Every day, I evaluate and treat patients with droopy eyelids (ptosis) and excess skin (dermatochalasis). A droopy eyelid (ptosis) is surgically corrected with a ptosis repair, while excess skin (dermatochalasis) is corrected with a blepharoplasty (commonly referred to as an eyelid lift). Although a patient may have both droopy eyelids (ptosis) and excess skin (dermatochalasis), they can have just ptosis or excess upper eyelid skin.
Upper eyelid ptosis repair is almost always covered by insurance, as it can block a patient’s peripheral vision and can interfere with daily activities. If it is severe enough, a ptotic, droopy eyelid will block some of the colored part of the upper eye (iris) or even the pupil (dark circle in the middle of the eye). In order to ensure that the surgery is considered medically necessary, we provide them with clinical photos documenting the droopy eyelid, visual field results documenting peripheral vision deficit, and my exam notes. Ptosis surgeries are done under intravenous sedation and are a same-day-surgery (meaning you go home the same day you have surgery). Ptosis repairs truly lift the eyelid and can involve one or both upper eyelids.
An upper eyelid blepharoplasty can be done for medical and/or cosmetic reasons. In order for an upper eyelid blepharoplasty to be considered medically necessary, the skin has to cause a pseudoptosis (“fake” droopy eyelid). All the criteria that is needed for a ptosis repair, needs to be met for an upper eyelid blepharoplasty to be covered by your insurance. A patient must have: 1. complaints about their eyelids, 2. peripheral vision deficit on visual field testing and 3. photos that document pseudoptosis. Pseudoptosis or “fake” droopy eyelid means that if the excess skin is gently lifted to expose the actual eyelid, the eyelid is in the correct position/height; the excess skin either hangs over the lashes or weighs down the eyelid and touches the eyelashes. If the purpose of the surgery is to improve the aesthetic appearance of the upper eyelid area, then it is considered a cosmetic upper eyelid blepharoplasty and will not be covered by insurance. An upper eyelid blepharoplasty does not truly lift the eyelid, but instead removes excess skin so that more of the eyelid is seen. As mentioned, this can be done to improve appearance (cosmetic), improve symptoms of heavy upper eyelids, and improve peripheral vision. Upper eyelid blepharoplasties are almost always done on both upper eyelids.
The term “eyelid lift” is most commonly used to describe an upper eyelid blepharoplasty, even though it is more appropriate to use when describing an upper eyelid ptosis repair. It is important to realize that not every eyelid surgery is the same and there are several differing techniques used for both ptosis repairs and blepharoplasties. Often, patients can have droopy eyelids (ptosis) and excess upper eyelid skin (pseudoptosis) which would both benefit from repair. If a patient has ptosis and only has a blepharoplasty, their eyelid will continue to be droopy. Conversely, if a patient has ptosis and also has significant excess skin on his or her upper eyelids they will still have droopy eyelids if only a ptosis repair is performed because of the excess skin; this patient would still have pseudoptosis until a blepharoplasty was performed. It is important for the patient and the surgeon to know the difference between a droopy eye (ptosis) and a “fake” droopy eyelid caused by excess upper eyelid skin.