weight loss face

it is very clear that i had ptosis at birth.i did not have surgery until i was around 4 or 5. what is the cost of this? i checked into having this surgery done afew years ago but since it did not interfere with my vision, it was considered cosmeticso insurance would not cover it. i would like to have the surgery done. i feel it is onlygoing to droop even more as i get older. it

weight loss face, is not a neurological problem. i wonder whatthe cost is for this surgery and how complicated it is? in addition, is it too late for meto have this surgery done? i was teased as a child quite a lot. thank you for your question!

you submitted some photos and you mentionedin your question that you have congenital ptosis. you did have surgery when you werearound 4 and 5 years of age and that apparently you had difficulty with insurance coverageseveral years ago because it wasn’t blocking your vision enough. and you keep asking severaltimes about the cost of the surgery. so, i’m going to explain to you a little bit aboutthe challenges that are unique to someone who is a little bit older who has congenitalptosis and i’ll share with you how we approach and evaluate and then make recommendations.this will also help give you understanding of what the cost will be even though you stillneed to have an examination before you can determine this and i’ll give you my opinionon insurance companies and coverage in this

type of stuff. first of all, congenital ptosis means thatthe muscle that lifts the eyelid called the levator like the word elevator did not developfully during gestation. it tends to run in families but sporadically. except for exceptionalfamily patterns, most of times, it just tends to express differently so several siblingscan be born and only one may have ptosis. anyway, the point is that, this muscle caneither be mildly affected in terms of the level to severely affected in terms of thelevel and the actual activity that of the muscle can be everything from fully functionalto very weak. so when we do a ptosis examination, we look at a patient and see what their eyelidlevel is, see how much it blocks their pupil

and we ask them to look down and up to establishhow much muscle function they have. from an ophthalmologic point of view, from the pointof view of eye health, we also want to look at conditions such as dry eye and also somethingcalled bell’s phenomenon where the eyes roll, it’s a protective mechanism to makesure that the eye rolls a little bit so that when you are sleeping, even if your eyes opena little bit, that they’re still protected. all of these are very important factors. so in choosing the type of surgery, it’sbasically divided into those with good enough muscle function versus those who have no musclefunction. those with good enough muscle function, we’ll typically do something called a levatormuscle resection and that means shortening

this muscle so that eyelid can come up. sowhen you shorten that muscle, that means that the eyelid will open but it will not relaxand close the exact same way as the other eye. and in addition, you have to be prepared,you also add lubrication to your eyes as part as your post-operative care for the long term.one of the things especially people who are older have to understand that almost everyonebeyond the age of 40, has some degree of dry eye and the older you get, the dryer youreyes get. so when your eyes are drooping, it’s actually covering more of your eyeand you’re actually not as exposed when the eyes open, the eyes are more exposed.so you’re going to have to use some type of strategy to make sure that the eyes areproperly lubricated.

something that i didn’t mention, even ifyou have congenital ptosis and a common speech i have for patients who have congenital ptosisis that, it is not surprising for people who have ptosis to have more than 3 operationsin their lifetime. one in childhood for visual development, one at adolescence to early adulthoodfor aesthetics and one in later in life because as the tissue stretches and the facial agingprocess goes on, you’ll need it for more functional and aesthetic reasons. now, another type of ptosis affects peoplewho don’t have congenital ptosis and this is called levator muscle dehiscence or aponeuroticptosis. this is a normal age-related attenuation or thinning of the muscle that causes theeyelid to droop. so you may be dealing with

that in the other eye and so an examinationhas to be established whether or not there’s any merit to addressing the other eye at thesame time. there’s something called hering’s law where we actually lift the more droopyeyelid and very often, the other eyelid actually descent. it has to do with amount of signalthat is generated by the brain to push the eyelid open but is something that is a partof an examination to determine the optimal procedure. now the other option besides a levator resectionis a procedure called a frontalis sling. it is done routinely in younger children butwhen it is done for an adult, there is a challenge here. when the child has a procedure likethis, their eyes are open all the time particularly

when they are sleeping but because they areyoung and they produce a lot of tears and they have a functional bell’s phenomenaand there’s stretch, with time, they don’t end up with dry eye symptoms. you do thisprocedure on an adult, you have one eye that is actually always open and to summarize,it’s actually a procedure where the forehead muscle called the frontalis muscle is connectedwith the eyelids so that when you raise your eyebrows which you do now flexibly, you actuallyable to force the eyelid effectively open because your using the muscle activity ofthe frontalis muscle to lift the eyelid. that’s one eye that actually has to be forced toblink while the other eye blinks normally. and it takes a long time for an adult to acclimateto this. it’s kind of like a teaching your

body and brain to create new habits. therehave been times when i’ve done this procedure where i actually have to go back and releasethe eyelid in order to protect the eye more even though the aesthetic result was so nicebecause of tearing and eye irritation. so that means that you really need a very thoroughexamination and evaluation. in terms of the cost of this procedure, you’regoing to have to see if your doctor that you choose accepts insurance and is willing togo through the process of insurance approval. the problem with the modern world and whyover 10 years ago i stopped accepting any kind of medical insurance is that insurancecompanies are openly deceptive in their practices. they will approve a procedure and then lateron deny the procedure. or they will go back

and audit doctors and say their proceduresare not indicated and ask for refunds and i never live for that but i saw how very deservingpatients whose eyes are completely closed where denied by insurance companies. and basically,as much as they play the game of working around legal contracts, they’re essentially practicingmedicine as far as i’m concerned so i have nothing but contempt for insurance companies. so as far as that financial hurdle is concerned,you’re going to have to try and find a doctor that either accepts insurance and is willingto go through that with you or find a doctor who you can afford but of course, cost isa factor and the procedure does require, in our practice for example, a surgeon fee, anesthesiaand facility costs which are part of delivery

high quality care. you never want to do shortcutsor go cheap in such a type of procedure. so that being said, you need to meet with doctorsand most likely, you’ll meet with oculofacial or oculoplastic surgeons who have extensiveexperience in this area. most general plastic surgeons are not trained in this area anddon’t really practice this so you’ll not likely find too many whose willing to do thistype of surgery. but meet with doctors and so who you are comfortable with and figureout what options you are comfortable with and moving forward, i wish you the best ofluck, i hope that was helpful and thank you for your question!