It is very clear that I had Ptosis at birth.
I did not have surgery until I was around 4 or 5.
What is the cost of this?
I checked into having this surgery done a few years ago but since it did not interfere
with my vision, it was considered cosmetic so insurance would not cover it.
I would like to have the surgery done.
I feel it is only going to droop even more as I get older.
It is not a neurological problem.
I wonder what the cost is for this surgery and how complicated it is?
In addition, is it too late for me to have this surgery done?
I was teased as a child quite a lot.
Thank you for your question!
You submitted some photos and you mentioned in your question that you have congenital
ptosis.
You did have surgery when you were around 4 and 5 years of age and that apparently you
had difficulty with insurance coverage several years ago because it wasn’t blocking your
vision enough.
And you keep asking several times about the cost of the surgery.
So, I’m going to explain to you a little bit about the challenges that are unique to
someone who is a little bit older who has congenital ptosis and I’ll share with you
how we approach and evaluate and then make recommendations.
This will also help give you understanding of what the cost will be even though you still
need to have an examination before you can determine this and I’ll give you my opinion
on insurance companies and coverage in this type of stuff.
First of all, congenital ptosis means that the muscle that lifts the eyelid called the
levator like the word elevator did not develop fully during gestation.
It tends to run in families but sporadically.
Except for exceptional family patterns, most of times, it just tends to express differently
so several siblings can be born and only one may have ptosis.
Anyway, the point is that, this muscle can either be mildly affected in terms of the
level to severely affected in terms of the level and the actual activity that of the
muscle can be everything from fully functional to very weak.
So when we do a ptosis examination, we look at a patient and see what their eyelid level
is, see how much it blocks their pupil and we ask them to look down and up to establish
how much muscle function they have.
From an ophthalmologic point of view, from the point of view of eye health, we also want
to look at conditions such as dry eye and also something called Bell’s phenomenon
where the eyes roll, it’s a protective mechanism to make sure that the eye rolls a little bit
so that when you are sleeping, even if your eyes open a little bit, that they’re still
protected.
All of these are very important factors.
So in choosing the type of surgery, it’s basically divided into those with good enough
muscle function versus those who have no muscle function.
Those with good enough muscle function, we’ll typically do something called a levator muscle
resection and that means shortening this muscle so that eyelid can come up.
So when you shorten that muscle, that means that the eyelid will open but it will not
relax and close the exact same way as the other eye.
And in addition, you have to be prepared, you also add lubrication to your eyes as part
as your post-operative care for the long term.
One of the things especially people who are older have to understand that almost everyone
beyond the age of 40, has some degree of dry eye and the older you get, the dryer your
eyes get.
So when your eyes are drooping, it’s actually covering more of your eye and you’re actually
not as exposed when the eyes open, the eyes are more exposed.
So you’re going to have to use some type of strategy to make sure that the eyes are
properly lubricated.
Something that I didn’t mention, even if you have congenital ptosis and a common speech
I have for patients who have congenital ptosis is that, it is not surprising for people who
have ptosis to have more than 3 operations in their lifetime.
One in childhood for visual development, one at adolescence to early adulthood for aesthetics
and one in later in life because as the tissue stretches and the facial aging process goes
on, you’ll need it for more functional and aesthetic reasons.
Now, another type of ptosis affects people who don’t have congenital ptosis and this
is called levator muscle dehiscence or aponeurotic ptosis.
This is a normal age-related attenuation or thinning of the muscle that causes the eyelid
to droop.
So you may be dealing with that in the other eye and so an examination has to be established
whether or not there’s any merit to addressing the other eye at the same time.
There’s something called Hering’s law where we actually lift the more droopy eyelid
and very often, the other eyelid actually descent.
It has to do with amount of signal that is generated by the brain to push the eyelid
open but is something that is a part of an examination to determine the optimal procedure.
Now the other option besides a levator resection is a procedure called a frontalis sling.
It is done routinely in younger children but when it is done for an adult, there is a challenge
here.
When the child has a procedure like this, their eyes are open all the time particularly
when they are sleeping but because they are young and they produce a lot of tears and
they have a functional Bell’s phenomena and there’s stretch, with time, they don’t
end up with dry eye symptoms.
You do this procedure on an adult, you have one eye that is actually always open and to
summarize, it’s actually a procedure where the forehead muscle called the frontalis muscle
is connected with the eyelids so that when you raise your eyebrows which you do now flexibly,
you actually able to force the eyelid effectively open because your using the muscle activity
of the frontalis muscle to lift the eyelid.
That’s one eye that actually has to be forced to blink while the other eye blinks normally.
And it takes a long time for an adult to acclimate to this.
It’s kind of like a teaching your body and brain to create new habits.
There have been times when I’ve done this procedure where I actually have to go back
and release the eyelid in order to protect the eye more even though the aesthetic result
was so nice because of tearing and eye irritation.
So that means that you really need a very thorough examination and evaluation.
In terms of the cost of this procedure, you’re going to have to see if your doctor that you
choose accepts insurance and is willing to go through the process of insurance approval.
The problem with the modern world and why over 10 years ago I stopped accepting any
kind of medical insurance is that insurance companies are openly deceptive in their practices.
They will approve a procedure and then later on deny the procedure.
Or they will go back and audit doctors and say their procedures are not indicated and
ask for refunds and I never live for that but I saw how very deserving patients whose
eyes are completely closed where denied by insurance companies.
And basically, as much as they play the game of working around legal contracts, they’re
essentially practicing medicine as far as I’m concerned so I have nothing but contempt
for insurance companies.
So as far as that financial hurdle is concerned, you’re going to have to try and find a doctor
that either accepts insurance and is willing to go through that with you or find a doctor
who you can afford but of course, cost is a factor and the procedure does require, in
our practice for example, a surgeon fee, anesthesia and facility costs which are part of delivery
high quality care.
You never want to do shortcuts or go cheap in such a type of procedure.
So that being said, you need to meet with doctors and most likely, you’ll meet with
oculofacial or oculoplastic surgeons who have extensive experience in this area.
Most general plastic surgeons are not trained in this area and don’t really practice this
so you’ll not likely find too many whose willing to do this type of surgery.
But meet with doctors and so who you are comfortable with and figure out what options you are comfortable
with and moving forward, I wish you the best of luck, I hope that was helpful and thank
you for your question!