Blepharoplasty and Eyelid Surgery Questions

I am interested in improving the appearance of my eyelids. Will insurance pay for my surgery?

Medical insurance will sometimes pay for upper eyelid blepharoplasty, but only in patients who have so much excess eyelid skin that it is blocking a significant portion of their vision. In these instances, the surgery is termed functional blepharoplasty and the goal of the surgery is to improve vision. While the appearance of the eyelids often does improve after a functional procedure, this is not the main goal of the surgery. Several steps of a cosmetic procedure which improve the appearance of the eyelids, such as removal of excess eyelid fat or formation of an eyelid crease, are not typically performed. Insurance never pays for lower eyelid blepharoplasty.

Why pursue eyelid surgery over other types of cosmetic surgery?

When we look at a person's face, the largest part of our attention is subconsciously focused on the eyes. As a person ages, excess skin and fat accumulate around the eyes and result in a "tired" appearance, often many years before significant signs of aging are visible on the rest of the face. Rejuvenation of the eyelids not only makes a person look younger, but more awake and energetic. See the before and after eyelid surgery photos on this website for examples. 

Do I need a referral from my insurance company to see Dr. Kapadia?

It depends. If there is a medical reason why you think you need surgery, you may obtain a referral from the ophthalmologist who does your regular eye exams, a dermatologist or from your primary care physician. If your main interest is in improving your appearance, you are encouraged to come in for a cosmetic consult for a flat out-of-pocket fee of $100. If you decide to have surgery, the cost of the consultation will be subtracted from your cost of your procedure.

What is an ophthalmic plastic surgeon?

There are essentially three different types of plastic surgeons, each of which undergo surgical training with emphasis on different parts of the body. After finishing college, all plastic surgeons complete four years of medical school, followed by an additional year of internship. An ophthalmic plastic surgeon (also known as an oculoplastic surgeon or eye plastic surgeon) completes a three year residency in ophthalmology (eye surgery) and then pursues an additional one to two years of specialized training in plastic surgery. Most ophthalmic plastic surgeons spend the majority of their time performing eyelid surgery.

A general plastic surgeon receives training in general surgery, with an emphasis on gastrointestinal and abdominal surgery, before pursuing specialized training in plastic surgery. Because of the emphasis of their training, most general plastic surgeons choose to concentrate on surgery of the trunk, including liposuction and breast surgery. A facial plastic surgeon completes a residency in ear, nose and throat surgery prior to training in plastic surgery. Most facial plastic surgeons focus their practice on facelifts and rhinoplasty (nose surgery).

More information about oculoplastic surgery is available at the visionchannel website, wikipedia and at eyemdlink.com.

What types of surgeons perform cosmetic eyelid surgery?

Most plastic surgeons and some other physicians (including non-surgeons!) perform cosmetic eyelid surgery. However, ophthalmic plastic surgeons receive the most comprehensive training in eyelid surgery and are uniquely qualified to perform cosmetic eyelid procedures. 

Eyelids play an essential role in eye health by spreading the tear film across the surface of the eye. Without properly functioning eyelids, the cornea of the eye becomes dry, leading to severe eye pain, vision loss and infection. While surgery related complications are not common, they do sometimes occur. Ophthalmic plastic surgeons are also fully trained eye doctors and most qualified to manage postoperative problems.

In addition to cosmetic surgery, ophthalmic plastic surgeons perform large numbers of reconstructive eyelid surgeries in patients with eyelid skin cancers or eyelid malpositions. Dr. Kapadia performs hundreds of eyelid surgeries each year, making him uniquely qualified to perform cosmetic eyelid surgery.

What if I have already had cosmetic surgery and am unhappy with the results?

There are a variety of reasons why patients may be unhappy with the results of cosmetic surgery. Dr. Kapadia performs a large number of eyelid surgeries each year and is uniquely qualified to treat patients who are unhappy with prior surgery. 

How are dark circles under the eyes treated?

Dark circles under the eyes can represent a number of different problems, each of which is treated differently. The space behind the eye, known as the orbit, contains a significant amount of fatty tissue. Orbital fat probably evolved to help cushion the eye from impact. However, as we get older, the support structures which keep the fat behind the eye weaken, and the fat moves forward into the eyelids. This results in a fullness to the lower eyelids which most people find aesthetically unpleasing. This fullness, commonly referred to as "puffy eyes" or "baggy eyes", makes people look older and tired. The best treatment for this type of problem is usually removal of excess fat with a lower lid blepharoplasty procedure. Excess skin can be trimmed and tightened at the same time.

Some people have a minimal amount of extra fat, but have a significant depression or hollowness in their lower eyelids. If you have this problem, you can usually feel the underlying bone when you touch the area with your finger. Patients who have had an overly aggressive lower lid blepharoplasty in the past may have a similar problem. The modern way to treat this hollowness is with injectable fillers such as Restylane or Juvederm. These treatments are less invasive than traditional surgery but need to be repeated 2-3 times a year to maintain the full effect of treatment. Some surgeons advocate grafting or repositioning of fat to reduce hollows under the eyes, but I find that this treatment is much less reliable than injection of fillers. In some patients, a lid tightening procedure known as canthoplasty can make a big improvement in the appearance lower eyelid contours.

Does Dr. Kapadia perform non-cosmetic surgical procedures?

Yes. Dr. Kapadia has a large functional (non-cosmetic) surgery practice. He performs a wide range of procedures on the eyelids, orbit (the space behind the eyes) and lacrimal (tear drainage) system. A partial list of procedures is located here.

How are skin cancers around the eye treated?

Periocular skin cancers are treated using a team approach with expert dermatologists at Tufts-New England Medical Center. Tumors are excised by dermatologists trained in Mohs micrographic surgery. Tissue is removed and checked under the microscope until the surgical margins are tumor free. After the excision of the tumor is complete, patients report to the operating room to have reconstruction of their eyelids by Dr. Kapadia. The excision of the tumor and reconstructive surgery are performed on the same day, limiting the number of trips for the patient and their family. Skin cancers such as basal cell carcinoma and squamous cell carcinoma are usually treated in this manner, other types of skin cancers may be treated in this manner as well. Patients with aggressive cancers such as malignant melanoma, Merkel cell tumors or sebaceous cell carcinoma may benefit from sentinel node mapping, a procedure to see if the cancer has spread to lymph nodes. This procedure is performed by a head and neck surgeon at Tufts-New England Medical Center.

What will my surgical experience be like? Do I have to stay overnight in a hospital?

Most procedures are performed on an outpatient basis while patients are awake. Local anesthesia, similar to the Novacaine used in dental procedures, is used for local pain control and a certified anesthesiologist provides intravenous sedation to make sure you are relaxed and comfortable throughout the surgery. This type of anesthesia is known as monitored anesthesia care and provides many of the benefits of general anesthesia with much less risk. Most patients are able to leave the hospital or surgery center less than one hour after surgery.

What can I do before surgery to reduce my chances of bruising?

Detailed instructions are provided. The most important factor prior to surgery is to discontinue the use of all blood-thinning medications with permission of your primary care physician. Typically, aspirin, plavix and non-steroidal medications such as ibuprofen, Motrin, Alleve, naprosyn and Celebrex are stopped for two weeks prior to surgery. Vitamin C, vitamin E, multivitamins and all herbal medications should also be stopped two weeks prior to surgery. Patients on coumadin typically stop this medication five days prior to surgery. Again, you need permission from your primary care physician before making any changes to your daily medication regimen. All medicines can usually be resumed 1-3 days after surgery. If you are having a procedure with intravenous sedation, your primary care physician will need to complete a history and physical prior to surgery. 

What is the usual recovery time after surgery and how long do I need to take off from work?

The recovery after surgery varies considerably from patient to patient and is difficult to predict before surgery. There is often a considerable amount of swelling which peaks at 1-2 days after the procedure and gets better each day afterward. Some patients may get "black and blue" bruises in their eyelids and cheeks from the breakage of small blood vessels. Most people feel comfortable returning to work 7-10 days after surgery, but some people go back to work as early as the day after surgery, especially if they are able to work from home. There is often a small amount of residual swelling which persists for 2-3 weeks after surgery. Asian patients tend to have a slightly longer recovery time. Coverup type makeup can be worn the day after surgery. Dark makeup such as eyeliner or mascara should not be worn for at least 2 weeks after surgery.

How can I take an active role in my recovery after surgery?

Arnica montana is an herbal supplement which may help reduce the amount of bruising and swelling after surgery. This supplement is recommended to patients who want to do everything possible to minimize their recovery time. However, many patients do not feel comfortable taking herbal medications which do not have proven therapeutic value and should not feel that it is necessary to take this supplement. 

Complete postoperative instructions are available on this website.

How much does cosmetic eyelid surgery cost?

Cosmetic surgery by an experienced professional can produce dramatic results. See the before and after eyelid surgery photos on this website for examples. Dr. Kapadia will provide you with an exact price at the time of your consultation, but the approximate cost of eyelid surgery ranges from $3500-$8000 depending on which surgeries are being done and which operating room is used. The quoted price will cover the surgeon's fee, as well as operating room and anesthesia fees if applicable. Follow-up visits are covered for one year. There are no hidden charges related to surgery - the fee you are quoted includes all major costs related to the scheduled procedure. Many patients opt to have surgery on either their upper eyelids or lower eyelids alone and still see an enormous improvement in their appearance, surgery which is often at the lower end of the price range described above.

There are really no bargains in cosmetic surgery. It is not worth having surgery if you do not have full confidence in your surgeon's abilities or training. I frequently see patients who have complications related to surgery in other countries, by "trainees", or by non-specialist physicians in order to save money. These patients often have complications which require additional surgeries, which end up costing thousands of dollars more than if that patient had surgery performed correctly the first time around.

A significant discount is available to employees of Tufts-New England Medical Center and many of the other facilities where Dr. Kapadia operates and sees patients. Ask Dr. Kapadia during your consultation, or email him using the feedback link listed below if you are not sure if you qualify.