Insurance will often pay for eyelid surgery that is performed to improve your vision. For instance if your upper eyelids are drooping and this is blocking your vision your insurance company may pay for upper eyelid surgery. If the upper eyelids are blocking vision insurance companies require a visual field test be obtained to demonstrate that the eyelids block the peripheral vision and that the vision is improved by elevating the eyelids. If your lower eyelids are droopy and this is causing eye irritation or watering of the eyes, your insurance company may pay for correction of this problem. Insurance companies typically require that the medical need be documented with photographs which are reviewed by the insurance company during the preauthorization process. Some problems like bags in the lower eyelids do not affect vision and are never paid for by insurance companies. Other problems like excess skin in the upper eyelids effect vision when severe enough and are paid for by insurance companies when photographs and visual fields document a medical need for the surgery. Eyelid & Facial Consultants is glad to act as your advocate to help get your insurance company to pay for medically necessary procedures. Many of the procedures we perform are done only to improve appearances and these cosmetic procedures are not paid for by your insurance company. One of the goals of a consult with the doctors at Eyelid & Facial Consultants is to determine what procedures you may benefit from and to inform you on cost associated with those procedures.

Yes. It is very common for patients to have surgery done to improve function at the same time that cosmetic surgery is done. The portion of the surgery that is done to improve eyelid function may be covered by your insurance company.

Yes. In nearly all cases of upper eyelid blepharoplasty surgery there is excess skin in the upper eyelids. Removal of this excess skin is only possible with an incision in the upper eyelid. Fortunately the skin of the upper eyelid is some of the thinnest skin in the body and typically heals with little or no scarring. Furthermore, the incision site can be hidden in the fold of the upper eyelid allowing the incision to be hidden while healing. We often use absorbing sutures that do not require removal.

The tendency is to leave as much fullness in the upper eyelids as possible. Removal of too much fat from the upper eyelids can give one a hollow appearance that is not desirable. Often the fat pad in the upper eyelid adjacent to the nose is bulging forward and is reduced in size at the time of upper eyelid blepharoplasty surgery. This is done conservatively to get rid of the bulge without causing a hollow appearance.

Yes. Please see the tab on this web site about cosmetic eyebrow lift surgery and forehead lift surgery.

Please see the tab on this web site about cosmetic eyebrow and forehead lift surgery.

The upper eyelids are central to form and to visual function. Removal of too much skin from the upper eyelids does not look natural and causes problems with lid closure. Drs. Worley and Hariri are experts in both ophthalmology and plastic surgery which is why they are acutely aware of the need for the lids to look normal as well as function normally after cosmetic eyelid surgery. The most serious complications of facial cosmetic surgery from both a cosmetic and a function standpoint occur during eyelid surgery. Many patients come to Eyelid & Facial Consultants for facial cosmetic surgery because of the training, expertise, and experience of Drs. Worley and Hariri in performing cosmetic eyelid surgery as well as facial plastic surgery.

Typically not. Most patients with bags in the lower eyelid have little or no extra skin in the lower eyelids. The bags are typically caused by extra fat or fat that is positioned abnormally. If skin is removed from the lower eyelid when there is no extra skin to be removed it will pull down the lower lid so that the whites of the eyes show between the lower lid and the colored part of the eye. This is called lower eyelid retraction. Lower eyelid retraction is actually a sign of aging and creating this problem with surgery makes one look older. Lower eyelid retraction from removing skin from the lower eyelids during blepharoplasty surgery is probably the most common complication of facial plastic surgery. Many celebrities who have been labeled as having a “bad face lift” actually had too much skin removed from the lower eyelids. Next time you see a celebrity who is labeled as having a “bad face lift” or not looking like themselves after face lift surgery look at the lower eyelids for the signs of lower eyelid retraction. Lower eyelid retraction can be avoided in most cases by not making an incision through the skin of the lower eyelid and by not removing skin from the lower eyelid.

Patients often have wrinkles or texture changes of skin of the lower eyelids. Texture changes cannot be improved with removal of skin from the lids without causing eyelid retraction. They can often be safely improved by performing a TCA chemical peel at the same time as the lower eyelid blepharoplasty surgery is performed.

The doctors at Eyelid & Facial Consultants remove skin from the lower eyelids in less than 5% of patients undergoing lower eyelid blepharoplasty surgery. It is done when there is so much excess skin in the lower eyelid that it cannot be tightened with a chemical peel.

This is a common situation. The lower lids become loose with age and in addition to removing the bags from the lower eyelid the lid can be horizontally tightened to reduce this droop of the lower eyelid.

The incision is made through the pink tissue on the back side of the lower eyelids. Using this incision site the surgeon can remove excess fat in the lower eyelids or reposition the lower eyelid fat into the dark circle in the lower eyelid. This incision is hidden behind the lower eyelid and is not visible when healing.

It is often more complicated than that. Well done cosmetic eyelid surgery needs to correct all of the problems that have occurred with facial aging to make the lid look more youthful. Some patients only have extra fat in the lower eyelids. This is typically not an aging change as it is first noted as early as high school. This tendency to develop eyelid bags at a young age tends to run in families. In these patients fat removal alone can often correct the entire problem. However, most patients develop bags in the lower eyelids as a result of facial aging. In this situation the changes that need to be addressed are more complicated than simply removing fat from the lower eyelids. Simply removing fat from the lower eyelids of an aging face can cause a hollow appearance and hollow lower eyelids make one look older, not younger.

A number of changes may occur in the lower eyelid that causes bags and dark circles. A young normal lower eyelid is full, short, and has no dark circle under it. With aging of the face the fat from the cheek and the lower eyelid separate. This occurs because the cheek descends or droops with aging which makes the lower eyelid look longer and allows the eyelid fat to moves forward. This creates an empty space between the fat of the lower eyelids and the fat of the cheek just at the edge of the bone along the lower eyelid. The situation can be described as two mountains separated by a valley. The first mountain is the bulging lower eyelid fat. The second mountain is the drooping cheek fat. The valley lies between. We are normally in overhead lighting so that the bulging fat of the lower eyelid creates a shadow in the valley making it appear like a dark circle at the intersection of the cheek and lower eyelid. This can be tested by illuminating the lower eyelid with a flashlight while observing in a mirror. If the flashlight is pointed directly at the lower lid the dark circle nearly disappears in most Caucasian patients because the lower lid is no longer casting a shadow. In some patients of color there is a real deposition of pigment in this area that will still be observed when doing the flashlight test.

The operation needs to be customized to the patient. In most patients the result is best if the drooping lower eyelid fat is transposed as opposed to removed. In some patients the result is even better if the drooping cheek or midface is also lifted.

Fat transposition involves moving fat from the eyelid into the valley between the cheek and the eyelid. In other words, the fat from the lower eyelid is moved down to fill in the dark circle.

This varies from patient to patient, but it may be made either in the upper eyelid, the lower eyelid, or behind the temporal hair line. You should discuss this with the doctor.

Recovery varies on the exact procedure performed and the individual patients. Generally, eyelid surgery results in bruising and swelling of the eyelids. We ask that patients plan on being at home on the day of surgery and two additional days. During these first days ice is applied to the eyelids to reduce bruising and swelling. After the third day most patients can drive a car and get about without much difficulty. We ask that patients avoid heavy lifting and strenuous exercise for two weeks after the procedure. Most patients will wear sunglasses for 2-3 weeks to hide bruising and swelling. Eyelid & Facial Consultants will provide you with detailed written instructions prior to your procedure.

Asian patients have slightly different anatomy than occidental patients. Some Asian patients are born with a fold in the upper eyelid and others are not. When the fold is present, it is called a double eyelid. The fold in the upper eyelid of Asian patients is much nearer to the eyelashes than it is in the occidental eyelid. It is often said that Asian patients wish to have their eyelids westernized. In our experience, Asian patients seeking double lid surgery want their eyelids to look like those Asian patients that are born with a fold in the eyelid and do not wish to have their eyelids look like occidental or western eyelids. This form of cosmetic eyelid surgery is performed at Eyelid & Facial Consultants. If you are considering this type of surgery it is very useful to bring a photograph of a model with eyelids with the appearance you hope to achieve.

Yes. All medical procedures have some risk. You should discuss the risk of complications with your doctor prior to surgery so you can make an informed decision on how to proceed. Many patients select Eyelid & Facial Consultants for their surgery because they believe that the risk of complication with cosmetic eyelid surgery may be less when the procedure is performed by a surgeon with special training in plastic surgery of the eyelids who is experienced in performing these procedures.