Does insurance cover upper blepharoplasty?

If you are stumbling upon this blog, it is probably because you are considering cosmetic surgery on your upper eyelids, also called and “upper bleph” (short for blepharoplasty).  Many people in their 40s start to notice “hooding” of their upper eyelid skin.  Upper blepharoplasty surgery is a procedure that removes excess skin with an incision in the natural crease of the upper eyelid. In some patients, there is also bulging fat in the upper eyelids that can be removed through this same incision.  The result is a smoother, more youthful appearance of the eyelid.  The procedure is quite minimally invasive (usually just skin deep), making it very predictable and very safe.  The healing duration can vary person to person, but typically the bruising and swelling resolve within a couple of weeks.  The incision line will remain somewhat irregular and can be red or dark for 6 weeks or more, but they will eventually smooth out.  By 3-6 months, the incision is no longer detectable to the naked eye.


Typically, any procedure like this that is performed to enhance your appearance is considered elective and is not covered by medical health insurance.  There are instances where this surgery may be eligible for coverage by insurance, but this is often when the upper eyelid skin redundancy is quite severe.  For an upper blepharoplasty to be considered medically necessary, patients need to have a significant impairment in their daily activities (like driving, reading, etc.) that can be attributed to sagging eyelid skin.  This requires something called a taped and un-taped visual field test with their optometrist or ophthalmologist.  For many insurance carriers, the visual field testing will need to show a 20 degree or 30% improvement in the upper visual field when the eyelids are taped up in order to be considered medical necessity.


My training and experience as both a board-certified ENT and Facial Plastic Surgeon gives me a unique and highly attuned perspective on the anatomy and appearance of the face.  When deciding on your surgeon, you should choose a specialist who deeply understands this delicate interplay between form and function.


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