The insurance coverage criteria for upper eyelid ptosis repair and upper eyelid blepharoplasty are stringent, and what defines cosmetic versus insurance-covered surgery of vision impairing conditions is clearly defined. In order to qualify for insurance-covered upper eyelid surgical procedures, a patient's upper eyelid condition must be impairing their vision.
Figure 1A demonstrates a patient with upper eyelid ptosis (drooping upper eyelid) causing decreased peripheral vision due to a lower upper eyelid position (lower dots). Although the patient has excess upper eyelid skin (upper dots), the level of the skin does not drop below the level of the eyelid and therefore does not block any vision. In this situation, the lifting of the low eyelid height that is blocking vision is covered by insurance; however, the removal of the extra skin that is not causing vision impairment is not covered by insurance and considered a cosmetic procedure.
Figure 1B demonstrates the appearance of the upper eyelid skin after the drooping upper eyelid is lifted. Note that since the skin was not removed when the eyelid was moved to a higher level, it causes a more bunched and wrinkled appearance. However, since it is not covering the eyeball and impairing vision, the removal of this skin by blepharoplasty is still not covered by insurance and considered a cosmetic procedure.
Figure 1C demonstrates the appearance of the upper eyelid after cosmetic removal of the upper eyelid skin by upper eyelid blepharoplasty. Note that this procedure removes the excess tissue towards the nose, causing a smoother appearance (blue dot). Additionally, it creates a more youthful and refreshed appearance. In women, the distance between the red and yellow dots can be adjusted to allow for better application and visualization of eye makeup.
This patient had right and left upper eyelid ptosis (Figure 2A). After lifting of the drooping eyelids on both sides, the extra upper eyelid skin became more noticeable. While this patient could see better, he was bothered by the aged look of his eyes due to the wrinkled skin appearance. The patient was also concerned about the asymmetric appearance of the eyes due to unequal amounts of excess skin (Figure 2B). The patient was able to achieve a natural and more refreshed appearance after undergoing a cosmetic blepharoplasty by removing the extra upper eyelid skin and fat on both upper eyelids (Figure 2C).
Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
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