Flying into Denver for an eyelid procedure: Convenience vs “Doing the right thing”



A number of patients who fly in for eyelid procedures in Denver often want to fly in, get their procedure and fly out. Though that can work for certain procedures, but other procedures need careful analysis and dedication by the surgeon to make sure that everything goes smoothly. Procedures such as eyelid lifting to skin cancer removal are serious undertakings. Convenience is something that all patients want, but sometimes going through the right steps are the most important thing. Below are some key issues that out of town patients don’t think about.

Is this the right procedure?

Sometimes patients may have a perception what procedure they need. They may research online gold or even denvereyelid.com. Maybe they want to fly in for a blepharoplasty. Other times, it is an eyelid lift or eyelid cancer removal. They may have googled or had a friend who had a similar procedure and believe that is what they need.Then they fly in for the procedure. I examine them. After the examination I realize that in fact, they need a totally different procedure to fix the problem. A patient for example may think they need a blepharoplasty but in fact they have weakness of the eyelid muscle (this is called ptosis). This muscle weakness may be something that they were born with which means to fix it, they need a silicone thread to be placed in the eyelid. This thread needs to ordered and present in the operating room ahead of time. The case gets cancelled. The trip was a complete waste.

Has all the testing been done ahead of time for this surgery?

Some simple problems of the eyelid, eye socket and face are actually not that simple. An example is a growth on the eyelid or face. A superficial growth on the face or eyelid may be a large growth that is now only peaking out on the surface. I once had a patient who had a growth on the temple and asked me if I could remove it in the office. I ordered imaging (a cat scan) and determined that the it in fact was a brain tumor that had extended to the eyelid surface by its large growth. If I had surgically gone in without checking, I certainly would have entered the brain. It may have resulted in death. The patient was upset when I ask them to get a cat scan first and the case had to be cancelled and rescheduled. They felt differently when the tumor was found. Proper testing is critical to make sure that a catastrophe is avoided.

Has the proper preop testing and clearance been done?

Before a patient has surgery, they need to go through the proper testing. If a patient has an undiagnosed heart murmur or bleeding disorder, tragic events can occur during their procedure. That is why it is critical for patients to get clearance from their doctor before surgery. A young patient may believe “I feel healthy. What’s the big deal?”. Unfortunately, many medical problems are diagnosed during procedures with near calamity or calamity events. A patient has undiagnosed breathing disorder and when they undergo a procedure, they end up stopping their breathing. That is something that should be tested before a procedure is performed.

I have had patients who have driven from Nebraska for a procedure to have their eye socket biopsied. Since they did not know, they scheduled an “office appointment”. The patient comes to the office and asks are me if the procedure is going to be done that day. Well, the operating room needs to be set up. Staff need to be called in. The proper instruments need to be there. They haven't stopped their blood thinners before surgery. Undergoing surgery is a mistake in those situations.

If this is a medical issue, has the insurance company preauthorized the procedure?

Most medical procedures have to be cleared by the insurance company. This usually takes two weeks and necessitates an initial consultation or chart notes to be approved. It is not something that one can “do over the phone” or send a photograph from home. An initial consultation is needed to determine what surgery is to be authorized. Otherwise the patient may be on the hook for thousands of dollars if it is not approved.

Summary

Any patient that is undergoing a procedure needs an initial consultation to determine exactly what the problem is and what needs to be done and what special equipment is needed for the procedure. Then they need counseling to know what to do before surgery. If it is a medical issue, it has to be preauthorized with the insurance company. Further tests may or may not need to be ordered. Blood thinners need to be stopped. Once they come for their surgery, a followup appointment needs to be made. Eyelid, Eye Socket and Tear duct surgery is unfortunately not a “drive by” experience. The right steps have to be done to prevent a monstrous complication and the right things are done for the patient.


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