Mini Case Study: Ms. “M,” A beautiful, mature woman, somewhere between 48 and 60 years of age looks in the mirror one morning. She is objective, and she knows she can’t look 28 or 35 forever, but lately she notices the inevitable sleepy droop of her upper eyebags and puffiness. It’s an appearance of lack of rest, and it is accented by some bagginess in the lower lids also. She knows these droopy eyelids effect her expression. Lately people have asked her what is worrying her, but her life is going well. She hates the  way the drooping eyes make her look anxious.

The drooping eyelids are totally correctable with a procedure called blepharoplasty, but she feels a little guilty about indulging herself with cosmetic surgery. She puts on some lip gloss, shrugs and goes to work.

Later in the day, she suffers a headache while working on reports at her office. She does not even realize it’s caused by eye strain. Then, on the way home she scrapes fenders, while dodging a speeding truck as he passes her. She doesn’t understand that the upper bags on her eyes are hampering her peripheral vision.

In the case of Ms. “M.”, and others like her, blepharoplasty would not just improve how she looks, but how she sees!

Cases such as these were carefully investigated by Dr. Kenneth V. Cahill, MD, from Ophthalmic Surgeons and Consultants in Columbus, Ohio, and colleagues. “They analyzed results from 13 studies that examined the functional indications and outcomes of blepharoptosis repair and blepharoplasty.”

He said, “As oculoplastic surgeons, we see the visual improvement and comfort that patients obtain from the surgical correction of upper lid ptosis and dermatochalasis. This study was performed to analyze the scientific data available to substantiate this,” explained Dr. Cahill.

Thus, repairing those eyebags is not just catering to vanity. His team discovered that medicare and many other insurance providers vastly underestimate the improvement these surgeries can bring to a patient’s vision. Tamara R. Fountain, MD, clinical correspondent for the American Academy of Ophthalmology and executive committee member of the American Society of Ophthalmic Plastic and Reconstructive Surgeons, also stated that these insurance estimates and regulations are too narrow.

Doing The Math To Find The Hidden Benefits of Blepharoplasty

1. She also reported, “Medicare and many of the third party carriers have used [a] threshold of margin reflex distance (MRD) less than or equal to 2 mm and/or visual field of 12 degrees or improvement of 25-30% for consideration of coverage of ptosis repair or upper lid blepharoplasty for some time.”

2. In contrast, the research team found significant evidence that, “surgery is functionally beneficial for MRD 1 (MRD1) of 2 mm or less measured in primary gaze; superior visual field loss of 12 degrees or 24%; and downgaze ptosis that impairs reading, documented by MRD1 of 2 mm or less measured in down gaze.”

Studying Individual Cases

Because of the shape and droop of eye bags, many patient compensate subconsciously with odd lifts of their chins and an uncomfortable sloping back of the neck in order to read. Some patients have reported “impairment caused by upper-eyelid droop; chin-up backward tilt due to visual field impairment from droopy lids; interference with work-related activities and safety related to visual impairment from upper lids; and discomfort, eye strain, or visual interference caused by the upper-eyelid position.”

The researchers found these cosmetic procedures involving the eyelids significantly improved visual function and quality of life. “Patient-reported quality-of-life impairment caused by ptosis and dermatochalasis is highly correlated with functional improvement from ptosis surgery,” said Dr. Cahill.

Dr. Fountain added, “This ophthalmic technology assessment confirms, via robust data analysis, what we see in our offices every day: Patients have real benefit from fixing the peripheral vision impairment and facial fatigue that often results from ptosis and excessive upper lid skin.”

Orlando Cosmetic Surgery hopes studies like this one will allow third-party insurers to investigate their requirements, and make it more financially possible to help people like Ms. M. Once she was aware that blepharoplasty could help her see better, and feel better, as well as look better, she budgeted to have her surgery, even  without her insurance carrier’s help. No more eye strain. No more close calls in traffic. She is very contented with her investment and has never “looked back.”





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