Ask Dr. Barber

baberpicQ. My upper eyelid skin is hanging down and makes me look like my eyes are closing.  This is a family trait, as both my dad and his dad’s eyes looked just like mine do.  I am only in my 40’s and very healthy.  When is the right time to do something about this excess eyelid skin?  Is it something insurance will cover?

A. The medical term for what you are describing is dermatochalasia.  It is a condition of excess upper eyelid skin that hangs down toward the eyelashes and frequently covers much of the “eye shadow” portion the upper eyelid skin.  The excess skin can give the feeling of heaviness of the upper eyelids and, in addition, can make the eyes look smaller.  When it is severe, there can actually be some loss of peripheral vision because the excess skin blocks the full range of vision.  When the problem reaches this point, insurance will usually cover the cost of the surgery.  There is a very simple and painless test that is performed by an optometrist or ophthalmologist that can determine whether the excess skin is causing a visual field loss.  You must have this test performed by the eye doctor and it must demonstrate loss of vision before insurance will approve the surgery.  A quick rule of thumb that I use to predict whether the visual field test will be positive is if the eyelid skin is resting on your eyelashes when your eyes are open, there is a good chance that you are experiencing some peripheral visual field loss.

The operation to correct this issue is performed under twilight anesthesia, takes about an hour to complete, and will limit your physical activities for about a week to 10 days.  You can expect bruising and swelling after the surgery, however there is little to no pain.  As for when is the best time to do this surgery, it is totally up to the individual.  If there is loss of peripheral vision, I would say that now is the time.  If there is no visual field deficit, then you can do the surgery when it works into your schedule.  For most patients, the results of the surgery last a long time, and typically will not need to be repeated.


Q. I am 18 years old and will be starting college in the fall.  I have very large breasts (DDD cup) and I am embarrassed about their size.  I have tried to hide my breasts for most of my life but they are very hard to minimize.  At what age is it appropriate to consider breast reduction surgery?  Am I too young?

A. The correct age to consider breast reduction is after you are certain that the breasts have stopped growing.  That is usually after the age of 16 or so, but most plastic surgeons prefer to wait until the patient is 18 or older.  By 18, there is very little chance that the breasts are still in their growing phase.  If you are not happy with your breast size, then breast reduction is certainly a possibility.  Large breasts can be uncomfortable from both a physical standpoint as well as an emotional one for many young women.  It can certainly limit some physical activities and often will affect what kind of clothes that can be comfortably worn.  Over time, large breasts are often associated with upper back, neck, and shoulder discomfort.  Depending on the severity of a patient’s symptoms, insurance companies will sometimes pay for the surgery, however in recent years it has become progressively harder to get approval.  I would urge you to speak with your parents about your feelings and then seek a consultation with a board certified plastic surgeon.  The visit with the plastic surgeon will determine if you are a good candidate for breast reduction surgery and you will learn about the details of the surgery along with expected recovery.



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