Dermatochalasis (extra eyelid skin)

Dermatochalasis refers to the redundant or extra skin of the eyelid. This is often a normal occurrence in aging and can also be brought on by lots of weight loss, recurrent swelling of the eyelids.  Gravity is usually the main cause of the stretching of the skin as we age.  Dermatochalasis is most often seen in the upper eyelids but can be seen in the lower eyelid.

Patients often complain of :

  • Decreased vision in the upper fields
  • Decreased peripheral vision
  • Having to lift their lids to read
  • Chronic irritation of the upper eyelid skin
  • Heaviness of the upper eyelids

Treatment

The treatment of dermatochalasis is surgical, called a blepharoplasty. This is most often preformed in an outpatient surgical center but occasionally be done in the office. The patient is given some IV medications to help them drift of into a twilight sleep and during this time the lids are injected with a numbing agent. The patient is then allowed to remain awake during the procedure, but can be given medications in the IV to help remain relaxed throughout the surgery. In the operating room towels and covers are placed around the face after it is washed to keep the area sterile. Measurements and marks are then made to determine the incision areas and the skin to be removed. The skin is then incised with no pain to the patient only the slight feel of pressure. During this time the fat pad on the inside corner of the eyelid can often be thinned out to give less bulk to the eyelid. Once the skin is removed it is then reapporximated with suture. After both sides are done the patient is then sent to recovery and then home. During the post operative period it is important to use ice and ointment as prescribed. The eyelids will be black and blue looking for about a week and the swelling can be present for a month or more, but this all varies by the patient and most heal quickly. The sutures are often removed in one to two weeks.  It is important to have a trained oculoplastic surgeon preform the surgery to prevent too much skin from being removed and the eye being damaged.

Who pays for the surgery. insurance or the patient?

Most people believe that a blepharoplasty is a cosmetic surgery, and while this can be the case, most of the time the surgery is functional and is covered by insurance. This is true for most insurance plans including Medicare. To prove that the eyelids are indeed causing visual problems and functional nature special test must be done including extensive photos and visual fields.

 

Jody Abrams, MD

Oculoplastic Surgeon/ Neuro-Ophthalmologist 

Sarasota Retina Institute

Sarasota, Florida

 

 

Trackbacks

  1. […] The visual field will show the doctor the areas that a patient can see. This does not tell the doctor how clear the vision is but rather how wide the vision is and or if there are holes in it. Some patterns are more common for disease of the retina or optic nerve disease the most common being glaucoma. Other fields can show compression of the optic nerve from lesion such as a pituitary tumor or other brain tumor. Defects seen in both eyes (many times not even noticed by the patient) can indicate a stroke or other lesion of the brain. The visual field can also show that the eyelids are causing visual problems in the upper part of the vision and the test are often done to help prove to insurance the need for eyelid surgery. […]

  2. […] can look closed or droopy from either dermatochalasis or true droopiness of the eyelid, called ptosis. Ptosis is a downward deviation of any part of the […]

  3. […] The most effective treatment is to surgically remove the fat, a lower lid blephroplasty. Unlike an upper lid blephroplasty where skin is removed, the lower lid blephroplasty removes mostly fat and little if any skin. The […]

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