Abstract
Purpose :
Indications for blepharoplasty (bleph)may be categorized as “functional” or “cosmetic”. In the US, patients electing to proceed with functional blephs must demonstrate significant compromise of daily living activities due to visual impairment in order to qualify for insurance coverage. Patients who do not meet these requirements can elect to pay for the bleph, as it is considered cosmetic. The purpose of this study is to characterize the nature of the dermatochalasis evaluation (eval), indications for surgery, and subsequent functional vs. cosmetic bleph.
Methods :
A retrospective chart review was conducted from a single oculoplastic surgeon in the US. CPT (diagnosis code) was used to identify patients seen for dermatochalasis eval between 1/2019-1/2023. The primary outcome measure was whether the patient elected to proceed with functional or cosmetic bleph. Additional variables collected include indications for bleph, age (stratified 20-39, 40-59, and >/=60), gender, and race/ethnicity.
Results :
608 patients were seen for a dermatochalasis eval between 2019-2023. 243 (40%) patients then elected to proceed with surgery. Of these, 196 (81%) patients received cosmetic bleph. 47 (19%) patients received functional bleph. Neither age nor gender were reliable predictors of whether patients elected to proceed with surgery (p>0.5). Of patients who did receive surgery, age was a significant predictor of whether the bleph was functional vs. cosmetic (p<0.001), and gender was not (p=0.364).
Conclusions :
The data show that the majority (60%) of dermatochalasis evals did not lead to bleph. The rate of evaluation leading to surgery may be partially explained by a discrepancy in the understanding of insurance coverage between patient, referring provider, and surgeon. False expectations of insurance coverage for both initial eval and subsequent surgery may result in an excess number of evals as well as associated out-of-pocket expenses for patients. Both patients and referring providers should be aware of the insurance requirements for functional blephs.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.