anticipate at least 2 weeks of bruising and swelling after the blepharoplasty procedure. The surgery itself is only minimally painful and patients only take a few pain pills in their entire postoperative course after their blepharoplasty procedure.

#9 Does eyelid surgery changed the shape of the eyes?
In our practice we do not change the shape of the eyes. The appropriate amount of skin is removed from the upper eyelids to rejuvenate them. The procedure on the lower lids involves removal of fatty deposits from the inside of the eyelids also known as a trans-conjunctival approach. When patients have excess skin present at rest, a pinch technique of excess skin can be performed to conservatively tighten the lower lid skin. It’s important not to change the shape of the eyelids.

#10 What is laser blepharoplasty?
A laser blepharoplasty is the same thing as a traditional blepharoplasty only using the laser as a cutting tool, not a knife or a scissors. Since the laser is a thermal burn, the advantage is that there is minimal bruising, however since it is a burn, the incision takes longer to heal and there is just as much swelling if not more then using a knife and scissors. The laser doesn’t offer a better result in the long run, since the surgery the same with the laser versus a knife. If the laser were to ever enter the eyeball, blindness could ensue.

#11 Traditional lower blepharoplasty versus trans-conjunctival blepharoplasty?
It’s very important not to change the shape of the lower lids, and a trans-conjunctival lower blepharoplasty can accomplish that goal. A trans-conjunctival approach does not violate the lower eyelid muscle, so it preserves the shape of the lower eyelids. When patient’s have excess fat on the lower lids, the incision to remove that fat and puffiness is from the inside of the lower eyelids, also known as a trans-conjunctival approach. For many patients this is all that is required to rejuvenate the eyelids. In patients over 50 years of age, a pinch of excess skin is usually required which is closed with tissue glue.

#12 What type of anesthesia is needed for blepharoplasty?
In our practice, we perform eyelid surgery under general anesthesia by a board-certified physician anesthesiologist for patient safety and comfort. The procedure is also performed in a Washington state licensed, Medicare certified outpatient surgery center.

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