In 1978, Patterson joined Verne Gagne's American Wrestling Association. He formed The Blond Bombers with Ray Stevens, with the duo winning the AWA World Tag Team Championship later that year. Patterson performed intermittently for the AWA until 1983.
In 1979, Patterson debuted in the World Wrestling Federation (WWF), working as a heel, under the tutelage of manager The Grand Wizard. As a villain, Patterson's primary feuds were with then WWF North American Champion Ted DiBiase and WWF Heavyweight Champion Bob Backlund. During a television taping on June 19 in Allentown, Pennsylvania, Patterson defeated DiBiase for the WWF North American Championship by using a pair of brass knuckles to knock out DiBiase. Patterson was unsuccessful, however, in winning the WWF Heavyweight Championship from Backlund.
In September 1979, the WWE would introduce the WWE Intercontinental Championship, a secondary championship for its midcard wrestlers. Patterson was crowned the company's first Intercontinental Heavyweight Champion after an alleged tournament held in Rio de Janeiro. While Patterson's tournament "victory" is widely listed in wrestling title and match histories, the tournament itself never actually took place. Patterson's apocryphal title victory would later become something of an inside joke during Patterson's on-screen tenure as one of Vince McMahon's "stooges". On November 8, Patterson dropped the North American title to Seiji Sakaguchi.
It was during Patterson's reign as champion that he turned face, after a botched attempt by the Grand Wizard to "sell" Patterson's contract to "Captain" Lou Albano for $100,000; Albano's protégés, the Wild Samoans, attacked Patterson after he cut a promo insulting Albano. Patterson held the Intercontinental Heavyweight Championship until April 21, 1980 when he was defeated by Ken Patera in New York City, New York. The match ended in controversial fashion after Patterson placed his right leg on the ropes just before the three count was made. On May 4, 1981, Patterson's feud with Sgt. Slaughter culminated in a Bootcamp match in Madison Square Garden.
Patterson began doing color commentary in 1980 with Vince McMahon, calling WWF Championship Wrestling from 1980-84. While Patterson was a face commentator when partnered with Gorilla Monsoon and Vince McMahon, he hosted a heel interview segment for French WWF broadcasts known as "Le brunch de Pat", where he would politely ask questions in English but furtively mock his face guests in French. Patterson was on commentary with Monsoon when Hulk Hogan defeated The Iron Sheik for the World Heavyweight Championship, as well as for when Sheik defeated Bob Backlund. Patterson was also calling the action when Jimmy Snuka jumped off the steel cage and splashed Don Muraco in Madison Square Garden in 1983.
Patterson retired from wrestling in 1984. Although retired, Patterson continued to occasionally wrestle. On January 26, 1985 he wrestled Nikolai Volkoff in a losing effort in a house show in Cincinnati, OH. The following month he teamed with Andre the Giant at a pair of house shows in Canada and defeated Ken Patera and Big John Studd. He also appeared in a battle royal at a house show in Buffalo, New York on December 27. Patterson made a handful of additional appearances in Montreal in 1987, wrestling as a heel (while remaining a face or neutral backstage official in the United States and elsewhere in Canada). His most notable appearance was a win over the up-and-coming Brutus Beefcake on August 10. His final match would come three weeks later in Montreal as he fell in defeat to Beefcake.
He began working backstage as a road agent and right-hand man to WWF promoter Vince McMahon, and is credited with inventing and booking the Royal Rumble match. In the late 1990's, he also worked in the talent-relations department.
After his retirement, Patterson also worked as a WWF referee. He was selected as the in-ring referee for the main event at the first ever WrestleMania at Madison Square Garden on March 31, 1985, a well as the main event of WrestleMania XI.
In 1997, Patterson, along with Gerald Brisco, became comedy heels as the on-screen stooges of Vince McMahon, assisting their boss in his rivalries with Stone Cold Steve Austin, Mankind and The Rock. Patterson and Brisco were among the founding members of The Corporation. In order to mock Hulk Hogan, they used "Real American" as their entrance music and parodied Hogan's flexing routine as they approached the ring. on the May 18, 1998 episode of Raw, Patterson and Brisco competed in a 2 on 1 Street Fight against Stone Cold that ended in a no contest when Vince McMahon and Dude Love attacked Stone Cold.
Later in 1999, the two became entangled with the McMahon-Helmsley Faction. On the December 16, 1999 episode of SmackDown, Patterson and Brisco helped Test, who had been injured by D-Generation X. Triple H and Stephanie McMahon then forced Patterson and Brisco to compete for the WWF Tag Team Championship against The New Age Outlaws or be fired. Patterson and Brisco lost the match. In 2000, Patterson and Brisco joined Triple and Stephanie. On the May 8 episode of Raw, Patterson, Road Dogg and X-Pac faced Rikishi in a 3 on 1 handicap match and were disqualified after Patterson hit Rikishi with a chair. Afterwards, Patterson lowered his drawers to deliver a Stink Face to Rikishi with stained underwear, which commentator Jim Ross described as a "tractor-sized skidmark". On June 12, 2000, when the faction unmasked Kane, Patterson photographed Kane's "hideously scarred" face, and threatened to "expose him to the world" if he did not comply. Kane was forced to wrestle The Rock (then his ally) in a No Holds Barred match. When Patterson's film did not develop properly, Kane turned on the faction.
On June 19, 2000 Patterson helped Brisco win the perpetually contested WWF Hardcore Championship from Crash Holly but during the victory celebration turned on his ally, blinding him with champagne and then breaking a second bottle over Brisco's head, and pinning the (kayfabe) unconscious champion. Brisco pursued Patterson into the women's locker room, where Patterson was hiding in drag. Subsequently, Vince McMahon scheduled them to fight over Hardcore Championship in an evening gown match at King of the Ring 2000; in the course of the match, Crash Holly attacked both men and pinned Patterson to become Hardcore Champion. On the June 21 episode of Raw, Patterson and Brisco's match with Shane and Vince McMahon ended in a no contest when The Mean Street Posse ran in and attacked them.
The Intercontinental Championship, unified with the World Heavyweight Championship on October 20, 2002, was resurrected on May 18, 2003 at Judgment Day in a battle royal. Patterson, as the first ever Intercontinental Champion, was at ringside to present the belt to the victor. Booker T eliminated Christian for the win, but the referee was unconscious. As Patterson attempted to give the championship belt to Booker T, Christian attacked him, stole the Intercontinental Championship belt and used it to knock out Booker T. The referee then recovered and awarded the match to Christian.
In October 2004, Patterson retired from World Wrestling Entertainment. Patterson returned to WWE in a limited capacity in May 2005. At Breaking Point, Patterson made an appearance in his hometown of Montreal in an in-ring segment with Dolph Ziggler.
Patterson was a regular cast member on the WWE Network original reality show Legends' House.
On July 22, 2019, during the Raw Reunion episode, Patterson won the WWE 24/7 Championship by pinning Drake Maverick backstage. He would lose the title to Gerald Brisco off-screen later that same night. At 78 years old, he became the oldest person ever to win a title in WWE history, beating The Fabulous Moolah's fourth reign with the original WWF Women's Championship at 76 years old.
Patterson passed away on December 2, 2020.