Frequently Asked Questions

Cosmetic Blepharoplasty and Cosmetic Eyelid Surgery

Insurance will often pay for eyelid surgery that is performed to improve your vision or comfort of your eyes. 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 to demonstrate that the eyelids block your 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 is documented with photographs. Some problems like bags in the lower eyelids do not affect vision and are never paid for by the insurance companies. Other problems like excess skin in the upper eyelids can affect vision when severe enough and are paid for by insurance companies when photographs and visual fields document a medical need for the surgery. Many of the procedures we perform are done only to improve appearance and these cosmetic procedures are not paid for by your insurance company. One of the goals of a consult with the doctor 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 the 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 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 skin. Fortunately, the skin of the upper eyelid is very thin and typically heals with little or no scarring. Furthermore, the incision site can be hidden in the crease of the upper eyelid allowing the incision to be hidden while healing. We often use absorbable 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 blepharoplasty surgery. This is done conservatively to get rid of the bulge without causing a hollow appearance.
Yes. This can be done through either an eyelid crease incision or via a forehead lift procedure.
Patients with droopy brows, in addition to droopy eyelids, benefit from having their brows addressed at the same setting as their eyelids. This achieves the best functional and cosmetic results.
Yes. 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. Dr. Leyngold is an expert in both ophthalmology and eyelid plastic surgery which is why he is acutely aware of the need for the lids to look normal as well as to function normally after eyelid surgery.
The incision is made on the inside of the lower eyelid avoiding a creation of an external scar. Most patients with bags in the lower eyelids have little or no extra skin in the lower eyelids. The bags are typically caused by extra fat or fat that is positioned abnormally. For most patients skin removal is not advocated. If skin is removed from the lower eyelid when there is no extra skin to be removed the lower lid will be lowered 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.
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 or following the lower blepharoplasty surgery.
Dr. Leyngold removes 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 and vertically tightened to reduce this droop of the lower eyelid.
The incision is made through the pink tissue on the back 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.
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. 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 move 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.
The operation needs to be customized to the patient. In many patients the result is best if some of the drooping lower eyelid fat is transposed in addition to being removed. In some patients the result is even better if the drooping cheek or mid-face 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.
Where is the incision made to lift a drooping cheek?
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. We will provide you with detailed written instructions prior to your procedure.
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 Dr.Leyngold for their surgery because they believe that the risk of complication with cosmetic and/or reconstructive eyelid surgery may be less when the procedure is performed by a surgeon with special training in ophthalmology and plastic surgery of the eyelids who is very experienced in performing eyelid surgery.

Please do not hesitate to discuss any questions or concerns you may have regarding eyelid surgery with Dr. Ilya Leyngold.