BlueCross BlueShield of Tennessee Medical Policy Manual

Browplasty

DESCRIPTION

Browplasty, also known as brow lift, forehead lift, and browpexy, is generally performed as a cosmetic procedure; however, it may also be performed to repair severe brow ptosis resulting in excess tissue being pushed into the upper eyelid causing visual impairment. Browplasty may be performed alone or in conjunction with blepharoplasty to achieve a satisfactory functional repair.

Most cases of brow ptosis occur secondary to age-related changes of the periorbital soft tissues and soft tissues of the face. Brow ptosis may also occur secondary to paralysis or weakness of the frontalis muscle (e.g., facial neve palsy, myasthenia gravis, myotonic dystrophy, oculopharyngeal dystrophy), blepharospasm, facial dystonias, or cancer.

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 

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

SOURCES

American Academy of Ophthalmology. (2018). Brow ptosis and repair. Retrieved December 5, 2018 from https://www.aao.org.

American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). (2014). White paper on functional blepharoplasty, blepharoptosis, and brow ptosis repair. Retrieved December 4, 2018 from https://www.asoprs.org/.

CMS.gov. Centers for Medicare & Medicaid Services. Palmetto GBA. (2018, October). Blepharoplasty, eyelid surgery, and brow lift (L34411). Retrieved December 4, 2018 from https://www.cms.gov.

ORIGINAL EFFECTIVE DATE:  2/8/2009

MOST RECENT REVIEW DATE:  4/30/2019

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. 

This document has been classified as public information.