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Eyelid surgery to remove excess skin and fat is referred to as "blepharoplasty". Motivation for this procedure may be either functional (to improve visual field) or cosmetic.
As one ages, the upper and lower eyelid tissues begin to relax. These nonspecific changes may be accelerated by sun exposure , allergies or recurrent swelling and result in stretching of the skin. In some individuals, this process may be hereditary. The result is an excess of eyelid tissue referred to as "dermatochalasis". Stretching and relaxation of the orbital septum (middle layer of the eyelid) allows orbital fat to move forward. As a result, a "fullness" to the eyelid develops and increases over time. Excess eyelid tissue may create a tired look, a heavy feeling to the lids, and may make patients look and feel older. With time, the excess eyelid tissues in the upper eyelid may hang over the eyelid margin and cause an upper visual field restriction. In the lower eyelid, excess skin and fat occasionally affect the bifocal portion of a patient's spectacles, but functional problems are less frequent than with the upper eyelid. Surgical removal of the excess skin, and fat if needed, leads to an improved and more comfortable field of view. See Functional Blepharoplasty Preoperative and Postoperative Patient Photographs of Dr. Klapper's patients.
Your eyes are often the first thing people notice about your face and are an important aspect of facial attractiveness. Unfortunately, with age, the upper and lower eyelids become "droopy" or "baggy" in appearance. Aesthetically, such conditions may detract from the overall attractiveness of ones eyes and cause a "tired" or "older" appearance. This situation bothers some individuals more than others and at different ages. Removal of the excess skin and fat can restore a younger, more rested appearance. See Cosmetic Blepharoplasty Preoperative and Postoperative Patient Photographs of Dr. Klapper's patients.
A preoperative ophthalmologic examination is essential to document a patient's visual acuity, baseline tear function, tear film stability, strength of eyelid closure, symmetry of palpebral fissures (eyelid height), previous eyelid surgery, etc. For those considering surgery for functional reasons, a visual field test (with the eyelids relaxed and elevated) is required. Preoperative photos are routinely performed prior to both functional and cosmetic blepharoplasty.
Patients considering cosmetic eyelid surgery need to discuss with the eyelid surgeon what they want to achieve from a blepharoplasty. Blepharoplasty is able to remove the bulges created by fat herniation and remove excess skin that is becoming redundant. Skin discoloration, deep creases, and cheek fullness are not corrected by eyelid surgery. Patients also need to know that enough skin has to remain after surgery to allow proper eyelid closure. Blepharoplasty surgery can not remove "all" the fine lines in the eyelid. With skin removal, the fine lines will diminish a great deal, but to remove them all may prevent normal eyelid closure. Many patients also have a droopy eyebrow which must be addressed when considering upper eyelid surgery. (see Brow Lift)
The goal of surgery is to remove the excess skin and fat. In doing so, patients often look more alert and healthy, less tired, and generally have a younger, more rested appearance. It is important for patients to understand that although they will look better and may feel better about themselves, they should not expect their lives to change dramatically. See Preoperative and Postoperative Patient Photographs of Dr. Klapper's patients.
There are certain criteria that must be satisfied for most insurance carriers (including Medicare - see below) to pay for part or all of your eyelid surgery. For any health care plan to cover surgery, a patient's eyelids must restrict the superior field of vision resulting in some limitation of daily activities such as reading, writing, driving, sewing, etc. Photographs must be submitted and demonstrate significant narrowing of eye opening with a diminished distance from the upper eyelid to the light reflex (near the center of the pupil). Visual fields may also be required to further document constriction of the superior field. Visual fields are performed with the eyelids at rest and with the eyelids elevated to demonstrate the improvement expected with surgery. The predetermination process for commercial insurance may take a few weeks to a few months to complete. Lower eyelid blepharoplasty surgery is rarely covered by insurance or Medicare and is considered cosmetic in almost all cases.
With Medicare, the decision to cover surgery is not made until after surgery when the claim (with the photograph and/or visual field) is submitted from the doctor's office. Medicare does not have a pre-approval (predetermination) process. Dr. Klapper will discuss with you whether your photographs and/or visual fields meet the criteria outlined by the local carrier for Medicare. Dr. Klapper can not, however, guarantee whether your surgery will be a covered service. Lower eyelid blepharoplasty surgery is rarely covered by Medicare and is considered cosmetic in almost all cases. A referral from your primary care physician or eye doctor does not insure that Medicare will cover your eyelid surgery. All Medicare patients considering functional blepharoplasty and/or ptosis surgery will be asked to sign Medicare's Advance Beneficiary Notice (ABN) indicating that you understand your financial responsibility if Medicare does not cover your surgery.
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Contact our office to discuss your eyelid problem with Dr. Klapper or a member of his staff. (317) 818-1000
