Is Eyelid Surgery Covered By Insurance?

Eyelid surgery is a frequent procedure used to improve the appearance of the face. The technique removes extra skin and fat from the top eyelids, giving the eyes a more youthful appearance. Loose skin and tissue on the lower eyelids can also cause puffy bags under the eyes, which can be removed with eyelid surgery. Eyelid surgery is deemed elective when performed exclusively for cosmetic purposes, and hence is not covered by medical insurance.

Medical insurance may cover eyelid surgery if it is judged medically essential. Heavy skin that hangs over the lash line and obstructs vision is removed with functional eyelid surgery. Excess, hanging upper eyelid skin can obstruct eyesight, making it harder to do things like drive, read, or send text messages.

In order to assess coverage for eyelid surgery, most insurance companies require proof in the form of a vision test. A board-certified eye doctor, such as an oculoplastic surgeon, must perform the vision test. If the vision test reveals that the patient has a vision problem, the surgeon takes photographs of the problem and sends them to the patient’s insurance company. The patient’s unique coverage plan determines whether the insurance company covers all or part of the cost of eyelid surgery.

How do you qualify for eyelid surgery?

Insurance companies will only cover the surgery if it is classified for reconstructive or functional problems like ptosis (eyelid drooping due to muscle weakness or nerve damage), blepharochalasis (eyelid swelling), dermatochalasis (excess skin), herniated orbital fat (excess fat), floppy eyelid syndrome, and visual field obstruction, according to the American Society of Plastic Surgeons.

  • You must first schedule a consultation with your optometrist to establish your requirements. Make a note of the requirement for surgery. Any of the following concerns must be documented by your doctor to establish that blepharoplasty is medically necessary:
  • Orbicularis oculi hypertrophy (enlargement) (muscles that work the eyelids)
  • Request that a surgeon take images of the issue that requires treatment. Patients will be required to sign a release form if an insurance company requests to see the photos.
  • Get all of the pre-operative diagnostic tests that your doctors recommend. These may include the following:

Is droopy eyelid surgery covered by insurance?

Certain requirements must be met in order for insurance to reimburse the cost of upper eyelid surgery. The surgery must be deemed “medically necessary,” not just for the sake of appearance. Here are some things to think about when you decide whether or not insurance will cover your individual situation:

  • The surgery will be covered by insurance if the presence of excess eyelid skin (dermatochalasis) from the upper eyelid is considerably and unequivocally obstructing your eyesight.
  • You’ll also need to have a physician’s examination documented in order to get insurance coverage. A visual field test that shows considerably enhanced vision when the eyelid skin is temporarily taped out of the way may also be required.

If you need upper eyelid surgery to increase your field of vision, the Ministry of Health in Ontario will pay for it as long as an optometrist confirms a 50% loss in your visual field.

How much should I expect to pay for eyelid surgery?

What is the price of eyelid surgery? According to 2020 figures from the American Society of Plastic Surgeons, the average cost of cosmetic eyelid surgery is $4,120. This is only a portion of the entire cost; it excludes anesthesia, operating room facilities, and other related costs.

Does insurance pay for upper blepharoplasty?

Though the requirements are stringent, you may be eligible for insurance coverage for upper eyelid surgery if the eyelid is obstructing your vision severely. Blepharoplasty is no longer regarded cosmetic in cases of severe drooping or ptosis, but rather a medical necessity.

Who is not a good candidate for eyelid surgery?

A person with diabetes, eye disease, thyroid condition, high blood pressure, or a cardiovascular disorder, on the other hand, may not be a good candidate for blepharoplasty.

Patients should have realistic expectations for their surgery’s outcome. While eyelid surgery can improve the appearance of the eyes, it does not significantly alter the face’s overall appearance.

Are you awake during eyelid surgery?

In an office-based surgical suite, a hospital, or an outpatient surgery center, eyelid surgery is conducted. You will normally only be admitted to the hospital or operation center for one or two nights. The procedure itself normally takes one to three hours.

You will be given local or general anaesthetic to keep you comfortable during your surgery. The eyelid and surrounding area are numbed with local anesthetic, which keeps you asleep but conscious during surgery. You’ll be sleeping for the duration of the procedure thanks to general anaesthetic. You and your surgeon can discuss which sort of anesthesia you prefer.

Your surgeon will create incisions along the natural creases of your upper eyelids if your upper eyelids are being treated. Traditional scalpels or lasers are used to make these incisions. The incisions on the upper eyelids run from the upper inner corners to the “crow’s feet” area. The excess skin, muscle, and fat will subsequently be removed as needed by your surgeon. Small sutures (stitches) are used to close the incisions, which are removed or dissolve after about a week.

Your surgeon will create an incision along the lash line and natural smile creases of the lower lid if the lower eyelids are being treated. After that, any excess fat, muscle, or skin is removed before the incision is closed with fine sutures (stitches).

Excess fat can cause puffiness in the eyes, which can be treated with a procedure called transconjunctival blepharoplasty. An incision is made inside the lower eyelid and extra fat is removed during this treatment. Sutures are undetectable to the naked eye when used to close this type of incision. They also dissolve on their own and leave no apparent scar.

How long does it take for upper eyelid surgery to heal?

After eyelid surgery, most people return to their typical activities in 10-14 days, but you should plan on taking some time off to allow your eyelids to heal. Covering your key obligations ahead of time is a fantastic approach to speed up your recovery.

It’s critical to clear your schedule so you can focus on relaxing, whether you need to stock the pantry with easy-to-prepare items or ask a friend to drive your children to their activities.

How long is recovery from eyelid surgery?

For the first 1 to 3 weeks after surgery, your eyelid may be puffy and bruised. It’s possible that the appearance of your eye will improve for another 1 to 3 months. In about 10 to 14 days, most people feel ready to go out in public and return to work. This may be determined by your profession and how comfortable you are with others knowing about your surgery.

How can I fix my hooded eyes without surgery?

Botulinum toxin (commonly known as Botox) injections can help you raise your brow without surgery. Simply explained, Botox injections stop the brain from sending impulses that cause the muscles in your brows to droop. This can help to smooth the skin around your brow and may lift the arch of your eyes.