The $21,000 Eye Lift

Scenario: Age 45, the "morning mirror blues", time for a pick-me-up birthday present to yourself, time to make your slightly tired eyes look as energetic as the rest of you still feels.

After reading about lid lift surgery in several magazines, you peg the costs at somewhere between four to five thousand dollars and budget that amount into your lifestyle. Months pass, the money is saved, your vacation time has been scheduled, and you're eager to move forward. After checking with your local eye doctors, you settle in on Dr. X, a plastic surgeon well known for his stunning results. In walks the doctor and--at last--your consultation begins.

Thirty minutes later, you're convinced that you've come to the right surgeon. Dr. X is polite, thorough, and intelligent. He listens carefully to your reasons for requesting lid surgery and agrees that the bags on your upper and lower lids do need to go.

Just as it seems that your consultation is finished, though, he sits back, takes a long look at your face, and then tells you that a blepharoplasty alone will do little to eliminate your wrinkles. He asks you if your wrinkles bother you. Well, you think, who really is attached to their little wrinkles? Dr. X goes on to explain how with a laser he can readily soften those wrinkles not just around your eyes but over your entire face. He shows you a picture of a recent patient who has had exactly the procedure he's described. You have to admit that her skin does indeed look wonderful, not that your own tiny crowsfeet ever bothered you.

Then Dr. X holds up a mirror and asks you to take a look at your brow. Has it fallen, he wants to know, a question that takes you by surprise because the idea has never before entered your mind. He uses his finger to lift gently upward at the outer corner on the eyebrow and--yes, it's hard to deny that what he's doing doesn't make your upper lid look better. He explains how the brow and forehead provide the foundation from which the eyelids hang and how if the brows are sagging, the upper eyelid skin may appear baggier than it really is. You can really tell that this doctor knows what he's talking about, not that your brows have ever really bothered you.

Then Dr. X asks you to take a closer look at your lower eyelid while he points to a slightly hollowed area just below the bulging fat. He explains how the fat and muscles of the cheek relax over time and how this gravity-driven descent can alter the lower eyelid-cheek continuum, as he calls it, and leave you with a concavity where there should be convexity. If you stare hard enough into the mirror, yes, you can see what he talking about, not that this little hollow has ever really bothered you.

Then Dr. X patiently and thoroughly explains how each of these problems that are contributing to the appearance of your eyelids can be fixed. His bedside manner is superb, and you just know that you can place your total confidence in his abilities. You feel your enthusiasm for surgery growing and can already imagine the "new" you.

The consultation ends as Doctor X introduces you to Nurse Y, his assistant in charge of surgery scheduling and patient counseling.

"Absolutely!", you tell Nurse Y, you're ready to fix your eyelids. Great, she says, as she dutifully prepares a written statement of your anticipated charges. And while she thumbs through her appointment book to find the next opening, you glance down at the piece of paper and try hard not to gasp.

$16,000 is what it says. Sixteen grand! At first you feel shocked, but then reality hits hard and you ask Nurse Y to explain the fees, which she does in a most professional manner.

Your upper and lower blepharoplasty will cost you $6,000. Your endoscopic brow lift will add another $6,000. Your midface lift runs a cool $6,500. And your laser resurfacing procedure tacks on another $4,0000. Your total adds up to $22,500, but Nurse Y has agreed to generously shave off $6,500 if you agree to have all of the procedures performed simultaneously.

Oh, yes -- but that total doesn't include the extra fees for the surgicenter, the anesthesiologist, the lab studies, a long list of pre- and post-operative medications, and the two nights in a specialized recovery center. While Nurse Y can't quote you an exact price for such services and supplies, she estimates them to run around $5,000.

Too embarrassed to protest, you tell Nurse Y that you need to check your calendar before scheduling (not true) and promise to call her back in a day or two. You walk out of the office both dazed and deflated and then vaguely remember the television story about the thirty-two year old Hollywood model who spent $58,000 "rejuvenating" her already beatutiful face. But, really--why should fixing your eyelids cost you well over $21,000?

It doesn't! Fixing your eyelids will run you the cost of a blepharoplasty from which you will get quite a "bang for your buck."

But fixing everything connected to your eyelids or even remotely contributing to their appearance will cost you a whole lot more.

Unlikely scenario? No, it happens all the time (and often the prices are much higher).

Is Dr. X taking his patient to the cleaners or using bait-and-switch tactics? Not in this example. Our particular Dr. X happens to be as reputable as they come and is simply educating an inquiring patient about absolutely everything that can be done to improve the appearance of her lids.

Recall the childhood song that went, "Foot bone connected to the leg bone. Leg bone connected to the knee bone. Knee bone connected to the thigh bone," and so on and so forth? The song is absolutely true, although in this case it could be rewritten to sound something like, "Forehead connected to the eyebrows. Eyebrows connected to the eyelids. Eyelids connected to the midface. Midface connected the wrinkles" and on and on.

The moral? There is no moral. This story is not a morality play but rather a simple fiction intended to demonstrate the consequences of some practitioners' aggressive approach to "comprehensive" eyelid-facial rejuvenation surgery.

Yes, these operations do exist. And, yes, if money (and risk and recovery times) were of no object, it would be wonderful for each and every patient to take full advantage of all the latest and greatest, even if some of the procedures yield only a subtle effect.

But is it truly necessary to undergo so much surgery just to make your eyelids look better?

Of course not!

Okay, but are you harming yourself by doing so much less?

No, not in the hands of a knowledgeable and experienced surgeon.

Well, then, will your result be less dramatic? Possibly by a little, although possibly not at all, especially if the changes in the surrounding facial structures are not that prominent relative to the changes in your eyelids.

And if you're still searching for a moral as this story now ends, perhaps this will do:

Cosmetic surgery around the eyes may or may not be limited to blepharoplasty, depending on the state of your face and just how aggressive you and your surgeon wish to be. Not everyone is after the exotic glamour look that can often broadcast "I've had plastic surgery!"

And also this: To be successful, blepharoplasty does not require total facial rejuvenation.

• Dr. Meronk's Fees

• The Natural Blepharoplasty

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