Dr Naveen Somia – Is Eyelid Surgery Functional or Cosmetic?

Dr Naveen Somia

Dr Naveen Somia:
I’m Dr Naveen Somia. I’m a plastic surgeon based in Sydney. This weekend I’ve been in Melbourne attending a conference about eyelid and facial cosmetic surgery. The prevalent question this weekend has been, is eyelid surgery predominantly functional or is it cosmetic? I feel that I should shed some light on that important topic.

In summary, eyelid dysfunction is a natural process of ageing, but the impact of eyelid dysfunction is quite significant that in the over 65’s it is a big fall risk. In other words, if you have visual impairment due to eyelid dysfunction, you will put yourself at a higher risk of falls in the over 65’s. In the under 65’s, it impacts productivity because nowadays a lot of productivity is based on computers and light-based devices, so your interaction with those is limited if you have some degree of eyelid dysfunction.

Very commonly my patients come and say that, “My eyesight is getting worse, but I went to my optometrist and he or she could not find anything wrong with it.” We tend to discount the role the eyelid plays in impacting your vision; visual fails enhance your interaction with your daily environment.

Over the last few years we’ve found an explosion in light-based devices, namely tablets and computers. As a result, Australians have been quoted as spending more time on devices – more than sleeping and that has put a lot of strain on the eyes. It’s a documented condition called computer-vision syndrome that if you spend more than three hours a day in front of a computer you have some symptoms. The eyelid has to keep open for such a long period of time and that ultimately puts a lot of strain on your muscle to keep it open. Over time, it could stretch.

There is no question that eyelid dysfunction is a predominantly functional impairment due to the degenerative process that we see with ageing. As a result, trying to rectify that structurally will result in a better functional outcome and a collateral benefit of looking good. The looking good aspect, improving appearance, is not the primary, but it is a secondary benefit. It is the same as say if you have an amputated fingertip and you put it back. Yes, you restore normalcy, you restore proportion, and hence aesthetics, but that is not the primary reason why a fingertip that has been amputated has been put back. It’s mainly for the function, but the secondary benefit is to improve the appearance.

Needless to say, anything that has been distorted by either trauma, accidents, cancer, or the degenerative process of ageing, if you restore things back to its normal anatomy it is seen as a perceptible difference and hence a visual improvement in the aesthetics. That does not make it a cosmetic procedure. A face lift is a cosmetic procedure. Yes, there is a significant improvement in appearance. The functional improvement is debatable, but compare that to an eyelid operation where the function impairment is critical.

That is kind of why I believe that an eyelid is a functional operation and it’s impact on the vision enhance the impact of decreased vision, on productivity, risk of falls, risk of accidents is still not very well documented and understood. Right now the Medicare Schedule looks at eyelid surgery as a medical procedure with the typical if it has an impact on your vision, then there is some degree of cover for the procedure. The health funds that subscribe to this theory do offer varying degrees of support based on your plan. As we speak, there is some degree of support with Medicare and the private health funds if you want to undergo eyelid surgery if eyelid surgery is causing some disturbance in the vision, if you’ve got a droopy eyelid causing ptosis, or an eyelid that is overhanging so much that it is affecting your visual fields.

Over the last nine years a lot of my practice has been focused around eyelids and periorbital rejuvenation involving the area around your eyelid. The bulk of my practice is that and I’m very happy to see you if you wish to come and consult with me. Very frequently, if you’re far away from Sydney, we usually request you send us some photographs and I can have an opinion emailed to you or we initially connect with you that way so that you don’t have to travel all the way to Sydney to see me. If we think it is reasonable to have eyelid surgery, then it is mandatory that you come and see me for a consultation. Thank you.