Thank you for your question.
You submitted your question with two photos.
And you stated in your question that you had ptosis repair due to a weakened muscle and
that you are satisfied with the repair.
However, there is a certain amount of skin that is present after the ptosis repair.
And that your surgeon stated that you would have to pay to have the skin removed.
And you’re asking if should it have been done as part of the surgery.
Who is right?
Well, I can share with you what I think is the general opinion of doctors in this oculoplastic
community assuming that you did have this surgery by an oculoplastic surgeon.
And I’ll explain what I think is the thought process behind what your doctor is stating
without knowing much of the detail.
And I can understand your confusion.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Dealing with eyelid ptosis is a significant part of my practice as well as cosmetic surgery.
In my practice, I don't accept any insurance and I do see patients who come for ptosis
surgery who make the choice to come to a specialist like myself to have the cosmetic elements
of their eyelid surgery addressed in addition to the function.
And this is where I think it has to be clarified.
I think that one of the things I find when patients come to me for examination regarding
eyelid ptosis that there is this unspoken assumption from really generations of practice
where people who had a degree of either dermatochalasis which is extra skin over the eyes or ptosis,
the eyelid drooping that was affecting the visual field would undergo surgery through
their insurance because it was a functional limitation.
Well unfortunately, there has been a tradition also of abuse of that particular issue and
a lot of times people try to get cosmetic surgery covered by insurance.
And of course, insurance companies don't want to do that or neither do any third party.
And that of course is a challenging point.
I think that a lot of times, when people want to have a procedure covered by insurance,
the surgeon is going to be limited to doing only what is covered by insurance.
And so it becomes also actually an issue when it comes to the hospital or surgery center
that they’re working in because the time involved in doing the other procedures that
are more cosmetically oriented costs in terms of anesthesia, time and facility and other
factors.
Now there is always going to be a certain amount of controversy with that type of statement.
But when I see my patients and I say to them, well if your goal is to only lift the eyelid,
the strict definition of improvement is essentially lifting the eye and improving vision.
Insurance companies don't care whether it looks good or not.
And so I think that this is something that could have been discussed with your doctor
prior to the surgery.
I think that the challenge here is also whether or not your procedure, in the context of how
it would be performed, there are going to be costs and I think that’s what is somewhat
confusing to patients who get procedures covered by insurance and if they don't like the aesthetic
outcome, then they want to get the cosmetic procedure but they are faced with dealing
with paying for a cosmetic procedure, one of the many reasons why I stopped taking insurance
many years ago.
I think that if you like the doctor that did your surgery and you feel comfortable with
that doctor, I think that you should be able to come to terms which can be balanced for
both of you.
Understanding that there are certain costs in doing surgery and that doctor's time etc.
have to be recognized and also about what was your discussion preoperatively.
If there was a discussion about the cosmetic aspects of your procedure, I think it’s
very important to have a lot of just clear full disclosure of what is covered and what
is not covered.
And so I simplify it by simply stating that nothing is covered when you come to a cosmetic
surgeon who does not accept insurance.
Then what I’m essentially doing in my practice is telling my patients that by having my own
facilities, by having my own setup, that any type of enhancement, I will essentially factor
in into the cost of doing the procedure.
And therefore, my patients have a more sense of security as to what they will get by addressing
all the issues both functional and cosmetic.
The tricky part happens when people get procedures under insurance and then they want cosmetic
things covered.
And so again, it’s not exactly a black and white situation.
I think defining the distinction between functional versus cosmetic is very important and having
this discussion with your doctor will hopefully lead to some kind of solution.
Otherwise, I think that if you were to go to any doctor to have the upper eyelid addressed,
that would be a cosmetic blepharoplasty and that may itself be the basis to understand
that part of your issue is ultimately a cosmetic procedure.
So I hope that was helpful, I wish you the best of luck and thank you for your question.