Is Ptosis Surgery Part of a Blepharoplasty or is It a Separate Procedure?

  Ptosis surgery is needed if the muscles of the upper eyelid are weak, whereas blepharoplasty refers to the need to remove extra skin and fat for medical or cosmetic reasons.  The two procedures are unquestionably distinct and not part of one another.  Nevertheless, the procedures may be performed at the same time BUT only by experienced oculo-facial plastic surgeons.  You would NEVER want any other specialist to do a ptosis repair although many specialties do perform blepharoplasties. 

Ptosis surgery is where the upper eyelid elevating muscle is tightened to lift the height of the lid (distance of lid margin where lashes are to the pupil). It truly opens the eyes. This can be a cosmetic or functional surgery depending on degree of lid droop. This is more complex than standard blepharoplasty surgery in which skin and fat are addressed (reduced). A poor outcome to ptosis surgery can be a lifelong problem so make sure to see an experienced ptosis surgeon for this. By and large these are oculoplastic surgeons only. Best,  Dr. Massry

These are two different things, that happen to be in the same area.

Blepharoplasty is the removal of the eyelid skin and/or fat.  It is typically a cosmetic procedure.

Ptosis repair is one of a variety of procedures to re-adjust the level of your eyelid, often by shortening and suturing the lid-opening structures.  It is typically a functional (insurance) procedure.

Good luck with your surgery.

As noted by the responding surgeons... Ptosis repair is usually considered medically necessary surgery and may be convered by insurance. Blepharoplasty surgery may be covered if severe restriction in visual fields is noted. Predetermination of benefits may help to answer your questions but does not guarantee that your procedures will be paid by the insurance company 

Blepharoptosis repair is considered distinctly separate from blepharoplasty. The former is primarily a muscle and tendon operation whereas the second is a skin and fat procedure

Ptosis describes a condition whereby the eyelid "window-shades" the pupil, which the functions as the light aperture for the eye. The causes can be congenital, or more commonly, age related.  The levator aponeurosis, which effectively lifts the eyelid can become stretched, attenuated, or undergo fatty degeneration over time.  This leads to a less optimal baseline eyelid position, obstructing the superior visual field.  Ptosis is commonly seen in conjunction with eyelid skin excess (dermatochalasis), which can also cause a visual field impairment.  Both procedures (Blepharoplasty and Levator Advancement) can be performed during the same procedure.

Ptosis or droopiness can be due to the brow position, heaviness of the eyelid tissues and/or "intrinsic" ptosis due to poor function of the eyelid lifting muscle itself.  Typically eyelid surgery does not involve correction of "intrinsic" ptosis as that is a more specialized procedure and not commonly needed.

It will be up to your surgeon to determine if your condition is primarily cosmetic (much more common)  or if you have a medical condition that is obstructing your vision.  If so, with proper documentation it may be covered by insurance but that should be clearly sorted out prior to surgery. 

Just to be clear, there is brow ptosis (sagging of the eyebrows) which can cause pseudodermatochalasis of the upper eyelids (dermatochalasis is excessive or sagging eyelid skin), and there is eyelid ptosis, which is droopy eyelid. The latter requires levator surgery to lift and tighten the eyelid to the proper position. The former requires forehead lift to move the brows out of the upper eye socket to the orbital rim (for a man), or just above the orbital rim (for a woman). Then there is true dermatochalasis of the upper eyelids, which is treated by blepharoplasty.

Each of these three operations is different, though blepharoplasty and levator surgery are both done through the same upper eyelid incisional approach. If severe enough to cause vision field blockage, surgical correction may be covered by insurance. Each state and each insurance company may have different requirements. Your doctor is aware of these differences, so be sure just what is planned, and exactly what is being covered by your insurance, as anything else will be considered "cosmetic" and payment your responsibility.

You are running into these issues because you are asking your potential surgeons to have your health insurance pay for the eyelid surgery.  Billing health insurance is encumbered by a lot of rules which may or may not make sense to you.  You look at your eyelid and only see it as a single problem.  That is not how surgeons and insurance companies think.  Ptosis surgery and blepharoplasty are distinct and are billed accordingly.  Also in an effort to control costs, some insurance companies have rules requiring these procedures to be bundled essentially meaning that one of the procedures will be paid if both procedures are performed at the same time.  The insurance payment for these procedures is very small so most surgeons are now unwilling to accept this type of insurance company discounting.  This has lead to a very inconvenient situation where some surgeons will only repair these closely related but distinct problems in separate surgeries.  An alternative would be to privately contract with your surgeon, pay for surgery out of pocket and then you are likely to find the surgeon more willing to perform both procedures at the same operative session.

Ptosis repair is a separate surgery from blepharoplasty but can typically be done at the same time as blepharoplasty. Ptosis surgery may be coverable by insurance.