Reconstructive Surgery / Medically Necessary

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Treatments performed by plastic surgeons may be divided into three major categories: procedures that are clearly needed from a medical perspective to maintain someone’s health such as (treatment of skin cancers, severe lacerations/cuts, repair of broken facial bones, etc.), procedures that are clearly not medically necessary (surgery performed for the sole purpose of producing a more youthful look, treatment of unwanted wrinkles and lines, removal of tattoos or other unwanted spots) and treatment of conditions that, in the strictest of terms, do not impair one’s ability to function but which are still needed to give someone a more normal appearance and thus help them live more comfortably. Examples of conditions falling into this category include correction or removal of dark-colored birthmarks treatment of unsightly scars, scars, etc.

Insurance and Reconstructive Surgery

Traditionally, treatments performed for reasons of medical necessity have been covered by insurance, while those performed for cosmetic reasons are paid for by the patients. The third group of conditions has been a “gray” area with insurance sometimes covering the costs of treatment and other times the responsibility falling on the patient. Today, with increasing tightening of purse strings by insurance companies, the responsibility for payment of even those procedures performed out of medical necessity or to correct birth marks or scarring caused by injury or surgery may fall upon the patient.

Overview of Medically Necessary and Reconstructive Services Offered

Blepharospasms and Hemifacial Spasms

Blepharospasms and hemifacial spasms are neurologic disorders in which the eyelid and facial muscles contract and squeeze involuntarily. This can not only result in social embarrassment, but also the spasms can be so severe that affected individuals are unable to open their eyes and are rendered functionally blind.
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Drooping or sagging eyelids in infants or adults

Ptosis (pronounced “toe-sis”) is the medical term for drooping of the upper eyelid(s). This lowering of the upper eyelid margin may cause a reduction in the field of vision when the eyelid either partially or completely obstructs the pupil. Patients with ptosis often have difficulty keeping their eyelids open. To compensate, they will often arch their eyebrows in an effort to raise the drooping eyelids. In severe cases, people with ptosis may need to lift their eyelids with their fingers in order to see. Children with ptosis may develop amblyopia (“lazy eye”) or developmental delay from limitation of their vision.
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Entropion/Ectropion (eyelid rolling in or out)

Entropion is a condition in which the eyelid is rolled inward toward the eye, causing irritation, pain, and even infection or scarring.. It can occur as a result of advancing age and weakening of certain eyelid muscles. Entropion may also occur as a result of trauma, scarring or previous surgeries. Entropion can affect adults or children.
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Excessive Tearing in Infants and Adults

Tearing may occur as a reaction to dry or irritated eyes or as a result of problems with the tear drainage system. A number of structures must be in perfect working order for tears to drain normally: the eyelids must be in the proper position to channel the tears to the opening of the tear duct drain, the drain opening must be large enough to accommodate the flow of tears and the drainage ducts themselves must be open. A simple analogy that will help the layperson understand this better is the way water goes down a kitchen sink drain. If the water sits on the countertop and does not flow into the drain, it will simply pool and eventually drain over the edge; if the opening to the drain is too small, the water will eventually overflow; and, finally, if the drainpipe under the sink is blocked, the water will not drain successfully. Problems with tear drainage may occur with laxity or malposition of the eyelids, narrowing of the opening to the tear duct drainage system and blockage of the tear duct themselves.
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Functional Blepharoplasty of the Upper Eyelids

Due to the effects of time, heredity and environmental influences, the upper eyelids can become heavy. When the lids become too heavy, they can limit our side or peripheral vision, thus affecting our ability to drive and do other activities of daily living comfortably. In these cases, surgical treatment can lead to improved peripheral vision and a better quality of life.
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Orbital Fractures

The eyes sit in bony cavities known as the orbit. Each orbit has a roof, a floor and two side walls (one near the nose and the other near the ear). The bone around the front of the orbit and the outside wall is relatively thick and strong, while that making up the floor and wall nearest the nose is extremely thin (like eggshell). It is not uncommon for one or more of the bony walls of the orbit to break following blunt trauma as may be caused by falls, accidents or trauma.
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Orbital Tumors

The eyes sit in a bony space referred to as the eye socket or, in medical terms, the orbit. In addition to the eye, the orbit contains the nerves, muscles, blood vessels, fat and other tissues that help the eye function properly and protect it from injury. In rare circumstances, tumors may arise from those structures normally found in the orbit or may spread to the orbit from a distant location.
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Skin Cancer of the Eyelids and Face

Skin cancers commonly affect the eyelids. Most of these tumors are treated with surgical removal, a procedure that creates a defect once the tumor has been removed . Repair of eyelid defects is always performed with the goal of producing the best functional and cosmetic outcome. Small defects may be repaired quite easily with a minimum amount of work while reconstruction of larger eyelid defects can require more extensive surgery. Recovery times after eyelid reconstruction are typically related to the amount of surgery performed.
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Thyroid Eye Disease

Graves’ thyroid disease causes inflammation and swelling of the fat and muscles surrounding (including behind) the eyes. There are many ways in which the eyes may be affected by Graves’ disease: red, swollen, painful eyes, protrusion of the eyes, very wide opening (retraction) of the eyelids that may result in a “staring” appearance, excessive tearing, blurred vision, sensitivity to light, an inability to close the eyes completely, crossing of the eyes and even loss of vision. Patients who smoke cigarettes are known to be at greater risk for serious complications of thyroid eye disease. Smokers who develop Graves’ disease must stop smoking.
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Treatment of Blind Painful Eye

The discomfort associated with some blind eyes can be so great as to impair one’s ability to work, sleep and function.

  • Medical treatment for blind, painful eyes is usually unsuccessful.
  • Surgical treatment of blind, painful eyes is extremely successful in relieving pain and typically produces highly favorable cosmetic outcomes.
  • Enucleation refers to the removal of the entire eye.
  • Evisceration refers to the removal of the eye’s contents, while the white, outer wall of the eye and the muscles controlling eye movement are left intact.
  • An artificial eye is typically fashioned six weeks following enucleation or evisceration surgery.
  • Due to injury, disease, or surgery eyes can sometimes become blind and painful. The pain can be severe enough that affected individuals are unable to work, sleep, or function normally. When this occurs, special treatment is required.

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