When is Blepharoplasty Medically Necessary?

When is blepharoplasty considered to be medically necessary? The skin on my upper eyelids hangs down over my eyelashes. It tends to push my eyelashes into my eyes and makes it hard for me to use my computer without tilting my head back. My eyes also get tired and my vision blurs towards the end of the day. I would like to get this fixed, but I am not sure if insurance typically covers this sort of thing.  When I talk to my insurance company about this, is there anything in particular that I should mention?

Doctor Answers 29

Blepharoplasty and Insurance

Thank you for your question. In order to obtain insurance coverage for an upper blepharoplasty there are several items that are submitted to insurance to document medical necessity. Most importantly, there are Visual Field Tests that have to be done by an ophthalmologist, not by a plastic surgeon. If you have an ophthalmologist, they can arrange for you to have it done and then you can see if you are insurable. Insurance companies typically do not cover the lower eyelid blepharoplasty. Fortunately, the costs of eyelid procedures are among the lowest of all facial cosmetic surgeries and the results are great! Best to you!

Sounds like you are the perfect candidate for upper blepharoplasty

Your description of your eyelids covering your eyes and blocking your vision is the typical case that gets covered by insurance. It will be necessary to prove your vision loss with in office testing (visual fields). See an oculoplastic surgeon who can evaluate your eyelids, do the testing and tailor a treatment plan individualized for your particular issues. 


Blepharoplasty is designed to correct upper and lower eyelid aging.  Visual field testing can determine if this procedure is medically necessary.  

John Burns, MD
Dallas Plastic Surgeon
4.5 out of 5 stars 19 reviews

Insurance coverage

Unless it's for health reasons, insurance doesn't usually cover eyelid surgery since it's considered cosmetic. However, for your situation, you may be able to get it covered because your vision is impaired.

Insurance coverage for eyelud surgery

Upper eyelid surgery may get considered medically necessary if it interferes with your vision.  This can be determined by having a test called a visual field exam, which most insurance companies will require to document the visual problem.  To be sure, contact your insurance company to determine what tier policy requires.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 17 reviews

When is blepharoplasty medically necessary.

Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. Some insurance plans have exclusion criteria for certain procedures. Also, it is an obligation of the surgeon not to attempt to authorize purely cosmetic procedures through insurance.  Lower eyelids are generally not covered for this reason.  Upper eyelids need a detailed description of your complaints, examination, testing, and photographs. 

Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 14 reviews

Blepharoplasty & Insurance Coverage

The majority of blepharoplasties are viewed as cosmetic by insurance carriers. Rarely, insurance companies will cover the expense of an isolated upper eyelid blepharoplasty. Under these circumstances the insurance company will declare that the procedure is medically necessary.

                  Before this can occur, the insurance carrier requires that certain criteria be met. These include medical documentation of symptoms and physical findings associated with visual field obstruction. In addition, they require formal visual field studies performed be an Ophthalmologist or Optometrist. These studies must confirm the presence of significant visual field obstruction.

                  Once these studies are complete, a prior authorization letter is sent to the third party payer. This should include the visual field studies and any other pertinent information. If the insurance company’s criteria are met, then occasionally they will cover the expense of blepharoplasty surgery.

Visual Field Impairment & Eyelid Surgery

Some patients seeking eyelid surgery actually have visual field impairment secondary to eyelid skin obstructing their vision. If actual visual disturbance is suspected, then it will be necessary to have the visual fields tested. The visual field is the area that one would expect a person with normal vision to see. If drooping eyelids actually obstruct the vision it is often in the upper outer portion of the normal field one commonly sees. In order to document this, it will be necessary to undergo an examination by an ophthalmologist or an optometrist to document the actual visual field impairment. Once this documentation is received by the plastic surgeon, a letter will be formulated and photographs taken. This preauthorization letter will include the recommendations for the procedure or procedures necessary to correct the visual field impairment. When properly documented, many insurance companies will pay for these procedures.

John J. Edney, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 90 reviews

Insurance Coverage for Upper Eyelid Surgery

Thank you for the question. Typically, this requires documentation of obstructed field of vision (generally by an ophthalmologist or optometrist). Even then, some insurers will make it difficult. Best of luck!

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 71 reviews


Upper Blepharoplasty may be medically necessary and in some cases covered by insurance if your vision is impaired due to excess upper eyelid skin. Insurance companies typically have you see an eye doctor first, who will put you through a series of tests to see if you qualify. Consult with your doctor to see if you are a potential candidate for an insurance related upper Blepharoplasty then consult with a board certified facial plastic surgeon who takes insurance claims.


James Chan, MD
Portland Facial Plastic Surgeon
5.0 out of 5 stars 49 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.