What are my droopy eyelid options?
I am 44 years old.
My right eye lid is dropping more than left and causing a very heavy feeling in my eye
and irritation.
Left isn't so great either but not as bad.
What are my options?
Would insurance cover?
I am curious of costs if insurance wouldn't cover.
Thank you.
Thank you for your question!
You submitted a question with photos that demonstrate one eyelid appearing heavier than
the other eyelid and you’re asking about options as well as about whether insurance
coverage would be appropriate.
So in reviewing your photos, and anytime someone like yourself comes to our practice and we
look at heavy looking eyelids, we try to first differentiate, is there extra skin over the
eyelid which is termed dermatochalasis, is the eyelid drooping because of a muscle issue
related to the muscle that lifts the eyelid called the levator muscle and that term is
ptosis and we also look at the at the brow position.
The brow position could also result in extra skin being pushed downward on top of the eyelid.
We refer to that as brow ptosis.
Now, when you look at your photos, it is clear that the brows are relatively asymmetric.
This is something that is very much normal.
At 44 years old, I would suspect that your brows have not come down significantly and
I would also advise against a brow lift because I think with your brows elevated even with
a few millimeter, it may have a negative impact on your facial expression and you may look
eternally surprised.
So I think that looking at your photos and looking at how your eyes appear where the
upper eyelid margin is not low enough to be affecting the pupil, what appears you have
is something called dermatochalasis.
Dermatochalasis means extra skin over the eyelids.
And for that, the solution is blepharoplasty.
Blepharoplasty basically means to address extra skin, extra soft tissue, extra fat,
anything that is impinging on top of the upper eyelid.
Now there is an art of doing cosmetic blepharoplasty in that you want to look natural, you don’t
want too much extra skin removed.
If you do any kind of online research, one of the most common concerns is the unfortunate
event when someone has too much skin removed and they have difficulty closing their eyes.
As a cosmetic oculofacial plastic surgeon for 20 years, we have patients who come from
all over the world for revision surgery where it’s for drooping of the upper eyelid after
blepharoplasty as well as skin shortage of the upper eyelid after blepharoplasty.
So this something that cannot be overstated as being so important for your situation.
The idea is that blepharoplasty for the eyelid is not only taking as much skin as possible.
It is really about the art of the design as well as employing techniques that can allow
skin to fold in properly so that it will look attractive and will look natural and you won’t
look just as tired.
Now to address the question about insurance coverage, having practiced for 20 years, I
have watched how insurance companies have become very strategic in the way they present
themselves to patients and doctors.
And if you were to call your insurance company, I would believe likely, well yes, if you were
covered if your doctor shows it’s medically necessary.
This is where the whole medical industry became so abused.
And someone like yourself, even if few years ago, 15 or 20 years plus ago, if you had any
visual field defect, it would be something be covered.
That unfortunately led to a lot of abuse in the system and a lot of people who didn’t
have a functional issue, functional problem for eyelid surgery would get covered and so
now the pendulum swung to the other direction, now this is something extremely difficult.
This is one of the reasons why over 10 years ago, in my practice, we stopped all insurance
altogether.
We found there the deceptive practiced to be detrimental to our ability to deliver the
proper care to our patients.
The insurance companies would improve something and then later on, deny it and that’s kind
of what they do.
Looking at your photo, I doubt, I think it is unlikely that any medical director of any
insurance company would consider your upper eyelids heavy enough to be blocking your vision
to at least a significant enough degree.
Essentially, the general rule of thumb is, if someone can see your pupil, that means
you can see out.
And it really takes really low eyelid to the point of complete coverage before an insurance
company would consider that and I even had cases that even then, it got denied.
So it’s no secret my discussed with the insurance company.
So I think ultimately, you would save yourself the hassle by just accepting that this mostly
likely a truly cosmetic procedure.
Identify an expert in upper eyelid surgery.
Many doctors perform eyelid surgery in the hierarchy of specialties, one would argue
that a sub specialty is super specialty like oculoplastic or oculofacial plastic surgery
is a position uniquely qualified to perform this type of procedure so you may want to
start there but certainly you have many options and you can do your research and learn about
cosmetic surgeons and other doctors who also perform blepharoplasty.
So once you find a doctor who you are comfortable with, move forward.
I think looking at your eyes, there’s a lot of opportunity to have your eyes looking
better after it’s done.
So I hope that was helpful, I wish you the best of luck and thank you for your question!