Eyelid surgery, medically known as blepharoplasty, is a common cosmetic procedure that is used to correct sagging, hooded and puffed eyelids. But, before actually going into the surgery, you need to understand how to qualify for eyelid surgery. Whether your treatment goal is for enhancing aesthetics or to improve vision, there are some things that are important factors for you and your surgeon to consider before undergoing the surgery.
In this comprehensive article we will explore cosmetic, medical and insurance criteria that will help you make an informed decision about potentially undergoing eyelid surgery.
What is Eyelid Surgery ?
Before we answer the question of how to qualify for eyelid surgery let us understand what an eyelid surgery is.
Blepharoplasty, commonly called eyelid surgery is a cosmetic surgery that helps to improve the look on the areas surrounding the eyes. Also called an eyelift, it removes bagginess from your lower eyelids and reduces hooding of the upper eyelids. As you age, your skin will lose elasticity and this combined with gravitational pull can cause excess skin to accumulate around the eyes. This can make you look tired and might even cause changes in your vision.
There are two primary categories:
Cosmetic Eyelid Surgery: It is performed to improve the aesthetic appearance and give a more youthful look.
Medical or Functional Eyelid Surgery: It is done to improve vision and to correct any other medical issues caused by drooping eyelids.
What makes you medically qualify for eyelid surgery ?
If your drooping eyelids are affecting your vision, comfort, or eye health, you may be medically derived for eyelid surgery. It’s not just cosmetic-related surgery it’s about your eye health and function.
Here are the medical, or functional reasons, that may support your eligibility for the procedure:
Visual Field Impairment
One of the most common reasons a patient qualifies for the surgery is as a visual field impairment. When excessive skin from the upper eyelid drapes over the eyelashes, its position can impair some of your visual field, making reading, driving, or performing daily activities difficult.
An eye care physician or plastic surgeon may conduct a visual field test to determine if your droopy eyelids significantly impact your sight, and if it is justifiable with a medical procedure. You may be eligible for diagnosis if you struggle to keep your eyes open when you are awake, if you have strain in your muscles trying to keep your eyes open or if your eyelids are drooping so low, it essentially covers your pupils.
Chronic Irritation or Discomfort
Excess skin around the eyelids can cause irritation, rashes, or inflammation of the eyelids. If you have persistent irritation or more serious infections you might medically qualify for eyelid surgery.
Malpositioning of eyelids
Some conditions like ptosis (drooping of upper eyelids), and outward or inward turning eyelids (ectropion and entropion) are medical reasons that make you qualify for eyelid surgery. These conditions can cause irritation, dryness and if left untreated can damage the cornea.
Difficulty wearing glasses or lenses
Eyelid surgery can be considered a functional necessity if drooping eyelids makes it difficult to wear your contact lenses or glasses.
How to Prepare and Qualify for Eyelid Surgery ?
Be In Overall Good Health
Having good overall health is a basic requirement for any surgery. Surgeons will evaluate if you have any chronic medical conditions like diabetes, thyroid or hypertension which can affect the healing process. A stable health minimizes surgical risks and helps for a smoother recovery.
Have Realistic Goals
While an eyelid surgery can deliver improvements, it is essential to understand what it can and cannot achieve. It should be kept in mind that blepharoplasty is performed to enhance the appearance and not to change it completely. Keeping realistic expectations helps you to achieve satisfiable results.
Prepare your body
This may include, but is not limited to, some healthy lifestyle choices, medication changes to be made in conjunction with your doctor’s recommendations, and preparing your body for the best possible condition. Any planning you do ahead of time will help promote healing, but it will also make your overall experience for the surgical process more smooth and safe.
Insurance Criteria: When Is Eyelid Surgery Covered?
One of the more common questions patients ask is if eyelid surgery will be covered by their insurance. Ultimately, the answer depends on how you qualify for eyelid surgery under medical necessity.
Insurance companies tend to only cover eyelid surgery if it is done for the purpose of restoring function (i.e. provides more vision or resolves a medical condition). Cosmetic eyelid surgery, which is done solely for the purpose of aesthetics, is generally not covered.
You may qualify for an eyelid surgery that is covered by your insurance if:
- You have visual field testing showing a loss of 20-30 degrees of peripheral vision.
- The eyelid skin hangs below the margin of your pupil or lashes.
- The droop causes headaches, eye strain, or fatigue.
- Your surgeon or ophthalmologist provides medical records with functional impairment documented.
There are differences with each insurance company (Medicare, Aetna, or Blue Cross) as to its criteria, but the majority will follow these general criteria.
What Factors might disqualify you?
Even if you want to have the surgery, there still might be some factors that can actually make you ineligible for it.
Severe Dry Eye Syndrome or Eye Infections
If you have chronic dry eye syndrome or frequent corneal infections, surgery could worsen your condition, and your surgeon may suggest treating these before surgery.
Unreasonable Expectations or Psychological Issues
Patients with unreasonable expectations for the surgical outcome or those considering this surgery to address emotional issues may not qualify. Your surgeon can gauge whether or not you are a candidate for surgery during your consultation.
Not in good health
Those people with uncontrolled medical conditions like high blood pressure, clotting disorder or diabetes might put them at increased risk.
What to expect during initial Consultations?
Having a consultation with an experienced plastic surgeon will help you to understand if you qualify for eyelid surgery. Here are some of the things that might be expected during initial consultations:
- Reviewing medical history
- Physical Examination
- Discussion of goals and concerns
- Detail explanation of the Procedure
- Compare before and after photos of prior patients
So How to Actually Qualify for Eyelid Surgery?
To conclude, understanding how to qualify for eyelid surgery is the initial step towards achieving a refreshing and youthful look with improved vision. The easiest way to know if you qualify for an eyelid surgery is to make an appointment with a board certified plastic surgeon. Always remember that the right qualifications enable a safer procedure, better outcomes and insurance coverage.
Frequently Asked Questions
1. What makes someone a good candidate for eyelid surgery?
A good candidate for eyelid surgery is one who is in good overall health, has sagging or drooping eyelids that impairs their cosmetic appearance or vision. Candidates should have realistic expectations and do not have serious bleeding disorders or eye disorders.
2. I am wondering if my eyelid surgery is covered by my insurance?
Insurance coverage for eyelid surgery is usually only provided as a medically necessary surgery, for example, if your drooping eyelids are blocking your vision. Your surgeon may perform a field of vision test and provide you with the documentation and/or photos to submit to your insurance for approval.
3. How long is the qualification process for an eyelid surgery?
Usually, the procedure requires one or two consultations. Following examination, you could require insurance pre-authorization or medical testing, which could take several weeks before the surgery is scheduled.
