Will I Qualify for Insurance Coverage on a Blepharoplasty Procedure? (photo)

Question

I am 23 and I've had droopy eyelids for as long as I can remember and it just seems to be getting worse. It's mainly my right eye that droops the worst and sometimes I notice that my right eyebrow is lower than my left eyebrow. Judging from my picture.. do you think it's at all possible I will qualify for insurance coverage? Would I be better off just getting botox? Thank you!

Kenneth D. Steinsapir, MD · Answer

You do exhibit interference of the brow fold with the eyelid.  Your fold actually rests on the upper eyelid margin.  There was a time when this would be covered by insurance.  Now this is almost universally regarded as a cosmetic issue.  You are an excellent candidate for a very conservative upper blepharoplasty.  You can see examples of this type of work on my website.  The key is not removing all of the upper eyelid fold.  One only wants to remove enough of the fold to expose a uniform strip of the eyelid platform.  One should preserve essentially all of the upper eyelid fullness.  Less is more.  A microdroplet cosmetic botulinum toxin treatment also lifts the eyebrow and will reduce the heaviness of the upper eyelid fold but this only lasts a few months.  Yours is basically a surgical problem but too much upper eyelid surgery will rob you of your upper eyelid fold which is a very important aspect of your youthful appearance.

Jerome Edelstein, MD · Answer

Unless it's for health reasons, insurance doesn't usually cover eyelid surgery since it's considered cosmetic. However,you may be able to get it covered if your vision is impaired. This needs confirmation through a vision test.

Stephen Prendiville, MD · Answer

Insurance companies have placed upper eyelid surgery squarely in the automatic challenge list.  The pre-approval process has become so onerous for the Physician that it has become very hard to justify use of resources for this category of treatment. At age 23, you face a Herculean task in getting your procedure approved.  Botox is a wonderful option in chemically raising the brow, but requires ongoing maintenance.

Stephen Weber MD, FACS · Answer

It is possible that blepharoplasty might be a covered benefit. It depends upon your insurance carrier's criteria. To make that determination you will need to consult with a Facial Plastic Surgeon or Oculoplastic Surgeon and have visual field testing. Notes, photos and the test results will be reviewed by your insurance carrier to determine whether blepharoplasty would be covered or would be out of pocket. I hope this information is helpful.Stephen Weber MD, FACSLone Tree, Colorado

Mitesh Kapadia, MD, PhD · Answer

Hello. Based on your photo, it looks like there is some excess skin on your upper eyelids, but not enough where you would qualify for insurance coverage for surgery. That being said, if you dont like the appearance of your eyes, upper eyelid surgery is probably the best option for you. Botox may help lift the brow a little, but I suspect you would only notice a modest improvement. A conservative upper blepharoplasty would give you a "platform" to wear eye makeup and reduce the tired look caused by the excess skin.

Will I Qualify for Insurance Coverage on a Blepharoplasty Procedure? (photo)

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Will I Qualify for Insurance Coverage on a Blepharoplasty Procedure? (photo)

Answers (10)

Answer: Will I Qualify for Insurance Coverage on a Blepharoplasty Procedure?

Answer: Will I Qualify for Insurance Coverage on a Blepharoplasty Procedure?

Answer: Eyelid surgery vs botox

Answer: Eyelid surgery vs botox

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Our mission is to create a world where every investment in modern beauty is Worth It.