Hello and welcome to case of the day. I’m Dr. Croley and today we’re gonna discuss a patient that came in and they were complaining about their upper lids drooping. And so they asked, “what can I do about my drooping upper lids and will I have to pay for this or will insurance pay for this?” So we’re gonna discuss Blepharoplasty of the upper lids or Eyelid Lift which is a common term for Blepharoplasty.
So what is Blepharoplasty? It’s a procedure where all the extra skin that is on the upper lid is removed and then that helps the appearance of the person’s face and eyes but it also improves vision. So this skin is hooding down and blocking your vision. Removing that out of the way does significantly improve a lot of people’s vision and that’s where it comes in where insurance will pay for this. So someone who’s interested in having their lids fixed or repaired or a Blepharoplasty done and they want to have this covered by insurance then we run tests. The insurance companies and Medicare have set up guidelines in which you have to meet and whether have them cover or have this be medically indicated as far as your eyelids are operated on.
So what does that do or entail? We do a side vision test to document what your side vision is with the lids down in the way and then we tape your eyelid out of the way and repeat that test and see how many degrees of improvement of your sided vision we get and then depending on how many degrees that is, insurance will either agree to pay for that or medicare. They have their own set of guidelines. Typically for private insurance that is 20 degrees of loss and for Medicare they are usually a little bit more forgiving as far as the number of degrees, but we find that most people who are interested in this have at least 20 degrees or more of loss and they typically get this covered by insurance.
Then the other thing that has to be done is we take photographs to document how far the skin is drooping drown and obstructing the vision. If you have private insurance then we have to send those test results and the photos off to the insurance company, in many cases and they will review those and then give an opinion about whether this is medically indicated or not and whether they will approve to pay for this or not. With Medicare, you just have to meet their criteria, document it in their record and then you can have the procedure done.
So what do we do with eyelid Blepharoplasty? What is that procedure? So basically what is done is typically you’re going to a surgery center. They start an IV. They’ll give you Valium-type drugs to keep you calm and relaxed and then while they give you a short-acting medicine that makes you sort of drowsy or sleepy, and they inject your lids to numb them up and before they do that then the surgeon comes in and marks how much skin can be removed from your eye and still let you keep your eyes closed.
So what we do is I take a marking pen and I mark across your upper lid and out to the side about 5 millimeters above the edge of your lid and then we go along with a forcep and pinch how much skin can I pinch from that line and still let you close your eye and so then there’s an upper mark that goes across and then all the skin between those two marks are removed. So when we bring you back to the operating room. We then make an incision along those marks, remove the skin. We also remove a strip of Orbicularis muscle, which is the muscle inside the skin here that closes your eye. Then we get down to the orbital septum which is a membrane that sort of keeps the fat that surrounds your eye back in the orbit, but as we age that tends to sort of stretch and lets the fat bulged forward so if there’s any fat that’s bulging forward we then isolate that and remove the fat as well and then suture the skin back together. Those stitches are typically left in place approximately 10 days or so and we have people put lots of ice to their eyelids after the surgery. There’s very little pain typically with this so we don’t even prescribe pain medicines in most cases and so people do excellent so they get an improvement in their vision and people come back and comment all the time, “I see brighter better, my side vision’s better,” and they are very happy with the improvement in their vision but they also get the cosmetic result as well.
So if you’re interested in knowing more about Blepharoplasty or eyelid lift and whether you’re a candidate or would be a candidate then certainly see your eye doctor or surgeon. And if you have any questions for us you can always contact us through the website if not may God bless you with healthy vision and healthy eyes.