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My Eyelids Look Tired. Will Insurance Pay for My Eyelid Surgery?

Medical insurance will sometimes pay for upper eyelid blepharoplasty, but only in patients who have so much excess eyelid skin that it is blocking a significant portion of their vision. In these instances, the surgery is termed functional blepharoplasty and the goal of the surgery is to improve vision. While the appearance of the eyelids often does improve after a functional procedure, this is not the main goal of the surgery. Several steps of a cosmetic procedure, which improve the appearance of the eyelids, such as removal of excess eyelid fat or formation of an eyelid crease, are not typically performed. Insurance never pays for lower eyelid blepharoplasty. Insurance does typically pay for ptosis surgery and there are in office assessments that need to be performed by Dr. Braunstein to determine if you qualify. Please call 973-998-8701 for an appointment.

Why Pursue Eyelid Surgery Over Other Types of Cosmetic Surgery?

When we look at a person’s face, the largest part of our attention is subconsciously focused on the eyes. As a person ages, excess skin and fat accumulate around the eyes and result in a “tired” appearance, often many years before significant signs of aging are visible on the rest of the face. Rejuvenation of the eyelids not only makes a person look younger, but more awake and energetic.

Do I Need a Referral From My Insurance Company to See Dr. Braunstein?

It depends. If there is a medical reason why you think you need surgery, you may obtain a referral from the ophthalmologist who does your regular eye exams, a dermatologist or from your primary care physician. If your main interest is in improving your appearance, you are encouraged to come in for a cosmetic consult for a flat out-of-pocket fee of $150. If you decide to have surgery, the cost of the consultation will be subtracted from your cost of your procedure.

What is an Oculofacial Plastic Surgeon?

There are essentially three different types of plastic surgeons, each of which undergo surgical training with emphasis on different parts of the body. After finishing college, all plastic surgeons complete four years of medical school, followed by an additional year of internship. An ophthalmic plastic surgeon (also known as an oculoplastic surgeon or eye plastic surgeon) completes a three year residency in ophthalmology (eye surgery) and then pursues an additional two years of specialized training in ophthalmic plastic surgery. Most ophthalmic plastic surgeons spend the majority of their time performing eyelid surgery.

A general plastic surgeon receives training in general surgery, with an emphasis on gastrointestinal and abdominal surgery, before pursuing specialized training in plastic surgery. Because of the emphasis of their training, most general plastic surgeons choose to concentrate on surgery of the trunk, including liposuction and breast surgery. A facial plastic surgeon completes a residency in ear, nose and throat surgery prior to training in plastic surgery. Most facial plastic surgeons focus their practice on facelifts and rhinoplasty (nose surgery).

What Types of Surgeons Perform Cosmetic Eyelid Surgery?

Most plastic surgeons and some other physicians (including non-surgeons!) perform cosmetic eyelid surgery. However, ophthalmic plastic surgeons receive the most comprehensive training in eyelid surgery and are uniquely qualified to perform cosmetic eyelid procedures.

Eyelids play an essential role in eye health by spreading the tear film across the surface of the eye. Without properly functioning eyelids, the cornea of the eye becomes dry, leading to severe eye pain, vision loss, and infection. While surgery related complications are not common, they do sometimes occur. Ophthalmic plastic surgeons are also fully trained eye doctors and most qualified to manage postoperative problems.

In addition to cosmetic surgery, ophthalmic plastic surgeons perform large numbers of reconstructive eyelid surgeries in patients with eyelid skin cancers or eyelid malpositions. Dr. Braunstein performs hundreds of eyelid surgeries each year, making him uniquely qualified to perform cosmetic eyelid surgery.

What if I Have Already Had Cosmetic Surgery and am Unhappy with the Results?

There are a variety of reasons why patients may be unhappy with the results of cosmetic surgery. Dr. Braunstein performs a large number of eyelid surgeries each year and is uniquely qualified to treat patients who are unhappy with prior surgery.

How Are Dark Circles Under the Eyes Treated?

Dark circles under the eyes can represent a number of different problems, each of which is treated differently. The space behind the eye, known as the orbit, contains a significant amount of fatty tissue. Orbital fat probably evolved to help cushion the eye from impact. However, as we get older, the support structures, which keep the fat behind the eye, weaken, and the fat moves forward into the eyelids. This results in fullness to the lower eyelids that most people find aesthetically unpleasing. This fullness commonly referred to as “puffy eyes” or “baggy eyes”, makes people look older and tired. The best treatment for this type of problem is usually the removal of excess fat with a lower lid blepharoplasty procedure. Excess skin can be trimmed and tightened at the same time.

Some people have a minimal amount of extra fat but have significant depression or hollowness in their lower eyelids. If you have this problem, you can usually feel the underlying bone when you touch the area with your finger. Patients who have had an overly aggressive lower lid blepharoplasty in the past may have a similar problem. The modern way to treat this hollowness is with injectable fillers such as Restylane or Juvederm. These treatments are less invasive than traditional surgery but need to be repeated 2-3 times a year to maintain the full effect of treatment. Some surgeons advocate grafting or repositioning of fat to reduce hollows under the eyes. In some patients, a lid tightening procedure known as canthoplasty can make a big improvement in the appearance of lower eyelid contours.

Does Dr. Braunstein Perform Non-Cosmetic Surgical Procedures?

Yes. Dr. Braunstein has a large functional (non-cosmetic) surgery practice. She performs a wide range of procedures on the eyelids, orbit (the space behind the eyes), and the lacrimal (tear drainage) system. A partial list of procedures is located under the reconstructive surgical procedure page.

How Are Skin Cancers Around the Eye Treated?

Periocular skin cancers are treated using a team approach with expert dermatologists. Tumors are excised by dermatologists trained in Mohs micrographic surgery. Tissue is removed and checked under the microscope until the surgical margins are tumor free. After the excision of the tumor is complete, patients report to the operating room to have reconstruction of their eyelids by Dr. Braunstein. The excision of the tumor and reconstructive surgery are performed on the same day, limiting the number of trips for the patient and their family. Skin cancers such as basal cell carcinoma and squamous cell carcinoma are usually treated in this manner, other types of skin cancers may be treated in this manner as well. Patients with aggressive cancers such as malignant melanoma, Merkel cell tumors or sebaceous cell carcinoma may benefit from sentinel node mapping, a procedure to see if the cancer has spread to lymph nodes. This procedure is performed by a head and neck surgeon at Morristown Medical Center.

What Will My Surgical Experience Be Like?

Most procedures are performed on an outpatient basis while patients are awake. Local anesthesia, similar to the Novacaine used in dental procedures, is used for local pain control and a certified anesthesiologist provides intravenous sedation to make sure you are relaxed and comfortable throughout the surgery. This type of anesthesia is known as monitored anesthesia care and provides many of the benefits of general anesthesia with much less risk. Most patients are able to leave the hospital or surgery center for less than one hour after surgery.

What Can I Do Before Surgery to Reduce My Chances of Bruising?

Detailed instructions are provided. The most important factor prior to surgery is to discontinue the use of all blood-thinning medications with the permission of your primary care physician. Typically, aspirin, Plavix, and non-steroidal medications such as ibuprofen, Motrin, Alleve, Naprosyn, and Celebrex are stopped for two weeks prior to surgery. Vitamin C, vitamin E, multivitamins, and all herbal medications should also be stopped two weeks prior to surgery. Patients on coumadin typically stop this medication five days prior to surgery. Again, you need permission from your primary care physician before making any changes to your daily medication regimen. All medicines can usually be resumed 1-3 days after surgery. If you are having a procedure with intravenous sedation, your primary care physician will need to complete a history and physical prior to surgery. Many of my patients also elect to take Arnika Forte tablets before and after surgery to minimize bruising. This supplement has varied results in the cosmetic scientific literature but very limited downside and anecdotally my patients feel it helps to minimize their downtime.

What is the Usual Recovery Time After Surgery and How Long Do I Need to Take Off From Work?

The recovery after surgery varies considerably from patient to patient and is difficult to predict before surgery. There is often a considerable amount of swelling which peaks at 1-2 days after the procedure and gets better each day afterward. Some patients may get “black and blue” bruises in their eyelids and cheeks from the breakage of small blood vessels. Most people feel comfortable returning to work 7-10 days after surgery, but some people go back to work as early as the day after surgery, especially if they are able to work from home. There is often a small amount of residual swelling, which persists for 2-3 weeks after surgery.

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