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Eyelid Surgery: Functional or
Upper Eyelid Surgery
Eyelid Surgery, medically known as Blepharoplasty has become one of the most popular and often performed cosmetic procedures for both men and women because of its high level of patient satisfaction. Fortunately, Medicare and most insurance companies now cover “functional” eyelid surgery for upper lids if the vision is impaired enough to hinder normal vision. This usually occurs when the upper eyelid encroaches upon the lid margin and eyelashes. (Before picture) A feeling of fatigue results from the patient unconsciously trying to raise their eyebrows enough to lift their eyelids to keep the extra skin and fat pads from blocking their vision. This unconscious and involuntary lifting of the eyebrows causes wrinkles on the forehead and fatiguing of the forehead muscles which may cause the patient to feel unnecessarily tired.
If a patient’s vision is not impaired by their eyelids, the procedure is considered only “cosmetic” and health insurance or Medicare does not cover the procedure. If the surgery qualifies as “functional” surgery, the insurance pays for the procedure which may accomplish the additional highly desirable result of a more youthful and rested appearance. (After picture) It does not, however, correct crow’s feet.
Lower Eye Lid Surgery
Lower eye lid surgery, also known as Blepharoplasty removes excess skin or/or the fat pads below the eye. This procedure is not covered by insurance plans or Medicare because it is considered cosmetic plastic surgery that improves the appearance of the person but does not improve their vision. It is a self-pay procedure that may be done at the same time as the upper lids and or a brow lift.
To better understand the transformation please take a few seconds to watch this.
Another type of plastic surgery performed by ophthalmologists to correct diminished vision is the brow lift. It is also often covered by Medicare and most private insurance companies when this functional surgery is medically necessary to improve the patient’s field of vision. It produces a more youthful and rested appearance for the patient, and may reduce the fatigue that results from constantly raising one’s eyebrows to see more clearly. Aging, your health and over exposure to the elements, especially the sun causes skin to lose its elasticity giving the appearance of too much skin in areas where it is not needed. This may become especially problematic in the forehead area where excess skin may cause brows to become heavy and extend over a person’s field of vision to the extent that it actually obscures the person’s peripheral vision. When given a Visual Field Exam the patient may show peripheral vision loss similar to that of a patient with Glaucoma.
To document medical necessity for either upper eyelid surgery or a brow lift, in order for their cost to be covered by Medicare or most private insurance companies, a visual field exam must be performed. The visual field exam is done with the eyelids taped up simulating the results of the surgery, and then the visual field exam is repeated with the eyelids in their natural state to document the improvement in vision that would result from the surgery. If the procedure would result in sufficient improvement in vision, the surgery is considered functional surgery and is covered by most insurance. If the surgery would not improve the patient’s vision, it is not considered medically necessary and the procedure is considered simply cosmetic surgery only to improve the patient’s physical appearance and is not covered by most insurance plans. It may still be performed if the patient desires it as cosmetic surgery, but is then a self-pay procedure.
The good news is that something actually can be done to restore the patient’s vision since it is simply being blocked by excess skin. The skin is actually forming a hood over the eyes causing light to not reach the eyes.
There are several surgical options available all known as forms of brow lift surgery. An Endoscopic Brown lift gives the result with the least scarring. This cosmetic plastic surgery is done with two cuts in the hairline that are not seen. Insurance plans and Medicare do not cover this procedure, so it is self-pay for the patient. Coronal Brow lifts remove skin at the hairline with a much greater chance for scarring. They also have never been covered by insurance plans or Medicare and have been largely replaced by the newer Endoscopic Brow Lifts.
The Direct Brow Lift is the only procedure covered by insurance plans and Medicare since it is considered a “functional” procedure when medically necessary to improve the patient’s vision. The incision is directly over the eyebrow or can be hidden within a crease in the brow, but some scarring may still be evident. The procedure improves the obscured vision and does result in a younger more rested appearance, but is only the procedure of choice for patients who want a procedure that Is covered by insurance or Medicare and can live with the possibility of visible scarring. This procedure may be done alone or at the same time as eye lid surgery known as Blepharoplasty.
You should arrange for someone to drive you home after surgery and to stay with you over night. Plan to stay home a few days to allow your eyelids time to heal and your appearance to return to normal. Most patients are back to work after a week. Do no wash your eyes and do not wear eye makeup during this first week. Most patients are back to full activities after ten days. Your appearance will continue to improve for up to six weeks as the last traces of swelling and bruising go away.
Some patients experience dry eyes after surgery, but this condition should not last for more than two weeks unless you were also experiencing dry eye syndrome prior to eyelid surgery. If the symptoms persist advise your doctor.
By six weeks the patient is considered surgically healed.
What to expect during eyelid surgery
Eyelid surgery is performed in our state-of-the-art AAAHC certified ambulatory surgery center on the second floor of our main office in Cape Coral. Patients are given intravenous (IV) sedation by our board certified anesthesiologist or his team of licensed nurse anesthetists. The surgery is performed by our board certified ophthalmologists trained in plastic eye surgery.
After surgery you will have stitches in the creases of both eyelids that should remain in your eyelids for up to one week. Do not disturb your stitches or pull on the small bows of suture extending to the edge of your eyelids. If your sutures are disturbed they will have to be replaced by your surgeon possibly causing some scarring to result.
Your after care is very important for a positive recovery. It is common for some swelling and bruising to occur after the surgery, but this can be kept to a minimum by conscientious icing of the eyelids and remaining upright for the first couple days after surgery. Your eyelids may also feel “tight” or “stiff” for a few days after surgery. Excessive tearing, light sensitivity and blurred vision may be experienced by some patients. With good after care, your eyelids’ appearance should return to normal within one to two weeks. Surgery does leave some scars, but they will be well hidden in the creases of the eyelids and normally fade in time. After 10 days makeup may be used to hide any remaining discoloration or scars.
Pre Surgery Preparation
- Do not take aspirin products, Advil, Motrin, Naproxen, Aleve, ibuprofen, vitamin E or medications that increase bleeding for 2 weeks prior to your surgery.
- Arrive for surgery with freshly washed hair and face.
- Arrive wearing loosely fitting comfortable clothes.
After Surgery Care
- Have someone to drive you home.
- Have someone to spend the first night with you.
- Ice your eyelids for the first 24 hours after surgery.
- 15 minutes of ice, 15 minutes no ice
- Place sterile gauze over eyelids before placing ice
- Apply antibiotic ointment, prescribed by your doctor, on the suture line twice a day.
- Sleep elevated in a recliner chair or with two to three pillows to minimize swelling and bruising.
- Do not wash your eyelids during the first week.
- Do not wear eye makeup during the first week.
- Avoid bending from the waist for about five days.
- Avoid strenuous activities such as lifting and rigorous sports for about 2-3 weeks.
- Wear dark glasses to protect your eyes from the wind and sun.
Cape Coral Eye Center will be happy to contact your
insurance company for authorization for your surgery. Most companies will not cover the costs of
blepharoplasty unless it is considered “medically necessary,” meaning your
baggy eyelids are impeding your vision.