Author Archives: The Seattle Eyelid & Blepharoplasty Center

Is Laser Better Than Traditional Blepharoplasty?

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Whats Better?

Seattle eyelid surgery experts Dr. William Portuese and Dr. Joseph Shvidler share the real differences, benefits, and considerations between laser and traditional blepharoplasty techniques.

What Is Blepharoplasty?

Blepharoplasty, also known as eyelid surgery, is a procedure that removes or repositions skin, fat, and muscle around the eyes to improve vision or appearance. In Seattle, patients often choose between traditional blepharoplasty (using a scalpel) and laser blepharoplasty (often using a CO2 laser).

Is Laser Blepharoplasty Better?

The short answer is — it depends on your goals and anatomy. Laser blepharoplasty uses a precise beam to cut and seal tissue, which can reduce bleeding and swelling. Traditional blepharoplasty is performed with surgical instruments and can be more versatile in complex cases. Neither method is universally “better”; the right choice depends on factors like skin type, degree of eyelid droop, and whether vision is affected.

Before and After Photos

Traditional and Laser Blepharoplasty in Seattle

Dr. Portuese and Dr. Shvidler perform both traditional and laser-assisted blepharoplasty at The Seattle Eyelid & Blepharoplasty Center. For patients in neighborhoods like Capitol Hill, Queen Anne, Ballard, and Bellevue, both methods can achieve natural-looking results when performed by an experienced surgeon.

What’s Better — CO2 Laser or Surgery for Upper Blepharoplasty?

For upper eyelids, the CO2 laser can make incisions with minimal bleeding, which may mean less swelling during recovery. Traditional scalpel surgery is equally effective and may be better suited for patients with more advanced eyelid drooping or complex anatomy. Your surgeon will recommend the best method after a thorough exam.

Can Laser Fix Hooded Eyes?

Yes, laser blepharoplasty can address hooded eyes by removing excess skin and tightening the eyelid area. In some cases, traditional techniques may provide a more tailored lift, especially for heavier tissue.

How Long Does Laser Blepharoplasty Last?

Results from laser blepharoplasty can last 10 years or more, similar to traditional eyelid surgery. Lifestyle, sun protection, and skin care play a role in maintaining results over time.

Can Upper Blepharoplasty Be Done With Laser?

Yes, upper eyelid surgery can be performed with a CO2 laser. Many Seattle patients choose this option for its potential to reduce recovery time, but your surgeon will determine whether it’s the best choice for your needs.

Recovery and Downtime

Laser blepharoplasty may lead to slightly faster healing and less bruising for some patients. Traditional surgery has similar recovery times, with most people returning to daily activities within 7–10 days. Swelling and mild redness can last a few weeks with either technique.

Choosing the Right Surgeon in Seattle

Experience matters more than the tool used. Both Dr. Portuese and Dr. Shvidler are board-certified facial plastic surgeons with decades of combined experience in eyelid surgery. They perform consultations and procedures for patients from all over the Seattle area, including West Seattle, Redmond, and Kirkland.

External References

Schedule a Consultation

If you’re wondering whether laser or traditional blepharoplasty is right for you, schedule a consultation with Dr. William Portuese or Dr. Joseph Shvidler at The Seattle Eyelid & Blepharoplasty Center. Call 206-624-0349 to speak with our team and plan your procedure.

The Most Common Eyelid Surgery Questions Answered

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Question: What’s the best approach for hereditary hooded eyes that make me looks sleepy/eyeless?
Answer: The photograph is rather limited, your eyes look very acceptable in the one limited photograph. If you want to improve the hooded look, a very conservative Upper eyelid blepharoplasty can be performed under local or general anesthesia. An in-person examinations going to be required to make that determination.

Question: Recommended surgeries to fix my nose, smooth out my eyes and straighten brows?
Answer: A revision rhinoplasty procedure can accomplish narrowing and straightening the bridge line in addition to reducing the hanging columella. It better set of pictures are required to make a determination about eyelid surgery.

Question: What options would be available to treat my under eye wrinkles?
Answer: The primary goal for lower eyelid surgery is to remove the fat bags through trans-conjunctival approach on the inside of the lower lids. The secondary, or minor goal is to root tighten up loose skin at rest, not when smiling. Laser resurfacing may be of some benefit. Crows feet are best treated with Botox.

Question: If a facelift revision is needed because a SMAS was not sufficient?
Answer: The photographs demonstrate a combination of fat deposits above and below the platysma muscle along with jowls and skin laxity inboth the face and neck. A high-SMAS lower face and neck lift can accomplish tightening the loose facial and neck skin, lifting the jowls, tightening loose facial and neck muscles, tightening the SMAS and removal of fatty deposits above and below the platysma muscle which also includes a platysma-plasty. An experienced facelift surgeon can accomplish your goals whether or not it is a primary or secondary facelift procedure.

Question: How soon can I get eyelid revision?
Answer: It is acceptable to undergo revision eyelid surgery at 1 year, since full healing will have take in place at that point. A full set of facial and eyelid photographs in addition to an in-person examination is going to be required to make a determination about how best to proceed.

Question: Infraorbital implants – What are the choices of incision placement and their associated risks?
Answer: Cheek implants are manufactured in a large array of thicknesses, sizes, and shapes which is best determined at the time of the consultation and examination. The cheeks, the maxilla, and the implants are three-dimensional structures, and the augmentation occurs in three dimensions. In our practice, we place solid silicone Cheek implants through an intraoral approach under a brief general anesthesia. From the one with very limited photograph, it shows that you also have significant bags in the lower lids which should be addressed from by a lower lid blepharoplasty performed through trans-conjunctival approach.

Question: Would I be a good candidate for Buccal Fat Removal and lower blepharoplasty?
Answer: In our practice, we do not recommend buccal fat pad removal due to the fact that there will be facial fat atrophy with aging process. The primary goal for lower eyelid surgery is to remove the fatty bags creating the puffy look in the lower lids. The incision is located completely on the inside of the lower lids, which is known as a trans–conjunctival approach lower blepharoplasty.

Question: What is the best way to treat the crepey skin under my eyes?
Answer: The primary goal for lower eyelid surgery is to remove the bags which are caused by herniated fat pads. The secondary, or minor goal for lower eyelid surgery is to remove any excess skin that may be present at rest, not upon animation. A Physical examination will be required to make a determination if the Pinch technique of excess skin can be performed safely. Botox is best used for crows feet and laser resurfacing can also help with under eyelid skin as well.

Question: Do young blepharoplasty patients scar worse than older patients?
Answer: The incision for upper eyelid surgery is located directly in the upper eyelid crease. It must extend outward laterally to remove the hooded skin in that area. Anticipate a pink incision line for several months until it turns into a fine white line.

Question: How can I improve the appearance of my eyes?
Answer: There’s only a small amount of puffiness located in the lower lids, therefore a lower eyelid blepharoplasty will only be of minimal benefit. The fat bags are removed through trans-conjunctival brooch on the inside lower lid. No external incision is required.

Blepharoplasty Q&A: What Patients Want to Know

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Question: What to do about heavy eyelids and uneven brows?
Answer: The goal of upper eyelid surgery is to remove excess skin and fat to rejuvenate the lids. The incision is located in the upper lid crease and the procedure can be performed under local anesthesia. Properly placed Botox may be of some benefit for the eyebrows. A browlift is not necessary.

Question: What incision is the best decision for my lower eyelid?
Answer: More information is needed such as your age, and the amount of laxity of the lower eyelid skin. The fatty deposits creating the puffy look are removed thru a trans-conjunctival approach on the inside of the lower lids. If there is excess skin present, then a small incision below the lash line is performed to tighten up loose and inelastic skin in that area. We close this incision with tissue glue. There is no sutures needed for the lower lids. 

Question: I am prone to keloid scarring. Can keloids form on the face?
Answer: Yes, keloids can form on the face, but they’re much less chance on the face that on the shoulder/ trunk area. It’s extremely rare to have a keloid form on the Eyelids after a blepharoplasty. A closed rhinoplasty approach can accomplish making the required changes to your nose which would completely eliminate the chance of a keloid. All the incisions are placed on the inside of the nose. No external incisions are required.

Question: Why do my eyes have that fold of skin at outer corners? What would fix it?
Answer: The fold of skin at the outer corners of your eyelids occurs because of aging process of the eyelids themselves. An upper eyelid blepharoplasty can accomplish improvement of this area. This procedure is called an upper blepharoplasty, and can be performed under local anesthesia as an outpatient procedure.

Question: Why is a fat transfer recommended for doing my lower blepharoplasty? And what will happen if I don’t include that procedure?
Answer: In our practice, we perform a conservative fat removal through trans-conjunctival approach on the lower lids. The incision is completely located on the inside of the Eyelids. When there’s excess skin at rest, then we perform a pinch technique of excess skin, and we close this incision with tissue glue. We do not recommend fat transferred to the eyelids. We also perform all lower eyelid surgery under general anesthesia for patient safety and comfort, since removal of the fat deposits can be rather painful and uncomfortable during the surgery itself.

Question: What kind of local anaesthesia is usually used for doing blepharoplasty?
Answer: In our practice we use lidocaine with epinephrine for local anesthesia. Upper blepharoplasty can be performed under either local or general anesthesia and is very well tolerated by the patients. Lower eyelid surgery is best performed under general anesthesia, since it is quite uncomfortable and painful to remove the fatty deposits in that location. Most patients do not want to have conscious awareness with twilight anesthesia.

Question: Why do many celebrities that have had their eyes ‘done’ seem to have smaller eyes afterwards?
Answer: Without a set of pictures, it is difficult ton give a definitive answer. When lots of fillers are placed in the cheeks, it tends to make the eyes smaller. The primary goal for upper eyelid surgery is hooded skin removal, while the primary goal for lower eyelid surgery is to remove the fat bags creating the puffy look.

Question: Does lower blepharoplasty work for crows feet and wrinkles around eye area?
Answer: The primary goal for lower eyelid surgery is to remove the fat bags creating the puffy look. The fat is removed through trans-conjunctival approach on the inside of the lower lids. When there is excess skin at rest ( not when smiling), a pinch technique of excess skin can be performed just below the eyelash line on the lower lids. In our practice, we close this incision with tissue glue, so there are no stitches required. Crows feet are best treated with Botox. Surgery will not help crows feet.

Question: How can I freshen my appearance, is a browlift/eyelid surgery warranted?
Answer: A full set of unadulterated photographs going to be required to make a determination about being a candidate for brow lift procedure or upper eyelid procedure. In some instances, both procedures are performed together. The goals of a brow lift are to raise low set eyebrows, address asymmetry, raise or lower the hairline, and soften the horizontal and vertical frown lines of the forehead. The goals of upper eyelid surgery is to remove excess and hooded skin.

Question: Is it possible to have lower eyelid surgery without causing dry eyes to worsen?
Answer: Much more information is needed such as the degree of dryness of your eyelids in addition to a full set of pictures to make sure your candidate for the procedure itself. The primary goal for lower eyelid surgery is to remove fatty deposits creating the puffy look in the lower lids. This can be performed through trends conjunctival approach through the inside of the lower lid which usually does not affect dry eyes.

Eyelid Surgery: Answers to Your Biggest Concerns

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Question: Can I include a rhinoplasty, chin lipo, brow lift and under eye procedure with my forehead lift?
Answer: Yes, a rhinoplasty, chin liposuction, brow lift and eyelid surgery can all be performed simultaneously under one anesthesia with one recovery period. From the photographs presented, the eyebrow position is normal, and therefore Brown lift is unnecessary. The side profile photograph demonstrates an overly projecting nose and an under projecting chin. Consider performing a chin implant procedure along with your rhinoplasty for better facial balance, especially from side profile. A closed rhinoplasty approach can accomplish straightening the nose, shaving down the dorsal hump, decreasing the projection of the nose with all incisions placed on the inside of it. Placement of a chin implant can accomplish augmenting the chin forward. 

Question: Would upper blastoplasty with forehead fillers (i.e. Juvederm) be an effective option for my sagging brow and eyelids?
Answer: Fillers placed in the forehead are not a good idea, Botox is the better option for a variety of issues. It’s impossible to determine which surgical procedure is required without a full set of unadulterated photographs from all angles. An eyebrow lift is performed for saggy eyebrows. An upper blepharoplasty is performed when there is hooded and excess skin on the upper lids. On some occasions both procedures are required.

Question: Do I need an upper blepharoplasty or an eyebrow lift?
Answer: The level of the eyebrows is more than adequate, therefore a brow lift the totally unnecessary. A very conservative upper blepharoplasty can accomplish improvement of the upper eyelid area by removal of a small amount of skin and fat.

Question: Do you recommend taking anything like arnica before upper and lower blepharoplasty? 
Answer: We do not recommend it routinely, but it is acceptable to take it. Revision eyelid surgery procedures tend to swell and bruise less the second time than the first time.

Question: I have Graves’ disease but do not have the related eye disease. Would I be considered a candidate for lower blepharoplasty?
Answer: Much more information is needed such as a full set of facial/Eyelid photographs, and clearance from your ophthalmologist and endocrinologist.

Question: Are antibiotics required for a brow lift and upper blepharoplasty?
Answer: Its important to know which antibiotic you had an adverse reaction to, so that you can avoid that one again. Antibiotics are needed for some surgical procedures, depending upon the surgeon, and the location of where the procedure is being performed. A full set of facial photographs are going to be required to make a determination about being a candidate for two surgical procedures which include a brow lift and upper eyelid surgery.

Question: Is it safe to have cosmetic blepharoplasty if I have autoimmune uveitis? 
Answer: It’s important to get medical clearance from your ophthalmologist for a blepharoplasty when you have a medical condition of the eyeball when you’re performing cosmetic eyelid surgery.

Question: Would CO2 fractional laser + Botox or blepharoplasty help for creepy and hooded upper eyelids?
Answer: From the one limited photo, it appears you are a good candidate for an upper blepharoplasty procedure. This procedure involves removal of excess skin and fat creating the hooded look The incision is placed in the upper eyelid crease and it can be performed under local or general anesthesia.

Question: I have droopy eyelids, would you suggest eyelid surgery or a brow lift?
Answer: A full set of facial photographs From all angles are going to be required to make a determination about being a candidate for two completely different procedures. A brow lift is performed when patients have low set eyebrows. An upper blepharoplasty is performed when patients have hooded and excess skin in the upper lids.

Question: I’m a 34 year old male, looks way older and tired, Thermage? Transconjunctival blepharoplasty?
Answer: The one limited photograph demonstrates herniated fat in the lower lids for which a trans-conjunctival approach lower blepharoplasty procedure can accomplish Improvement. The fat is removed from an incision is located on inside of the lower eyelids. This procedure is performed under general anesthesia.

Common Questions About Blepharoplasty Explained

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Question: Is there any surgery that can correct my eyelids?
Answer: The photographs demonstrate significant asymmetry of the upper lids which can be addressed with the upper blepharoplasty procedure. The more full eyelid will require skin and fat removal, while the fat would then be grafted to the more hollow upper lid on the opposite side to make them more symmetric. It’ll never be perfectly symmetrical, just improvement.

Question: Can I get a lower blepheroplasty if I’ve had Volbella?
Answer: A full set of eyelid photographs from all angles are required to make a determination about how best to proceed. Also best to have the filler reversed , to make an accurate determination about how much fat to remove from the lower lids.

Question: Can I get brow lift with plasma eye lift on dark skin?
Answer: The pictures demonstrate more than adequate position of the eyebrows, and therefore a brow lift is unnecessary. If the extra skin on the upper lids is of concern, then consider a conservative skin only upper blepharoplasty.

Question: Facial hairline/brow/eyelid and more asymmetry-let’s come up with a plan. Thoughts, advice?
Answer: Your eyebrow position appears normal, so a brow lift would be unnecessary. Botox can address some asymmetry. Consider a lower blepharoplasty procedure to address the bags in your lower lids. Hair Transplants to the scalp can help address the asymmetries in the forehead area.

Question: Will getting a brow lift pull my eyelid skin upward?
Answer: Yes, performing a brow lift will also lift the upper eyelid skin and open up the eyes to some degree. Some patients do require an upper blepharoplasty performed at the same time as the brow lift, but this must be determined at the time of the consultation and examination.

Question: Does it look like I need a nose job or maybe do something to my eyes or eyelids?
Answer: Performing cosmetic surgery is personal decision, and only the patient can make that decision. A full set of facial photographs in a chin neutral position from all angles are required to make a determination about two different surgical procedures. Digital computer imaging would also be helpful to understand what can be accomplished with your nose upon your facial features.

Question: Why does my eye have a triple eyelid crease?
Answer: Its difficult to make a determination based on photographs alone, However the extra skin/ in the eyelids lids can be adjusted with a cosmetic blepharoplasty, as long as no ptosis is present. If there’s ptosis present, and this must be addressed as well.

Question: What work could be done to improve the aesthetic of my nose? Also, are under eye fillers right for me?
Answer: The photographs demonstrate a wide tip which can be reduced and refined as long as there is not thick-skin present. Thick skin in the nasal tip prevents refinement in that area. The area in the midportion of the nose can be augmented with spreader graphs placed underneath the concave upper- Lateral cartilages. The dorsal profile is acceptable. All of this can be accomplished with a closed rhinoplasty approach with all the incisions placed on the inside of the nose. The third photograph demonstrates puffy lower eyelids with herniated fat pads which can be addressed with a trans-conjunctival approach lower blepharoplasty. This involves placement of two small incisions on the inside of the lid and removing the offending fatty deposits creating the puffy look. In our practice, we do not recommend fillers placed around the lower lids for a variety of reasons.

Question: Hooded eyes are making my eyes look small. Will I need an upper blepharoplasty?
Answer: The photographs demonstrate hooded upper eyelids for which an upper blepharoplasty can improve. Upper eyelid surgery accomplishes removing excess skin and fat creating the hooded appearance. The incision is placed directly in in upper eyelid crease. The procedure can be performed under local or general anesthesia depending on the patient’s desires. 

Question: One eye is more hooded and droopy than the other. What options are available to correct this? 
Answer: As long as there’s no ptosis present, an upper blepharoplasty procedure can accomplish a nice cosmetic improvement for your upper eyelids. Everyone has some degree of Eyelid asymmetry, and the amount of skin that is removed on each side during the blepharoplasty procedure is always quite variable depending upon the asymmetry. The goal is to make the eyelids look more symmetrical. This procedure can be performed under local or general anesthesia as an outpatient procedure.