Fresh eyes: will Medicare cover your eyelid surgery?

While it’s natural for the skin around our eyes to age, it’s also natural to wish things were different (especially if Medicare is covering most of the cost…).

By Citro Partner Pirk

It’s not pleasant when our skin starts to crinkle and sag, but it’s actually normal for skin to lose elasticity as we age. This is due to decreasing levels of collagen and elastin, the 2 proteins that give skin its strength and stretch.

Most of us accept the wrinkles and droops as simply part of getting older, but others are keen to fix it.

This isn’t just because ageing skin can affect confidence and self-esteem, but because for some it can alter quality of life. 

Many older patients seek upper blepharoplasty treatments (or upper eyelid surgery) to correct excess eyelid skin that droops to the point where it compromises peripheral vision or causes a visual field defect. Patients who require a blepharoplasty for recorded clinical reasons like this may be eligible to receive a Medicare rebate of up to 75% of the procedure costs covered.

As well as being a corrective surgery, however, blepharoplasty can also be carried out on patients looking to restore the shape of their eyelids and eyelid folds. But if you have eyelid surgery purely for cosmetic reasons, are you also eligible for the upper blepharoplasty Medicare rebate? 

5 different blepharoplasty procedures

There are 5 different types of blepharoplasty procedures. If any of these procedures are considered medically necessary, you may be eligible for Medicare cover.

  1. Upper blepharoplasty – performed to correct the upper eyelid.
  2. Lower blepharoplasty – performed to correct the lower eyelid.
  3. Bilateral eyelid surgery – performed to correct both the upper and lower eyelids in a combined procedure.
  4. Double eyelid surgery – performed to correct monolid eyelids, or patients (typically of East Asian descent) who have epicanthic folds. Double eyelid surgeries are designed to create natural looking folds (or supratarsal creases) that pull eyelids higher and make the eyes look larger.
  5. Transconjunctival eyelid surgery – performed to remove excess fat pockets situated around the eyelid and to correct pronounced eye bags.

Both upper and lower blepharoplasties tend to be completed faster than the latter three, with these first two surgeries typically only taking 1-2 hours from start to finish. Bilateral eyelid surgeries can take upwards of 3 hours, as precise incisions will need to be made on both eyelids. These incisions are typically made within the eyelid’s natural crease to reduce the likelihood of visible scarring.

Like the other types of blepharoplasty procedures, both double eyelid and transconjunctival eyelid surgery may involve surgeons making precise incisions to excise fatty tissue and loose skin. These unique blepharoplasty procedures may also, however, involve using the double suture and twisting technique (or DST), a process of strategically placing sutures to compress the eyelid in order to create a more natural crease.

Eligibility for blepharoplasty Medicare rebates

If your doctor believes that you could benefit from one of the five different types of blepharoplasty procedures for medical reasons, you may be eligible to receive a Medicare rebate on your eyelid surgery.

However, the Medicare Benefits Schedule for eyelid surgery is designed only to offer support for those that meet their defined patient criteria. Here is the Medicare criteria for eligibility to receive the blepharoplasty (eyelid surgery) Medicare rebate:

  • Patients with obstructed peripheral vision (i.e. a visual field defect) as verified by an optometrist or ophthalmologist.
  • Patients with fat herniation that results in exophthalmos (bulging or protruding eyeballs).
  • Patients with facial nerve palsy.
  • Patients whose excess eyelid skin or tissue has caused an intertriginous inflammation of the eyelid that has further risks of developing infection.
  • Patients with post-traumatic scarring.

All patients who may be eligible under these criteria must also possess medical records that support the above conditions. This means developing photographic and diagnostic imaging assets that clearly demonstrate the patient’s need for a clinical blepharoplasty procedure.

Cosmetic reasons not eligible

As the Medicare Benefits Schedule is designed to only provide rebates for clinical procedures, any patients that are looking to schedule a blepharoplasty procedure for non-therapeutic cosmetic purposes are unfortunately unlikely to be eligible for the rebate.

There is, however, every chance that your blepharoplasty specialist or ophthalmologist may be able to diagnose you with one of the conditions listed above during your preliminary blepharoplasty consultation.

If you are able to receive a diagnosis and have photographic or diagnostic images that support that diagnosis, then you will be able to apply for the eyelid surgery Medicare rebate with the support of your trusted healthcare professionals.

So if you have reason to believe that your sagging or drooping eyelids are obstructing your vision, or causing skin irritation or inflammation, then let your GP know prior to consulting your blepharoplasty specialist. Your GP can then help determine whether the procedure is medically necessary. 

Disclosing this information may help you attain the eyefold surgery Medicare rebate and save up to 75% of the costs associated with your blepharoplasty procedure. That said, the rebate coverage you’re eligible for depends on a range of factors (including whether you’ll be undergoing the procedure at a private or public hospital).

The information on this page is general information and should not be used to diagnose or treat a health problem or disease. Do not use the information found on this page as a substitute for professional health care advice. Any information you find on this page or on external sites which are linked to on this page should be verified with your professional healthcare provider.

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