Transconjunctival versus Transcutaneous Lower Eyelid Surgery
Transconjunctival and transcutaneous lower eyelid surgeries are each a type of lower blepharoplasty, a plastic eyelid surgery that can address a range of issues such as excess fat or “puffiness” around the lower eyelid, loose and wrinkled skin. For great results, your blepharoplasty must be carefully planned by your attending surgeon, who will consider the subtle details of your facial anatomy when determining which type of blepharoplasty is right for you, and details such as whether to remove any fat and where, how tight the eyelid skin should be, and how to achieve natural results for overall facial balance.
Lower eyelid blepharoplasty can be approached either through the skin, transcutaneously, or from behind the eyelid, transconjunctivally. There can be very specific reasons for choosing one approach over another. More commonly, surgeons use a particular approach, not due to inherent advatages of the approach but rather that was they way they were trained. For the most part, tranconjunctival surgery is performed by oculoplastic surgoens who by training are comfortable working near the eye. General plastic surgeons and others lack the specialized training in oculoplastic surgery. They prefer an approach to the eyelid that does not require they to work so close to the eye surface. This is unfortunate because the skin incision usually is made through the underlying muscle. This can damage the function of the underlying muscle, the orbicularis ocli muscle. After surgery, this muscle weakness account for the alteration of the lower eyelid contour that is routine associated with transcutaneous lower eyelid surgery.
Here is an overview of some important features of each surgery type:
Transconjunctival Blepharoplasty
• Incision made behind the lower eyelid
• Minimizes the risk of altering the contour of the eyelid margin after surgery
• Arcus marglinalis release can be performed through the same incision, wherein the eyelid fat is preserved and rotated into the hollow under eyes
Transcutaneous Blepharoplasty
• Incision made just below the lower eyelid lashes
• Can possibly damage the function of the orbicularis oculi muscle and affect the lower eyelid contour
• Permits the removal of excess skin
For some, removal of the lower eyelid fullness from behind the eyelid and removal of excess skin from the front is indicated, via a skin pinch technique or an infracillary incision just below the eyelashes that preserves the underlying muscle. Ultimately, the only way to know what treatment method is right for you is to consult with an experienced oculoplastic surgeon who will meet with you, discuss your concerns and treatment goals, perform a physical examination, and work with you to design an approach that addresses your specific anatomical features and overall facial balance. These are highly complex and specialized procedures that require a skilled and experienced hand, and can bring you many benefits both functional and aesthetic. To schedule a consultation with Dr. Steinsapir, a leading cosmetic eyelid surgeon who practices in Beverly Hills and at UCLA, please call us today.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Do I need an eye examination before I have eyelid surgery?
Cosmetic surgery clients often wonder what type of examinations they need prior to undergoing eyelid surgery. It’s important for your surgeon to give you a physical examination to fully understand your expectations, your anatomy, and any current health issues before any cosmetic surgery procedure. Before eyelid surgery, the same considerations apply. A detailed assessment of your eye and eyelid health should be performed in advance of eyelid surgery. This information is essential for your surgeon to understand your eye health and how it might be affected by eyelid surgery.
Insurance coverage for eyelid surgery
Insurance companies including Medicare have significantly restricted which eyelid procedures they will cover. In the past, coverage was much more generous; now coverage is greatly limited. Even functionally significant issues may be denied. Many of our patients, upon investigating co-pays and deductibles are surprised to learn that, in some cases, they actually save money by paying out-of-pocket for certain eyelid procedures as cosmetic surgery. Every situation is different, but it’s worth researching the charges you will be responsible for if you use applicable health insurance. It can sometimes be less expensive to pay for your procedure out-of-pocket because often, the rates for medically necessary surgery are much higher than the cosmetic rates. This difference can be particularly acute if you have a high-deductible insurance policy and you have not met your deductible limits. If your issue is not medically necessary, convincing your doctor to submit a false insurance claim is a crime. Just because you know someone who had eyelid surgery covered by health insurance, don’t assume you have the same issues.
Finding a highly qualified eyelid surgeon
The best course of action is to seek care from a fellowship-trained oculoplastic surgeon. Oculoplastic surgeons are board-certified ophthalmologists who have completed a two-year fellowship in eyelid and facial plastic surgery. They have the necessary experience and equipment to examine you and document your issues. If your problem requires surgery to help improve you quality of life and likely covered by health insurance, your oculoplastic surgeon will inform you of this. On the contrary, if it is not covered, please respect the surgeon’s opinion. For a list of names of qualified oculoplastic surgeons in your area, visit ASOPRS.org. This is the website for the American Society for Ophthalmic Plastic and Reconstructive Surgery and it features a geographic directory.
Cosmetic eyelid surgery
As with any surgical procedure, elective or otherwise, it’s important to find a surgeon who will perform an appropriate consultation. If you’re undergoing revisional surgery with a new surgeon, one who did not perform the original surgery, bringing pre-surgery photographs and any medical records to your examination will help your new surgeon create a treatment plan that will result in the changes you desire. The new surgeon may ask that you release you prior medical records for review before your visit.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Will my insurance company pay for my BOTOX for migraines
The FDA recently approved the use of BOTOX to treat migraines, which leads many hopefuls to ask, will BOTOX for migraines be covered by my medical insurance company? The answer depends on what is right for you, your medical history, and your insurance. However, don’t expect your insurance to pay for top cosmetic treatment if you have just had a few migraines. Let’s take a look at the studies that led the FDA to approve BOTOX for migraine treatment, some likely insurance limitations, and how you can determine your best treatment options.
The Science behind the FDA’s Approval of BOTOX for Migraines
First you must realize that the FDA approval was for individuals with chronic migraines, with benefits observed only in individuals who suffer from migraines at least 15 days per month—in other words, more than half of your days you experience serious migraines. As you can imagine or may already experience, such high frequency of migraines can be debilitating, and individuals who fit this provile need help from a doctor to find a solution. While many adults experience migraines at times, most do not endure them this often.
The studies that led to the FDA approval showed increase in days without migraines in both patients who received a placebo and in patients who received BOTOX. But the BOTOX patients did experience a moderately higher amount in migraine-free days than the placebo group, which is crucial to demonstrating a given treatment’s efficacy in these kinds of studies. For these individuals, about 150 units of BOTOX—a significant amount—was needed to achieve improvement. There was an additional 1% of study participants who experienced a worsening in their migraines, while another 2% of study participants dropped out due to side effects.
Given the variety of responses in this trial, we see that BOTOX is probably not going to be a cure-all for anyone who has ever had a migraine. Will this treatment be right for you? Maybe. That depends on a lot of factors like your medical history, your current condition, and what kind of response you have to the treatment.
What Are Some Likely Insurance Stipulations?
Your insurance company will probably want to see significant documentation about your condition before they agree to pay for these treatments. So be sure to get appropriate authorization before you seek this treatment. Your general practitioner or specialist can help you with this, but be sure to take responsibility for finding out what all you need to do. It may be beneficial to call your insurance company and ask them for more details about your insurance plan and coverage.
Your insurance company likely won’t allow your cosmetic surgeon to provide this type of treatment, and instead they may prefer for your treatment to be performed by a neurologist. This will help them to prevent fraud and abuse. If you are simply looking for a way to have someone else pay for your cosmetic treatment, your insurance probably won’t cover it and there is no reason why they should. However, if you are a true candidate for BOTOX for migraines then you may qualify for insurance coverage. Talk to your doctor and insurance provider to learn more about your situation.
Your Treatment Should Be Appropriate to Your Situation
If you have very frequent migraines, you and your doctor can discuss appropriate treatments or lifestyle changes to improve your health. If you are dissatisfied with your appearance due to issues like forehead wrinkles, frown lines, and pinched features, it is also a good idea to consult with a top cosmetic physician to find out if BOTOX or anther treatment like the facelift is right for you. But if you have both migraines and aging facial features, does this mean that BOTOX is the best option for both and that your insurance will cover BOTOX? Not necessarily.
Migraines and aging features are separate issues, so it is important not to take any medical shortcuts or be dishonest with your insurance company or doctor. There is professional medical help for both migraines and your aesthetic goals, but trying to “kill two birds with one stone” is not a reasonable approach. We advise you to talk to your general practitioner or neurologist openly about the nature of your migraines, and be truthful about why you are inquiring about BOTOX. We also advise you to talk openly with a leading BOTOX cosmetic surgeon to find out how treatment from the best BOTOX doctor can meet your aesthetic goals. These conversations will help your doctors to determine the best treatment plan for you.
Help with BOTOX in Los Angeles
Dr. Steinsapir is a leading cosmetic surgeon in Beverly Hills and at UCLA who focuses on minimally invasive treatments that emphasize natural results for balanced facial features. He is respected for being among the finest and most qualified BOTOX providers, and his patented Microdroplet BOTOX treatment is popular among high profile executives and celebrities who wish for natural, youthful improvements. To find out how the best BOTOX can meet your needs, contact us today.
Will Health Insurance Cover my Eyelid Surgery?
People seek an eyelid surgeon for a variety of reasons, including personal preference, aesthetic concerns, professional desires, trauma, and medical necessity. Whether your health insurance will cover your cosmetic eyelid surgery depends on your condition, the reason you seek surgery, and of course your insurance.
Eyelid Ptosis Surgery Before and After
Health insurance does not cover most cosmetic procedures because they usually are not medically necessary. Health insurance plans are there to help you when you medically need treatment, so while there are many good and legitimate reasons to seek eyelid plastic surgery, if your primary goal is to improve your appearance with no health benefit (other than peace of mind), then your insurance probably won’t cover the cost, nor should it have to. This is not to say that you should not seek cosmetic treatment or that you have few payment options; these are all points to discuss with your doctor, and you may be happy to learn that many doctors offer a variety of cosmetic surgery payment options.
How can I find out if my health plan will cover my surgery?
Health insurance does not cover cosmetic surgery. It may cover medically necessary reconstructive surgery. May is the operative word. Health insurance companies are increasingly unlikely to cover procedures that they previously did cover. This is their effort to maximize profit and minimize expenses. Examples of items that generally are covered include eyelid ptosis surgery because of vision problems, or if you have skin cancer and need mohs surgery for basal cell carcinoma, your insurance may help. To find out, call your insurance provider or read your insurance handbook. If you call, you can describe your situation and treatment desires, and also ask under what circumstances eyelid surgery is covered. Be honest and don’t try to scam an insurance provider into paying for care that isn’t really in your plan or that you don’t truly need for good physical health.
Will Dr. Steinsapir accept my insurance?
Dr. Steinsapir is not a network provider in any health care plans, so check with your insurance to find out if they offer out-of-network payment. For reconstructive surgery, you will be asked to make a good faith deposit for surgery. As the doctor is not an in-network provider, his fees are likely to be more than what is allowed or paid by your health insurance. Following surgery, a courtesy bill will be provided for you to submit to your health insurance company. However, they are only obligated according to their fee schedule. This generally means that you will be out of pocket for much of Dr. Steinsapir’s fees. The good news is that many health insurance plans do cover the hospital and anesthesia fees and part of their network. Because of how medically necessary surgery is billed, many patients are surprised to learn that they may actually save money when surgery is performed as self-pay cosmetic. If you have Medicare, you will be asked to sign a so-called opt out form that waives your right to bill Medicare for Dr. Steinsapir’s work.
I want to see Dr. Steinsapir, but my insurance won’t help.
There are a variety of ways individuals have financed their cosmetic treatment plan, including saving up or using CareCredit card, which offers care credit cosmetic surgery options. This leading patient payment program can help you to completely finance your cosmetic eyelid surgery in the Los Angeles and Beverly Hills area with Dr. Steinsapir on approval of credit. CareCredit is a great program that we are happy to offer as a service to our patients. This will enable you to seek treatment today that you can pay for in monthly installments.
Discuss Your Options
Depending on your need and condition, there is a good chance that your health insurance will cover a portion of your eyelid reconstruction in Los Angeles in medically necessary situations. We invite you to make Dr. Steinsapir a part of your treatment and healing. As a service to you, we will do our best to work with your insurance. Let us remind you that although Dr. Steinsapir may not be part of your insurance company network, we are still obligated to communicate honestly with your health plan regarding your health needs. At the same time, there are many responsible ways to pay for your treatment without health insurance. We find that if you carefully plan your treatment decisions, seek professional advice from your doctor, and keep communication open, then you will be very pleased with your decision to seek treatment from the best. Contact us today to for a private consultation with Dr. Steinsapir to learn how the best eyelid surgery available can be a reality for you.
I want Cosmetic Surgery but I don’t have Health Insurance
Cosmetic surgery can be an amazing experience when you make treatment decisions with care and thoughtfulness. Most people who obtain cosmetic procedures do look and feel better afterward, contrary to the stigma created by a few hyped, biased stories. A carefully planned, minimally invasive cosmetic treatment can improve your appearance and give you a boost in confidence. But is it financially responsible to get cosmetic surgery if you do not have health insurance?
I can’t afford health insurance, but I can afford a one time cosmetic surgery.
Here at our office for cosmetic treatment in Beverly Hills and Los Angeles, we have many concerns when we hear from people without health insurance seeking cosmetic surgery including anything from Microcroplet BOTOX to blepharoplasty. Before it is reasonable to consider cosmetic surgery, we urge you to take care of your basic needs and establish a relationship with a regular medical doctor such as a family practitioner, internist, or gynecologist. Health care is a basic necessity. Without health insurance you are a single illness away from financial ruin. People without health insurance should be especially mindful of their expenses, as they are especially vulnerable to emergencies. Please, before you consider cosmetic surgery payment plans, consider funding your basic health care insurance first. The peace of mind that comes from knowing you have this safety net has to be worth something in terms of less stress and tension that inevitably will be showing up on your face in some form or another.
Today, focus on obtaining health insurance, living a healthy lifestyle, and practicing preventative health measures. Cosmetic surgery benefits many people, and you can learn more about how it may help you too, but please first find out how a health insurance plan can help you and what steps you need to obtain one. Cosmetic surgery is not a replacement for basic health care, nor was it ever meant to be. Don’t spend all your discretionary money on cosmetic surgery if you haven’t met your basic healthcare needs.
Comprehensive Treatment for Your Whole Self
We will feel in good conscience about discussing our cosmetic surgery payment plans with you when we know that you can meet your most essential needs. You, too, will likely feel better about your cosmetic treatment options if you are able to find a doctor who is the best match for your personal needs, rather than the best match for your financial limitations.
Dr. Steinsapir is counted among the best cosmetic surgeons in California and beyond because of his professional experience, leadership, specialization, and natural yet definitive results. As you research your cosmetic treatment options, please add in some research about medical insurance options. Then when you do get cosmetic surgery, you can enjoy the results without feeling the guilt of indulging in this luxury without taking care of your basic necessities.
