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Blepharoplasty... Changes to Medicare

Upper eyelid surgery (or blepharoplasty) involves removing excess skin from the eyelid. As we age the skin of the upper eyelid can become loose, which can lead to a number of problems. It can cause irritation and infection; it may start to interfere with vision - acting as a shade over the visual field, and the constant activation of the forehead muscles to lift the excess skin up and out of the visual field can lead to headaches. Some people also choose to have the loose skin removed for primarily aesthetic reasons before it has a corresponding functional problem.

Medicare is the Commonwealth Government of Australia’s universal health scheme. It includes some operations performed by Plastic and Reconstructive Surgeons if they are classified as medically necessary as opposed to operations performed for purely aesthetic reasons. If a procedure is deemed medically necessary, there will be a Medicare Item Number assigned to it. If there is an item number there will be some kind of rebate; there may also be ‘out of pocket’ costs also.

Until 1 November, blepharoplasty is eligible for a Medicare rebate if the upper eyelid skin is seen to be resting on the eyelashes when looking straight ahead thereby obscuring your vision. Other indications for the surgery that attract a Medicare rebate include: addressing injury including skin scarring or nerve damage, and addressing problematic fat bulging from the eye socket - often related to thyroid disease. Currently, the assessment of the degree of visual obstruction has rested on individual patient reporting, followed by confirmation of this by a Doctor’s physical examination with no special investigations required.

In the last few years, the Department of health has been looking at the Medicare schedule to ensure Medicare is not being used for purely cosmetic surgery purposes. Changes in the Medicare Benefits Schedule have been announced for item numbers thought to be at risk of cosmetic misuse - including blepharoplasty. Effective from 1 November this year, patients will be required to have visual obstruction related to excess upper eyelid skin confirmed by an optometrist or ophthalmologist in order to be eligible for a Medicare rebate.

The criteria for Medicare rebates for Plastic and Reconstructive Surgery means that not all people will qualify for a rebate and even fewer people after the 1st of November. People who do not qualify for a rebate might still benefit from the procedure. People who feel there is excess upper eyelid skin that is becoming evident in their visual field or those suffering skin and eyelid irritation or a feeling of heaviness due to the skin may still benefit from the surgery even if formal visual field testing does not yet reveal an abnormality. In some ways, this may be addressing the problem before it becomes too severe.

The best way to determine what your procedure will cost, with or without a Medicare rebate and private health insurance, is to have a consultation with a Specialist Plastic and Reconstructive Surgeon who will spend time talking with you about your concerns and determine with you the most appropriate surgery, including all of the risks and benefits and costs involved.

Medicare does not pay for hospital admission into a private hospital - this is considered one of your ‘out of pocket’ expenses - although your private health insurance might cover this cost if a Medicare item number applies to your surgery and you have the appropriate level of cover.

An uncomplicated upper eyelid procedure is generally a day surgery in an accredited hospital, lasting under one hour, depending on any additional operations, with another hour of recovery time before the patient can go home. Bruising and swelling usually subsides 1-2 weeks after the operation, and approximately one week off work is recommended. The full results can take six months to a year to take effect.

Dr Avery has operated as a Plastic and Reconstructive Surgeon in the Hunter region for over five years, treating over 5000 people with reconstructive or aesthetic procedures.

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