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02.06.2016
Functional upper blepharoplasty surgery refers to an eyelid reshaping procedure to help improve poor vision due primarily to excess upper eyelid skin. Many patients seeking blepharoplasty surgery inquire whether or not their health insurance can be used to provide coverage to reshape their upper eyelids. The following photos demonstrate more graphically what an upper eyelid lift can do for people who have impaired peripheral vision from excess upper eyelid skin. Other patients suffer from a condition called upper eyelid ptosis (pronounced toe-sis) that can also contribute to impaired vision. As shown in the adjacent photo diagram (A), the lid margin (red arrow) is typically positioned 1-2 mm into the iris.
The typical patient who presents for an upper eyelid lift to improve their vision has a moderate to severe amount of excess upper eyelid skin. The adjacent patient photo is a good example of upper eyelid skin redundancy that is contributing to blocked vision.
A blepharoplasty procedure to help improve the visual field is done in a similar fashion as is done for cosmetic enhancement of the upper eyelid. Ptosis repair can also be performed through an upper eyelid incision and can be done at the same time as removal of the excess upper eyelid skin. Many patients who are considering upper eyelid surgery to improve their vision often ask whether or not they are going to look better from a cosmetic standpoint. The following photo examples demonstrate the type of improvement that can potentially result from an upper eyelid lift to address problems with peripheral vision.
If you are considering an upper eyelid lift to help with impaired vision, contact our San Diego plastic surgery office today. Ask An Expert > Parham Ganchi Message Board > I had upper and lower eyelid surgery one week ago. I would definitely suggest speaking with your surgeon at your follow up about your concerns but evaluating any results at one week after surgery is too soon.
The doctor eased my anxiety a little but I would have liked him to explain what can cause saggy eyelids after surgery. Information and services provided through Make Me Heal and this Site are intended for educational and informational purposes and are not a substitute for the advice of your physician or other medical professional. Before asking a question, we recommend you to browse through our existing collection of questions and answers to ensure that the question you want to ask have not already been answered by our highly experienced experts. Of course, this service is not a substitute for a doctor visit or a consultation with a plastic surgeon or cosmetic dermatologist. The answer is that some insurance companies will, indeed, pay to have an upper eyelid lift to help improve your vision. The top photo shows the effect of having excess, weighted skin hanging down along the upper eyelid. Another way to measure the upper eyelid position is by what is called the marginal reflex distance, or MRD. In most facial plastic surgery practices, it is more commonly due to an abnormality with a small muscle within the upper eyelid (called the levator muscle) and a connective tissue attached to the muscle (called the levator aponeurosis). As you can see by the arrows, this male blepharoplasty patient from San Diego has an excess amount of skin overlying his upper eyelids on both sides. Ptosis repair requires going deeper into the upper eyelid soft tissue to expose the levator muscle and aponeurosis.
Fortunately, one of the byproducts of having functional upper eyelid surgery is that there is likely going to be a passive cosmetic enhancement to the eyes.


These upper eyelid blepharoplasty photos represent actual patients of The Hilinski Clinic of Facial Plastic Surgery in San Diego, CA. There are many reasons for upper eyelid sagginess at this point including most importantly swelling. You have the normal concerns following this operation, but only a week is WAY to early to be so worried.
Our network of board certified physicians can answer any questions that you may have regarding plastic surgery, skin care, dermatology and other conditions.
The answer you will find here only serve as initial directions of thoughts and not as specific instructions.
In essentially all of these cases, there has to be specific medical documentation that confirms your upper eyelids as the source of the visual problem before it is medially indicated to undergo an upper blepharoplasty. As you can appreciate, the black shadowing corresponds to how much of the peripheral vision can be blocked in some patients because of the draping effect.
This measurement is taken between the light reflex seen just to the sides of the pupil and the upper eyelid margin. Therefore, the corrective procedure to fix ptosis of the upper eyelid includes some type of surgery involving the levator muscle and aponeurosis.
Either way, this is done on an outpatient basis where the patient can go home shortly after the eyelid lift has been completed. Some upper eyelid lift patients notice a mild to moderate amount of swelling during the first 72 hours of healing, but appear fairly presentable in public by day 7-10. Since the procedure is done in a very similar manner to esthetic upper eyelid blepharoplasty, there is often times a significant cosmetic improvement that is seen. Hilinski currently accepts a variety of PPO health insurance plans for medically indicated upper eyelid surgery. I would wait at least a month, sometimes even longer, before making your final judgement as things will definitely change with time. Allow 3 weeks healing time than if you are still unhappy THAN discuss with your chosen surgeon.
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You should remember that it is utterly important to consult a skilled specialist prior to scheduling any type of treatment in order to get acquainted with possible contraindications.
The bottom photo  demonstrates the type of improvement that is desired after undergoing an upper eyelid lift to remove the excess, heavy skin. Normally, the MRD is approximately 4 mm with decreasing numbers representing more ptosis of the upper eyelid.
This is usually in the form of a tightening procedure that is performed often times through the natural upper eyelid crease.
In medical terms this is referred to as dermatochalasis or dermatochalasia, which refers to excessive amount of eyelid skin. The upper eyelid is lifted by making an incision based on the natural eyelid crease so that the final scar is least visible as possible. This is accomplished by strategically placing very fine sutures into the levator aponeurosis. This includes, but is not limited to, Blue Cross, Blue Shield, United Healthcare, Aetna Healthcare and Tricare insurance plans.


This frequently asked questions section is opened to everyone and you need to set up an account with Makemeheal before you can ask your own question. Only a one-on-one meeting will enable your cosmetic surgeon to properly evaluate your condition, conduct examinations and explain their results. This is normally measured in relative terms based on the anatomical relationship to the pupil and iris.
On the right side (B) of the photo diagram, the upper eyelid has been modified digitally to show what a ptotic upper eyelid would look like in comparison. In cases where dermatochalasia is present, both procedures can be done during one operation – removal of the excess upper eyelid skin combined with ptosis repair surgery. This type of redundant upper eyelid skin can result or be aggravated from a variety of factors, which include sun exposure, allergies, constant rubbing, and congenital predisposition to sagging skin. As you can see, there is such an excess of upper eyelid skin in this patient that the natural crease has been nearly completely obscured.
The excess upper eyelid skin is then removed while leaving behind a sufficient amount to allow proper closure of the eye. In doing so, the upper eyelid is lifted to a more appropriate level thereby improving the opening of the eye.
This service is absolutely free and is available to those who are interested in learning more about a particular cosmetic procedure, treatment or product.
Basically, the visual field testing involves the patient looking into a box with one eye covered. The pupil is the round black circle in the middle of the eye and the iris is the colored circle surrounding this (which characterizes the color of your eye). As you can see, the eyelid margin has now fallen well into the colored portion of the eye and is even quite close to being into the pupil. If you will also notice, this patient’s eyelashes are also covered by the excess skin folds hanging down over the upper eyelid. By removing the excessive amount of skin that is bunched up along the eyelid, the shading effect can be reversed and the peripheral vision can be greatly improved. A series of brief light flashes are presented to the patient in the distribution of the normal visual field. With this type of situation, it is not surprising that this patient has trouble with his peripheral vision due to the skin folds hanging over the upper eyelid.
And in cases where dermatochalasia also exists, ptosis can significantly worsen the problem.
If the patient fails to press the button when the flash of light is presented it is assumed they did not see it in their visual field.
The patient’s excess upper eyelid skin is then taped upward to simulate what an upper eyelid lift might accomplish. If there is a significant improvement noted in the number of light flashes seen with the eyelid taped up, the test is considered positive – confirming the potential benefit of undergoing a functional upper eyelid lift, or functional blepharoplasty.



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