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Frequently
Asked Questions |
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Q:
What is blepharoplasty? |
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A:
Blepharoplasty refers to eyelid surgery which
is designed to remove the excess fat, along with
skin and muscle, from the upper and lower eyelids.
It is the second most common cosmetic procedure
performed with about 50,000 persons having the
procedure in the United States each year.
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Q:
What is the purpose of blepharoplasty? |
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A:
Eyelid surgery can
correct drooping upper lids which can hang
down and interfere with peripheral vision.
By removing the excess wrinkled skin, blepharoplasty
"opens up" the eyes and gives
the face a fresher, brighter, and more youthful
and rested appearance. During lower eyelid
surgery, bulging fat is removed, as well
as a minimal amount of skin. Thus blepharoplasty
procedure improves over-hanging eyelid skin
in the upper lids and removes the puffiness
and swelling of the lower eyelids. |
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Q:
What is the success rate of cosmetic eyelid surgery? |
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A:
Eyelid surgery is very successful in patients
who have been properly educated and have reasonable
expectations. Realistic expectation on the part
of the patient is critical to success. Sagging
tissue of the eyelids and bulging fat pads can
certainly be removed.
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Q:
Can eyelid surgery remove the wrinkles around the
eyes (crow's feet), elevate droopy eyebrows, and
take away dark circles under the lower eyelids? |
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A:
No, the blepharoplasty surgery will not
be able to achieve all of this. As the skin
tightens, many wrinkles go away. Some fine
ones may not. Dark circles under the eyes
may improve a bit if this is related to
large bags, but most often the dark appearance
of the lower eyelid skin remains.
Q:
How about bags in my lower eyelids that
make me look tired?
A: The fat
is removed with the laser through the inside
of the eyelid. The upper and lower eyelid
surgery can be done together at the same
time.
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Q:
What can be done for dark circles under my eyes? |
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A:
Dark circles may be treated by lower eyelid surgery
if it results from shadowing due to bulging fat
or bags. If the dark circles result from pigmentation
changes of eyelid skin, skin bleaching creams
or light chemical peels may improve this condition.
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Q:
How do you decide whether I need an upper eyelid
lift or a brow lift? |
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A:
When someone complains of the appearance of the
upper eyelids, the first thing we do is evaluate
whether the problem is excess skin in the upper
eyelids, or if the eyebrows have lowered in position
over time. If the eyebrows are in good position,
then we can perform the upper eyelid surgery to
remove the excess skin. If the eyebrows are particularly
low, the doctor raises the patient's forehead
skin by hand to an appropriate level. If most
of the upper eyelid skin disappears, a patient
would most likely benefit from a forehead lift.
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Q:
Why do people need eyelid surgery years before they
need a facelift? |
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A:
People look older and more tired once aging skin
creates baggy or puffy eyelids, and since this
occurs much earlier than wrinkles in the face,
it is common for people to elect eyelid surgery
years before they need a facelift.
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Q:
Who is a candidate for blepharoplasty? |
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A:
A natural part of the aging process is the development
of wrinkles, often around the eyes. Skin around
the eyes also becomes less elastic, resulting
in droopy eyelids. Sometimes this happens at an
early age. You may start working your forehead
muscles harder in an effort to lift your drooping
eyelids. This may cause brow aches and fatigue.
If you are having these symptoms, or simply do
not like the way your eyelids appear, you may
be a candidate for a blepharoplasty.
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Q:
Can all candidates have a blepharoplasty? |
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A:
No, the best patients are those who are healthy,
psychologically stable and well motivated. Patients
with significant eye problems like glaucoma
or dry eyes
may not be eligible. Uncontrolled high blood pressure
or thyroid disease is also of concern. If you
are on a blood thinning medication, you are not
a candidate for eyelid surgery. Through consultation
and examination, we can determine if you're a
candidate for this rewarding procedure.
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Q:
Can I get cosmetic eyelid surgery, if I have had
PRK or LASIK? |
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A:
Some patients after laser vision correction ( LASIK
or PRK)
find out that the glasses masked their eyelids.
Such patients are excellent candidates for cosmetic
eyelid surgery |
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Q:
Is blepharoplasty performed on both men and women? |
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A:
Yes. It should be noted that a significant number
of men and women of all ages elect to have blepharoplasty
to achieve a more youthful look and for more comfortable
positioning of the eyelid skin. |
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Q:
What is the age limit to undergo eyelid surgery? |
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A:
There is no correct age for obtaining eyelid surgery.
Excessive skin in the upper lids, or bulging fat
in the lower lids are commonly seen with signs
of aging. The exact age depends on your heredity.
Certainly, women in their forties and fifties
comprise the majority of patients. If you are
in good health without serious eye problems, your
age alone should not keep you from having this
procedure.
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Q: Can
eyelid surgery be a medical necessity? |
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A:
If drooping of your eyelids is interfering in
your field of vision, the blepharoplasty procedure
may be covered as a "medically necessary"
surgery. Before surgery, your ophthalmologist
will perform a comprehensive
eye examination. Photographs are
often required by insurance companies before surgery
to determine if the procedure is medically-necessary.
A visual field
exam may be ordered to determine
the extent to which the upper lid is interfering
with your vision. Final decision is made by your
insurance carrier after reviewing your condition.
Lower eyelids are not covered by insurance unless
there is a deformity. Patients should check with
their insurance carrier about their coverage.
As a general rule, insurance does not cover cosmetic
surgery.
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Q: Are
there any visible scars from the blepharoplasty
surgery? |
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A:
Most of the time there is no visible scar after
the healing is complete. Incisions in the eyelids
are made following natural skin folds and creases.
Once healed, the hairline scars will fade, leaving
a very inconspicuous incision line that becomes
virtually unnoticeable after the healing.
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Q: What
if I have a history of bad scars? |
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A: If you
have pierced ears, the way you healed there is
a good indication of how you will heal from facial
plastic surgery. Scars on the rest of the body
typically are not an indication for how patients
heal following facial plastic surgery. At the
time of your consultation, it's important to show
your physician any previous scars (called keloid
scars) that are of concern so he can give you
a realistic assessment of your healing potential
following facial plastic surgery. If you have
a history of abnormal scarring, there are medications
that can be used to help prevent excess scarring.
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Q: Can
I participate in the decision-making process of
where the incision is placed? |
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A:
Your surgeon will show you how the crease can be
created on your eyelid, and discuss with you where
you would like it to be placed. The final decision
is yours, together with what Dr.
Tandon feels would work well with your
own eyelid shape. |
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Q: Will
my eyelids look the same after surgery? |
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A:
Most patients' two eyelids are a bit different.
The goal of the surgery is to make them look exactly
the same. It is generally the result but cannot
be guaranteed.
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Q: Will
I still maintain my uniqueness after the surgery? |
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A:
Although the change may be significant to you,
it's not uncommon that friends and family members
don't really notice the change.
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Q: Can
you operate on only one eye? |
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A:
Sometimes it is easier to match the eyelids if
both are operated. You must be examined before
our surgeon can answer this question for you.
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Q: Is
the result of eyelid surgery permanent? |
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A:
The goal is to create a permanent crease. Generally
speaking, the benefits of a blepharoplasty are
long lasting, and few people need to have the
procedure done a second time. Fat that has been
removed will not come back. Of course with aging,
the skin gets looser and can hang down. The procedure
cannot alter or retard the natural aging process.
But the crease generally is permanent.
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Q: How
is the procedure performed? |
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A:
Eyelid surgery is usually performed by giving
small local anesthesia injection to numb the deeper
tissues. Generally there is no pain during surgery.
If you are very nervous, you will be given a Valium
pill to help you relax. A light intravenous sedation
is also given. Patients are awake during surgery.
Patients do not feel anything and are comfortable
during surgery. Eyelid plastic surgery is commonly
done on an outpatient basis. Intravenous sedation
is a type of anesthesia; therefore all patients
must have a responsible adult to stay with them
through the night following surgery.
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Q: What
is the difference between the conventional technique
and the laser technique? |
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A:
In conventional technique, a knife is used to
cut the skin and remove the underlying fat. The
skin is then closed with either regular or dissolvable
sutures. In laser technique, CO2 laser is used
to cut the skin and remove a thin strip of muscle
and fat. Then stitches are placed to make the
crease and close the skin. The stitches on the
skin dissolve by themselves after a week or 10
days. Regular stitches may also be used.
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Q: What
is the advantage of the laser? Are there any risks
from the laser? |
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A:
The laser allows a much more precise surgery,
with less swelling and bruising. During surgery
proper care is taken to avoid any unnecessary
exposure to the laser. There is no risk from the
laser, and Dr.
Tandon feels that there are important
benefits in precision and faster recovery.
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Q: Will
I be in pain? |
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A:
After any surgical procedure, some discomfort
can be expected. All patients are provided with
prescriptions for pain medication. Patients have
surprisingly little discomfort after most eyelid
procedures. Generally over the counter Tylenol
is all patients need (together with ice packs)
placed over their eyes for 24 hours. An occasional
patient will report unmanageable pain after surgery.
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Q: How
will I feel after my surgery? |
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A:
Your eyes are never patched closed. After surgery,
patients usually spend at least one day resting
with their head elevated on a pillow and often
apply ice packs to reduce swelling. Some patients
report a dull headache and tenderness or discomfort.
You may also experience bruising and temporary
numbness. Later on, you might experience some
itching during the healing process.
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Q: How
long does the surgery take? |
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A:
Surgeon spends about half an hour with you discussing
where the crease should go. The length of surgery
depends on several factors including the complexity
of each person's eyelids. Usually, surgery takes
about an hour.
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Q: How
long does the whole process take? |
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A:
We ask you to arrive at the center half-an-hour
before surgery and stay until you are ready to
go home. The whole procedure generally takes about
two to three hours for upper and lower eyelids.
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Q: Can
I drive myself back home? |
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A:
No, you should not drive yourself. Someone will
need to drive you home after your surgery and
stay with you overnight. Someone will need to
drive you back to our office for your first postoperative
appointment.
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Q: How
long will it take before I look normal? |
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A:
Usually, patients look normal after about two to
three weeks of surgery. Some patients heal faster,
and others take longer. The crease is high just
after surgery, and gets lower as the swelling resolves.
You will look better at six weeks and even better
still at six months. Final results are evaluated
at one year. However, at two weeks you know you
are well on the way to recovery. After three months,
most patients have about 90% of their final result.
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Q: Is
there swelling and bruising after the procedure? |
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A:
There is usually some swelling which gradually
resolves after one to two weeks. There may be
some bruising, but very little and this too fades
rapidly. Women can camouflage bruises fairly easily
at seven to ten days with make-up.
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Q: How
safe is the surgery? Are there any complications
or side effects? |
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A:
All surgeries have some risks. If performed by
a competent surgeon, complications are infrequent
and minor. The vast majority of these operations
go perfectly well with excellent results and happy
patients. All patients will experience some bruising
and swelling for a few days after the surgery.
The risk can include creases that do not form
where they are planned, and can be too low or
high, or not deep enough, or not exactly the same
in both eyes. In addition, a temporary problem
with closure of the eyelids is usually seen. Some
may have temporary blurring of their vision, usually
due to the ointments applied to the incisions
post operatively. Any surgery has some risk of
bleeding and infection.
Wound disruption and heavy scarring are also possible.
These are very rare in this surgery, and there
are other complications are even less common.
For some of these complications, a touch-up procedure
might be necessary for correction. Dr.
Tandon will discuss any possible
risks with you before surgery is done, and answer
all of your questions. Visual impairment is extremely
rare. There may be some temporary sensitivity
to bright light or wind and we recommend wearing
dark glasses
when outside.
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Q: How
soon can I go back to work? |
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A:
New techniques have significantly reduced healing
times. However, each patient's healing time varies
with the type of procedure performed, medical
history and physical health. You can expect to
go to your work place within a few days if you
do not mind looking a bit swollen and possibly
bruised. Many patients return to work in a few
days wearing glasses. If your appearance is important
then you need to take at least two weeks off.
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Q: When
can I resume regular exercise or play sports after
surgery? |
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| A:
You should plan to take it easy and put ice
on the eyelids for two days, and not work
out or play sports for a week. Aerobic and
other exercise programs are not allowed for
at least two weeks to decrease the risks of
bleeding, swelling and bruising. More strenuous
activities, such as weight-lifting and contact
sports, are not allowed for at least one month.
Absolutely no bending, lifting or straining
during the postoperative period as these activities
can increase swelling and delay healing. |
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Q: When
can I return to normal activities? |
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A:
Most patients watch TV and listen to radio 1-2
days after surgery. People generally can read
and work at the computer 3-4 days later, though
the eyes fatigue faster than usual.
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Q: When
can I take a shower or tub bath? |
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A:
You may take a tub bath and wash your hair in
the sink any time following the procedure. Hot
steamy showers should be avoided because they
could prolong swelling. Routine showers at one
week are fine.
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Q: When
can I wear contact lenses after surgery? |
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A:
Generally you should stay out of contact lenses
for two weeks after surgery.
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Q: What
if I need a touch-up? |
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A:
It is very rare that a second operation is necessary.
Rarely, the crease needs to be deepened or lengthened.
Your surgeon will advise you on the pros and cons
of a touch-up depending upon your unique situation.
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Q: If
I am eligible for the surgery, what is the next
step? |
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A:
Schedule a pre-op appointment with your eyelid
surgeon at NeoVision Eye Center. In keeping with
our efforts to maintain the highest standards
of patient safety and in an ongoing effort to
avoid possible complications, we ask that each
of our blepharoplasty patients undergo an extensive
and comprehensive
eye exam by an ophthalmologist prior
to surgery on the eyelids. During your pre-op
visit, your health history will be reviewed, all
your questions will be answered, you will be instructed
on how to prepare for surgery, you will be given
the prescriptions for use after surgery and we
will tell you what to expect. If you are on blood
thinners, you will be asked to stop them approximately
two weeks prior to surgery. You will be asked
to sign an informed consent. Full payment for
your eyelid surgery is due at the time of your
pre-op visit.
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Q: What
does “informed consent” mean? |
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A:
Informed consent means you have an excellent understanding
about the benefits of surgery as well as any risks,
and all the preoperative and postoperative information.
You are making an "informed" decision
as to whether surgery is right for you.
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Q: Are
there any dietary restrictions before the procedure? |
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A:
Anesthesia medications can cause stomach upset.
The best way to prevent after effects from anesthesia
will be to avoid food or drink from midnight the
night before surgery.
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Q: Are
there any dietary restrictions following surgery? |
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A:
No. Patients can eat whatever they want. Advance
your diet from liquids to soft food to solids
as tolerated. Please drink as much fluid as you
can which will help you from becoming dehydrated.
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Q: Will
I need any special prescriptions following surgery? |
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A:
Yes. Postoperative prescriptions are provided
well in advance of surgery day so you arrive home
completely prepared. Postoperative prescriptions
and over-the-counter medications for blepharoplasty
patients include the following: an antibiotic
ointment (Polysporin / bacitracin ophthalmic)
to place on the sutures and gently in the corners
of the eyes and pain medication as needed. You
should start ointment the day of surgery. You
will be asked to use ice pack for 24 hours after
surgery.
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Q: Who
will do my surgery? |
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| A:
Dr. Tandon will meet with you, examine you,
discuss where you want the crease, discuss
all the possible complications, answer all
of your questions, and perform the surgery.
Dr. Tandon,
MD, PhD is a trained eye physician
and surgeon from Stanford University. She
is a board certified ophthalmologist. |
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Q:
What are NeoVision’s charges for eyelid
surgery?
A: At NeoVision
Eye Center, we believe the fairest approach
is to offer eyelid surgery for one Flat
Fee. That is why we offer one global comprehensive
fee, which includes all pre-operative, surgical,
and post-operative care. A price estimate
will be given at your consultation for cosmetic
surgery that includes the surgeon's fee,
fee for operating room, and fee for the
anesthesiologist. Fees reflect the specific
problem that you have and the extent of
surgery to correct it. A typical fee for
upper or lower eyelid surgery is $1500 for
both eyes. In addition to our fee, you will
be responsible for the payment to surgery
center and anesthesiologist as needed. Surgeon’s
global fee includes pre-operative examination,
surgery and follow-up care for three months.
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Q: Will
my insurance company pay for eyelid surgery? |
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A:
Most of these operations are cosmetic in nature
and are not covered by insurance. In some older
patients, if your vision is impaired by the excessive
skin of the upper eyelids, some insurance plans
will pay for all or part of the surgery. We will
perform a test
for visual field restriction, and
if there is impairment in this area, we will dictate
a letter of necessity for your insurance company.
Final decision is made by your insurance carrier
after reviewing your condition and the photographs.
Lower eyelids are not covered by insurance unless
there is a deformity. Patients should check with
their insurance carrier about their coverage.
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Q: How
does an insurance company find out whether I need
eyelid surgery for medical or cosmetic reason? |
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A:
Before surgery, your ophthalmologist will perform
a comprehensive
eye examination. Photographs are
often required by insurance companies before surgery
to determine if the procedure is medically necessary.
Final decision is made by your insurance carrier
after reviewing your condition. Lower eyelids
are not covered by insurance unless there is a
deformity. Patients should check with their insurance
carrier about their coverage.
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Q: I
am ready to get my eyelid surgery at NeoVision,
what is the next step? |
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A:
Schedule a complimentary, no-obligation personal
evaluation with your surgeon at NeoVision Eye Center
to determine if you are a likely candidate for eyelid
surgery. There is absolutely no-fee for this assessment,
whether or not you choose to have the procedure
done. Call toll free at
1-877-NEOVISION (1-877-636-8474). |
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