How to qualify for eyelid surgery?

Author: Deontae Dickens  |  Last update: Tuesday, June 3, 2025

The best candidates for blepharoplasty surgery are generally people at least 30 years old who are in good health and have no other eye conditions. Tell your healthcare provider if you have any of the following conditions: Eye disease, like glaucoma, dry eyes or a detached retina.

What do I say to qualify for eyelid surgery?

Do You Qualify For Eyelid Surgery?
  • You have drooping or sagging eyelid skin that may also impair your vision.
  • You have puffiness, bags, or dark circles under your eyes.
  • Your eyes show signs of aging (n.b., drooping can be hereditary and may occur in younger patients)
  • You are a non-smoker and in overall good health.

What is the criteria for upper eyelid surgery?

NHS Eligibility: Surgery is only funded for medical reasons like vision impairment, chronic irritation, or eye strain—not for cosmetic concerns. Common Conditions Covered: Ptosis (drooping eyelids), dermatochalasis (excess skin), entropion/ectropion (eyelid turning in/out), and blepharospasm (involuntary movement).

What is the criteria for insurance to cover blepharoplasty?

A minimum 12 degree or 30 percent loss of upper field of vision with upper lid skin and/or upper lid margin in repose and elevated (by taping of the lid) to demonstrate potential correction by the proposed procedure or procedures is required.

What makes eyelid surgery medically necessary?

When the eyelid muscle weakens, the condition is called ptosis. When there is excess skin and fat, the conditions is called dermatochalasis. But whether it's due to ptosis or dermatochalasis, both conditions can impair your field of vision, making eyelid surgery medically necessary.

Is Eyelid Surgery Covered By Insurance? Surgeon Answers

How much is eyelid surgery without insurance?

The average cost of cosmetic eyelid surgery is $3,359 for an upper blepharoplasty and $3,876 for a lower blepharoplasty, according to the latest statistics from the American Society of Plastic Surgeons.

How to pass a test for blepharoplasty?

Basically, for blepharoplasty to be covered, a visual field test needs to be performed by a licensed ophthalmologist. The findings of this test should indicate that there is a minimum of 30% or 12 degrees of upper field of vision loss, due to overlying upper eyelid skin.

How do you get approved for blepharoplasty?

As a general rule, a patient must have a field of vision obstruction of at least 30 percent (12 degrees) in order to get coverage for blepharoplasty. This will be determined by a visual field test, which must be performed by a licensed ophthalmologist.

How bad do your eyelids have to be for insurance to pay?

In general, insurance companies will cover blepharoplasty or ptosis repair if the eyelids cause a “visually significant” obstruction of the upper visual field that “affects activities of daily living”.

Who is not a candidate for blepharoplasty?

Preparing for the Blepharoplasty

If you have any pre-existing medical conditions, let the surgeon know during the consultation. Persons with dry eye, diabetes, and glaucoma may not be suitable candidates for eyelid surgery. Persons with drooping and uneven eyebrows may also not make good candidates.

Who should not get upper eyelid surgery?

Eyelid surgery may not be right for you if you have thyroid problems, dry eye, high blood pressure, cardiovascular disease, diabetes, detached retina or glaucoma. Prior to the procedure, your plastic surgeon will evaluate your medical history and may advise you to see an eye doctor for an evaluation, as well.

What test for upper eyelid surgery?

The evaluation should include a thorough ophthalmologic evaluation that includes visual acuity, ocular motility, visual field testing, and basic tear secretion testing such as the Schirmer test.

How bad do hooded eyes need to be for surgery?

According to Dr. Wilson, there are a few key signs you may need droopy eyelid surgery. “If you feel like you can't see as well as you used to if you're using your eyebrows to lift your eyelids, or if you have to raise your head to see, these are all signs you may need surgery,” she said.

How painful is eyelid lift surgery?

Blepharoplasty is one of the least painful cosmetic procedures. You may have some slight discomfort on the day of surgery, but you should feel better quickly.

How do they test for blepharoplasty for insurance?

When you visit the doctor, standardized photos will be taken and the doctor can determine if the eyelid is blocking your vision. A visual field test will be needed, as many insurance companies require proof in the form of a visual field test in order to determine coverage for eyelid surgery.

How to fix droopy eyelids without surgery?

Dermal Fillers

These fillers, usually composed of substances naturally found in the body like hyaluronic acid or polylactic acid, are injected into the upper face. They provide volume and lift to the eye area, reducing the appearance of sagging or drooping eyelids.

How much does eyelid lift surgery cost?

A lower blepharoplasty surgery will cost from $7,000 to $9,500. An upper blepharoplasty surgery will cost $4,000 to $6,000, and a surgery to address both upper and lower eyelids will cost from $9,000 to $11,000.

What to say to get blepharoplasty covered by insurance?

Insurance companies need specific reasons to cover eyelid surgery. Medical necessity is often required. Conditions like ptosis or vision impairment can qualify. Provide evidence that surgery is not just for cosmetic purposes.

How to fix hooded eyelids?

Blepharoplasty is the type of surgery that repairs droopy eyelids. An ophthalmologist or a plastic and reconstructive surgeon can perform this surgery. During the surgery, the surgeon makes an incision in the natural fold of your eye, and removes excess skin, muscle and possibly fat along your upper eye lid.

How do you know if you qualify for eyelid surgery?

The first step in qualifying for eyelid surgery involves an initial consultation with a plastic surgeon. During this meeting, the surgeon will evaluate signs of skin elasticity loss, face symmetry, and pre-existing medical conditions. They will then discuss your goals and concerns with you.

What is better than blepharoplasty?

By lifting the eyebrows, Ultherapy can produce subtle make your eyes look larger and less tired or droopy. Key factors regarding Ultherapy: Results occur within the first 3-12 months after treatment. Effects are milder than with Blepharoplasty.

What time of year is best for blepharoplasty?

Many people wait until winter, when frigid weather keeps them at home anyway. Others prefer undergoing cosmetic eyelid surgery in the summer, when school schedules slow down or when they can hide the evidence of their blepharoplasty with a good pair of sunglasses.

What are the requirements for blepharoplasty?

A minimum 12 degree or 30 percent loss of upper field of vision with upper lid skin and/or upper lid margin in repose and elevated (by taping of the lid) to demonstrate potential correction by the proposed procedure or procedures is required.

What is the rate of blindness after blepharoplasty?

According to this, the overall incidence of visual loss following blepharoplasty was calculated at 0.0052% (five of 100,000 cases, or one in 20,000). Permanent visual loss was calculated at 0.0033% (three in 100,000, or one in 30,000) and temporary visual loss at 0.0019% (two in 100,000, or one in 50,000).

Can I drive myself home after blepharoplasty?

You will not be allowed to drive yourself home after eyelid surgery because the ointment and swelling can make your vision blurry.

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