Browplasty
DESCRIPTION
Browplasty, also known as a forehead lift or brow lift, is a surgical procedure. The procedure removes excess tissue and tightens the muscular structure in the brow region. Browplasty can be either reconstructive (functional) or cosmetic (aesthetic).
Reconstructive browplasty is designed to restore function that has been altered due to the disease process, surgery, trauma, accident, or injury resulting in brow ptosis.
Cosmetic browplasty is a surgical procedure to improve an individual’s appearance due to sagging tissue and loss of elasticity in the brow region.
POLICY
Reconstructive browplasty for the treatment of brow ptosis is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Non-reconstructive browplasty is considered cosmetic.
MEDICAL APPROPRIATENESS
Reconstructive browplasty for the treatment of brow ptosis is considered medically appropriate if ALL of the following criteria are met:
Documentation of functional deformity as evidenced by visual fields
Photographs exhibiting significant functional congenital or acquired deformities, deformities beyond normal variations (color photos preferred)
SOURCES
American Society of Plastic Surgeons. (2008). Brow lift. Retrieved September 16, 2008 from http://www.plasticsurgery.org/patients_consumers/procedures/CosmeticPlasticSurgery.cfm#six.
BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2003). Reconstructive/cosmetic services (10.01.09). Retrieved July 22, 2008 from BlueWeb. (0 articles and/or guidelines reviewed)
Henderson, J. L., & Larrabee, W. F. (2007). Analysis of the upper face and selection of rejuvenation techniques. Otolaryngologic Clinics of North America, 40 (2), 255-265.
Horn, C. E., & Thomas, J. R. (2007). Subgaleal endoscopic browlift with absorbable fixation. Otolaryngologic Clinics of North America, 40 (2), 267-281.
Krist, J. D., & Goco, P. E. ((2006, July). Browplasty. Retrieved July 9, 2008 from http://www.emedicine.com/ent/fulltopic/topic100.htm.
U. S. Food and Drug Administration. (2006, June). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K060249. Retrieved July 22, 2008 from http://www.fda.gov/cdrh/pdf6/K060249.pdf.
Zins, J. E., & Moreira-Gonzalez, A. (2006). Cosmetic procedures for the aging face. Clinics in Geriatric Medicine, 22 (3), 709-728.
ORIGINAL EFFECTIVE DATE: 2/8/2009
MOST RECENT REVIEW DATE: 2/8/2009
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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