Solving Extra Skin Over the Upper Eyelids to Relieve Irritation and Heaviness
A 44-year-old woman’s right eyelid is drooping more than the left that's causing a heavy feeling in her eye. She wants to know her options to fix the drooping eyelid. She is also curious if her insurance would cover her procedure.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that when a patient with droopy eyelids comes to his practice, he first tries to differentiate if there is extra skin over the eyelid (dermatochalasis), or if there is drooping (ptosis). Drooping of the eyelid or ptosis is caused by a defect of the levator muscle which is the muscle that lifts the eyelid. He also looks at the brow position that could result in extra skin being pushed downward on top of the eyelid called brow ptosis.
After looking at this woman’s photos, Dr. Prasad says that her brows are relatively asymmetric which fortunately is normal. He suspects that her brows have not come done significantly so he would advise against a brow lift. If her brows are elevated even with a few millimeters, it may have a negative impact on her facial expression where she could look always surprised.
By how her eyes appear, Dr. Prasad says that the upper eyelid margin is not low enough to be affecting the pupil. She may have dermatochalasis which means extra skin over the eyelids. The solution for that is blepharoplasty which addresses extra: skin, soft tissue, fat, and anything that is impinging on top of the upper eyelid. However, there is an art of doing cosmetic blepharoplasty to look natural by not having too much skin removed. One of the most common concerns is when someone has too much skin removed and they end up having difficulty closing their eyes. As a cosmetic oculofacial plastic surgeon for 20 years, Dr. Prasad has had patients come from all over the world for revision surgery for drooping of the upper eyelid after blepharoplasty, as well as skin shortage of the upper eyelid after blepharoplasty. Blepharoplasty is not about taking as much skin as possible, it is about the art of the design and employing techniques that can allow skin to fold in properly so it looks attractive and natural.
Having practiced for 20 years, Dr. Prasad has watched how insurance companies have become very strategic in presenting themselves to patients and doctors. 15 to 20 years ago, if someone had any visual field defect, it would be covered by insurance. That unfortunately led to a lot of people who didn’t have a functional issue or problem to have it covered. Presently, insurance companies only cover procedures if they are medically necessary. In Dr. Prasad’s practice, he stopped accepting insurance altogether as he found that it was detrimental to his ability to deliver the proper care to his patients. Looking at this woman’s photo, he thinks it is unlikely that any medical director of any insurance company would consider her upper eyelids heavy enough to be blocking her vision. The general rule of thumb is, if someone else can see their pupil that means they can see out. It really takes a really low eyelid to the point of complete coverage before an insurance company would cover it.
Dr. Prasad suggests that she identify an expert in upper eyelid surgery. Many doctors perform eyelid surgery. In the hierarchy of specialties, one would argue that a sub-specialty like oculofacial plastic surgery is a position uniquely qualified to perform this type of procedure. She certainly has many options, but must do her research and learn about cosmetic surgeons and other doctors who also perform blepharoplasty. Once she finds a doctor who she is comfortable with, she may move forward with the surgery.
For more information about upper eyelid surgery, please visit our website:
http://prasadcosmeticsurgery.com/pras...