BlueCross BlueShield of Tennessee Medical Policy Manual

Browplasty

DESCRIPTION

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.

POLICY  

See also:  Blepharoplasty

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

SOURCES

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

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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