Browplasty also known as a browpexy, forehead lift, or brow lift is a surgical procedure that 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 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, wrinkles or loss of elasticity in the brow region.
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.
See also: Blepharoplasty
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)
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits, or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
American Society of Plastic Surgeons. (2008). Brow lift. Retrieved September 16, 2008 from http://www.plasticsurgery.org.
Danile, R., Kosina, A., Sajjadian, A., Cakir, B., Palhasi, P., Molnar, G. (2013, September) Rhinoplasty and brow modification: a powerful combination.Anesthesia Surgery Journal 1:33(7):983-4. Abstract retrieved February 22, 2017 from PubMed database.
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. (Level 5 evidence)
Horn, C. E., & Thomas, J. R. (2007). Subgaleal endoscopic browlift with absorbable fixation. Otolaryngologic Clinics of North America, 40 (2), 267-281. (Level 5 evidence)
Nahai, F. (2013, January). The varied options in brow lifting. Clinical Plastic Surgery, 40 (1), 101-4. Abstract retrieved February 12, 2018 from PubMed database.
Palmetto, Government Benefits Administrators. (2018, February). Local Coverage Determination (LCD): Blepharoplasty, Eyelid Surgery, and Brow Lift (L34411). Retrieved February 22, 2018 from https://www.cms.gov/.
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.
ORIGINAL EFFECTIVE DATE: 2/8/2009
MOST RECENT REVIEW DATE: 3/8/2018
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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