The Get Healthy Tampa Bay Podcast

E125: Is Eyelid Surgery Cosmetic or Medically Necessary? Oculoplastics w/ Dr. Jennifer Landy

• Kerry Reller

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Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, I’m joined by Dr. Jennifer Landy, a board-certified oculoplastic surgeon who specializes in eyelid, tear duct, and orbital surgery. In this episode, we dive into eyelid surgery—what it is, when it’s medically necessary, and how it’s different from cosmetic procedures.

Dr. Landy explains the three main causes of droopy lids, how to test for insurance coverage, and what recovery looks like. She also clears up myths about Botox and shares tips on determining whether this surgery is right for you. If your eyes feel tired, heavy, or you’re losing peripheral vision, this episode is for you!

Dr. Jennifer S. Landy is a board-certified ophthalmologist specializing in oculoplastic and reconstructive eyelid surgery. With over 15 years of experience, she combines advanced techniques—including radiofrequency surgery—with a compassionate, patient-centered approach.

Dr. Landy earned her medical degree cum laude from the University of Maryland and completed her ophthalmology residency at the University of South Florida, where she served as Chief Resident. She completed her fellowship in oculoplastics at the Older and Slonim Eyelid Institute.

She practices in Brandon (brandoneyeassociates.com), St. Petersburg (sight360.com), and has a cosmetic office in South Tampa (midtownaesthetics.com).

Outside of work, she enjoys traveling and spending time outdoors with her husband and two children.

0:28 – Meet Dr. Jennifer Landy: Oculoplastics explained
1:48 – What is eyelid surgery and why do people need it?
2:56 – Symptoms: Tired eyes, vision issues, and when to worry
4:40 – How droopy lids impact peripheral vision and driving
5:20 – Who qualifies for surgery: Medical necessity vs cosmetic
8:19 – Insurance coverage, testing, and approval process
10:58 – What to expect: Surgery, anesthesia, recovery timeline
13:40 – Risks, healing time, and how long results last
16:43 – Conditions that mimic droopy lids (e.g. myasthenia gravis)
20:07 – Nervous about surgery? What to expect at a consultation

Connect with Dr. Brandy
brandoneyeassociates.com
sight360.com
midtownaesthetics.com

Connect with Dr. Kerry Reller
Podcast website: https://gethealthytbpodcast.buzzsprou... 
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Kerry:

All right. Hi everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have Dr. Jennifer Landy here to share her expertise with us today. Welcome to the podcast.

Jennifer:

Thank you for having me.

Kerry:

Yeah. I'm excited to hear a little bit about who you are and what you do. So why don't you share that with us?

Jennifer:

So my name is Jennifer Landy. I'm an oculoplastic surgeon, so I specialize in surgery mostly of the eyelids, upper and lower, the tear ducts and the orbits.

Kerry:

It is very a unique, like specialty. You must have gone through a lot of training for that. How did, can you walk me through like what levels you needed to do

Jennifer:

Sure. So I, I actually started off in general surgery and I did a year of that, and then I transferred to ophthalmology. So I did an ophthalmology residency, and then I did a oculoplastic fellowship after that.

Kerry:

I knew it had to be a lot of years. When you're dealing with the eyes, you wanna be very careful and well-trained, right?

Jennifer:

Correct, correct. Everybody wants their vision to be intact,

Kerry:

Yeah. So what we're gonna talk about eyelid surgery today. So what exactly is eyelid surgery and what are the most common reasons that patients come to you for it?

Jennifer:

so I think there's kind of a misperception out there that all eyelid surgery is the same and it's not. There's three main things that a patient presents with that indicates that they may need eyelid surgery. The first is a brow ptosis, which means a droopy brow that could be impairing their vision or aesthetically unpleasing. The second is excess skin weighing over the lashes or the eyelid, and that will cause a heavy, tired feeling. And the third is an actual droopy eyelid itself. So there are three different things, and when you get to a certain age, most of my patients present with all three of them. That doesn't mean all three of them need to be addressed or fixed but I always go over what the patient has and what the best course of action would be. very

Kerry:

As always very educational for me because I don't think I was aware of the three different topics either. Go ahead, sorry.

Jennifer:

Most patients present to me with complaints of their eyelids feel heavy and tired. They feel like their eyes wanna close. They have difficulty reading because they feel like they have to lift their eyelids up to keep them open, and a big complaint is that their peripheral vision is being cut off and when they're driving, they feel like they actually need to turn their heads to change lanes because they can't see out of their peripheral vision.

Kerry:

Do you think sometimes they end up like to, to ophthalmology, to get eye testing sometimes until they get, you know, properly diagnosed.

Jennifer:

That's a great question because I think a lot of the population does not even know what eyelid surgery is and doesn't know that it could be the cause of their decrease in vision, and when I say decrease in vision, I don't necessarily mean decrease in vision reading a chart or reading small letters while you're reading a book. Their overall peripheral vision, how much light they're getting in is decreased when they have a droopy eyelid or droopy brow type of situation. So they perceive it as their vision is poor, but a lot of times it can be caused by the eyelids, not their actual vision. I have a lot of patients come to me and they said, my doctor said my glasses haven't changed in the last year. My prescription's the same, but I feel like my vision is very much decreased and they think it's due to my eyelids, and then we'll do an eyelid evaluation.

Kerry:

And why? I mean, it might just be structural, mechanical, but why? Why the peripheral vision affected the most.

Jennifer:

Because when the, there's an overhang of skin, it's almost like a hooding effect. And then people get a brow ptosis, and it's almost like it, it's in a slanting position where their brows tend to droop laterally. First or initially, and then you get a lot of hooding over the peripheral aspect of your eyelids, and that's the main cause,

Kerry:

So it just happens mostly laterally first, which is gonna affect them

Jennifer:

correct? Or that's where they notice it the most.

Kerry:

Yeah. Yeah. So how do you know if someone's a good candidate for eyelid surgery?

Jennifer:

So when they present to me, we go over what their complaints are and if they have the typical complaints then we do a full eyelid evaluation and. I have certain measurements I take, I document if they have brow ptosis, or too much skin hanging over their eyelids or a droopy eyelid. And then what we do is every insurance company requires that we get certain testing to prove to them that their eyelids are blocking their vision. We go ahead and get that testing and then we submit it to their insurance company and we wait for their approval. You know, the patients often say to me, am I a good candidate? And I'll say to them, well, there's definitely a surgery I can do on you. However, whether you're a good candidate or not mostly depends on how bothered you are by the droopiness of the eyelids, is it causing you impairment or difficulty with your activities of daily living? And that's the biggest question. And really the quick and dirty test is if a patient's unsure, I tell them to go home and while they're reading or watching television or doing, driving, doing any of their normal activities of daily living, lift up your eyelids like this. It's that simple. Lift it up and if it makes an improvement, then you'll do well with surgery. If it makes no improvement, then you probably wanna wait a little bit longer,

Kerry:

You already alluded to this a little bit, but so is, is it considered medically necessary versus cosmetic? And you mentioned insurance, so is it ever covered by insurance?

Jennifer:

The majority of my patients are through insurance. That's mostly my population. However they have to meet certain criteria and every insurance company is different. So I never tell a patient this is, you know, gonna be covered or not covered. We, we wait to get all the correct documentation and the testing and then we submit it to the insurance company. There are some patients that are not quite ready for eyelid surgery. They're, they don't meet the criteria and we tell them to come back in six months to a year as the situation never improves on their own. As we continue to age things continue to get more lax and they will get droopier as time goes on. So if they don't meet criteria at that point, then we will have them follow back up.

Kerry:

So well, one, what are the criteria and kind of can you walk us through the process of basically seeing you for the first time and then maybe how the surgery process goes and from like prep to recovery.

Jennifer:

Sure. So the criteria are a little bit different for every insurance company, and I'm not gonna bore you with all the measurements I have to take and the details. However their eyelid has to be a certain distance from their pupillary margin. When you shine a light on their eye they have to typically have pudding of the skin that's touching their lashes. They have to meet certain criteria on what we call a visual field test, where the general premise is they look in a machine and they're pressing buttons when they're in their droopy position. They technically should not be seeing a lot of lights when we tape up their eyelids simulating what the surgery would do. They should see a lot more lights, and that's what the insurance company wants to see. So that's, the very general type of criteria the insurance company are looking for. I think it goes a little bit beyond that, but, that's the, the short version of it.

Kerry:

Yeah.

Jennifer:

When a patient comes in to see me I ask'em what brings them in. I like to hear their complaints and make sure their complaints consistent with what a droopy eyelid would do. Sometimes I have unusual complaints where ophthalmologist has felt it was due to the eyelids, but it's not a typical complaint. So I like to hear their complaints. I like to see if it's consistent with the amount of droopiness they have. And then after I've done my exam, I explain to them what surgery I would recommend for them. I explain. How I would do it. I explained that it's an outpatient surgery done at a surgery center. The average surgery takes anywhere between 20 and 30 minutes to do both eyelids. Most of the time they're under a, mac anesthesia, which is just a light sedation, and they wake up and they feel good and they go home. I do explain to them that they will look like they were in a bar fight for about a week or two. They're swollen and bruised for about the first two weeks. And really the only restrictions they have afterwards for two weeks are that they can't lift anything too heavy. They can't go in a swimming pool for risk of infection and they can't exercise. So most, most other things they can do normally afterwards. And then we proceed to get the testing for the insurance and we submit it to their insurance and, and wait for their approval.

Kerry:

So you do the surgery and then wait for the approval?

Jennifer:

No, no, we, we get the approval first and then put them on my surgery schedule.

Kerry:

So do they require like a preoperative visit with their primary to get this kind of procedure?

Jennifer:

Great question. We, we do get medical clearance on every patient, so we make sure with their primary or their cardiologist or their pulmonologist, that they are optimized to undergo anesthesia. And that they can stop their blood thinners. Certain blood thinners need to be stopped for a certain amount of time. And yes, we do that on every patient.

Kerry:

Mm-hmm. Well, you mentioned it was like a two week that you're gonna look like you're in a bar fight. Right. What other, what other things can they expect from the recovery process? Or is there any side effects that they should be aware of?

Jennifer:

So I think the, the main side effects of eyelid surgery are, I always tell patients, when I lift up your eyelids, your eyes are gonna be more open. The biggest things you can expect are that your eyes might get more dry, and a lot of patients have dry eyes to begin with, so I tell them that it can get worse. I tell them that they might be more light sensitive, so a lot of them are already light sensitive from possibly having cataract surgery in the past, or they're just naturally light sensitive. And that that can be exacerbated. Sometimes their vision can change postoperatively, so I warn them about that and ask them not to get a new prescription before they do this procedure. But those are the three big things. So, in terms of healing, I tell patients full healing is six months to a year. That's mostly for the scar to heal, and since it's in the eyelid crease and the eyelids have the best supply blood supply in the body, it, it typically heals great with no. Lasting scar. However, I tell them the first two weeks is gonna be the roughest, not in terms of pain, but just in terms of swelling and bruising. And their vision may be a little bit blurry, so it's your eyes and you have to consider that. But by four to six weeks, they're pretty much back to normal. They can wear makeup, they can do all their activities. And at that point they're, they're pretty much doing great. But I tell them, for them to feel like everything feels a hundred percent normal, it may take six months.

Kerry:

Are there any risks associated with the procedure?

Jennifer:

I mean, there's always a risk of anesthesia. And you know, the biggest risk we have is, is really bleeding behind the eye. If somebody were to have that in almost 20 years of doing this, I have never had that. So, knock on wood but, you know, that's, that's the biggest risk. Other than that dry eyes, light sensitivity, and a slight vision change are really the most common things that they can expect afterwards.

Kerry:

So how do, like, is this just a natural part of aging or once it's fixed, is it gonna come back? Or how long do the results last? Like, can you explain a little bit how it happens in the first place?

Jennifer:

So the brow droop and the excess skin is a natural progression of aging. We lose elasticity and unfortunately everything starts to descend as we get older. When somebody has a droopy eyelid, it's usually a weakening of the muscle. You can be born with that. So we do see congenital ptosis or the muscle can just weaken over time. I had just operated on a 20-year-old who had droopy eyelids and it, the muscle just weakened. So it's not always age related, but the majority of it is age related. As to how long the procedures last. When I remove the skin, the skin never grows back. However, as we age our, we lose elasticity in our skin. And again, everything starts to descend. So the brow can continue to get droopy and you can get more of an overhang over the eyelid itself as you age, I tell patients there's nobody that can tell you how long this procedure is gonna last in you because a lot of it has to do with your genetics, which you have no control over and your lifestyle. And if you smoke or if you are a sun worshiper, you're going to age a lot quicker and you're gonna need another procedure a lot quicker. This may be your one and only procedure. So it just really depends on the patient.

Kerry:

Okay. Do is it more, I guess, do you see more men or women with this condition?

Jennifer:

I would say I, I see close to an equal number of, of each. However, I think women come in more Proactively. And a lot of the men come in'cause they say their wives tell them that their eyelids, that their eyes look closed all the time. But I see maybe 60% women and 40% men, but it's pretty close.

Kerry:

Okay. I wasn't sure if it was like a estrogen deficiency thing that would make it worse or anything like that. Okay.

Jennifer:

yeah.

Kerry:

So what, have you ever been referred a patient who had like my myasthenia gravis or anything else that can mimic this?

Jennifer:

Sure. I have had patients over the years that have had myasthenia, that have had ocular pharyngeal muscular dystrophy, CPEO Muscle Weakness Disorders, and they're kind of put in a category of their own.

Kerry:

Mm-hmm.

Jennifer:

But we absolutely can help them. We can lift their eyelids, but what I tell them is they will fall back down based on the nature of their disease. That's, that's not a reason not to lift them if they're disabled by them drooping, because they tend to have some of the droops eyelids because of their muscle weakness disorders. But. It will fall back down at some point, and we don't know if it will fall back down in a year or it will fall back down in 10 years. Nobody can answer that question. But they know based on their disease that it will.

Kerry:

Mm-hmm. Are there any nonsurgical options for people looking to improve the appearance of their eyelids and everything?

Jennifer:

So the short answer is no, but the longer answer is there is a drop that's been out on the market for a couple of years that, it's not inexpensive and you have to use the rest of your life every day. But in some patients, not all, it can lift the eyelids, a millimeter or two. But there is no substitute for removing skin or lifting the brow. That is surgical

Kerry:

So it's the eye drop.

Jennifer:

and eye drop, correct? Correct.

Kerry:

Yeah. Are there any, like other, I think you kind of already dispelled some myths, but any other myths or misconceptions you hear about eyelid surgery?

Jennifer:

I think the biggest thing is, is that patients come in to me and they think, oh, no big deal. I'm gonna have eyelid surgery. I'll be better right away. And I, I think they don't realize that there's cutting involved, and it's actually a surgery where we're violating the tissues. So they're gonna be swollen, they're gonna be bruised, their vision may be blurry, and their healing process is not overnight. Right away. They're back to work the next day. And you know, they're looking like a hundred percent. So I think everybody wants a quick fix, but I try to explain to them this, this isn't a quick fix. It's gonna be, you know, a couple weeks before you start looking more normal. Because it's a, a surgery where we're violating those tissues.

Kerry:

Mm-hmm. Is there any like creams or medications that can help after surgery or beforehand, like for

Jennifer:

So we talk about scar gels afterwards if they really wanna use one. I typically recommend vitamin E cream at their five week post-op visit because I, the incision heals so well on their own. That most patients are going to heal fine without anything, but if they want to use a vitamin E cream, I recommend that. And if they want something stronger, I'll recommend some scar gels. We just have to be careful about which scar gels are around the eye if they get in the eye,

Kerry:

Yeah, definitely don't wanna get things in the eye.

Jennifer:

correct, correct.

Kerry:

So if someone's thinking about doing eyelid surgery, but kind of feeling nervous or unsure, what would you tell them?

Jennifer:

I would tell them it is 100% normal to be nervous. Everybody's nervous, so that is perfectly normal if they're thinking about it. Come in, have a consult, listen to what they would possibly need, what the process would be for them exactly.'cause no two patients are the same. Everybody's an individual and you know, a consultation never hurts. It doesn't commit them to anything.

Kerry:

You now, you told me you were general surgery first. What, what was the switch into I guess, did you say Opto and then oculoplastics. Okay.

Jennifer:

So I decided general surgery would not lend me any type of civilized life at least at the program I was at. So I wanted a surgical subspecialty and I started doing some research in ophthalmology and got very interested in that. So I went that route.

Kerry:

Yeah, I would imagine general surgery is a little bit tougher. Yeah. So do you have a good work life balance now?

Jennifer:

I do, I do. I have a great work life balance.

Kerry:

And where are you located?

Jennifer:

So I have three offices. Actually. I have an office in St. Pete. I have an office in Brandon, and I have a cosmetic office where I do Botox and fillers in South Tampa.

Kerry:

Mm-hmm. And Botox and fillers will not solve this problem, correct?

Jennifer:

Botox and fillers will not solve this problem. In younger patients, it may give them a little bit of lift but in most patients it, it does not solve the problem. Correct.

Kerry:

So, I mean, does it happen to everybody? Is everybody gonna need this surgery?

Jennifer:

It, it happens to. Aging happens to everybody. The degree to which it happens is variable, and the degree to which it bothers people is very variable. So I have patients that come in looking like me, like you, and they're very bothered by their eyelids. And then I have patients that come in that have slits for eyes because they have so much droopiness and they're not bothered at all. So. I never push surgery on somebody that's not bothered by it because I'm not going to help them at all. But it, it is just a very variable problem and it just depends to which degree it, it bothers you, but it will happen to everybody to some degree.

Kerry:

Mm-hmm. You know, I was trying to make my eyes. I think I have a problem though. So, well basically is there anything else you'd like to share on this topic before I ask you something else?

Jennifer:

I would just say if anybody has any concern that this is bothering them, that this is affecting their activities of daily living. A consult is always a great thing. It does not commit you to any surgery, but you can get the information you need and then make the decision on your own.

Kerry:

Are there any other types of physicians that do this procedure or do they really need to find like oculoplastics?

Jennifer:

Plastics is typically the best type of surgeon to do this type of thing, to determine what they need and what can be done. There are certain plastic surgeons that will do it, but they don't quite have necessarily the training that we have and they don't do certain types of the surgeries that we do. So I would say an oculoplastic surgeon is your best bet.

Kerry:

Okay. Well that's good. That's very helpful information. So, where can people find you if they wanna learn about your practice or schedule a consult with you?

Jennifer:

So I can be reached in brandon at brandoniassociates.com. I can be reached in my office in in St. pete at sitethreesixty.com and in tampa at midtownaesthetics.com.

Kerry:

Nice. Okay, great. Well, we will include all of that in the show notes. And, you know, thank you so much for coming on the podcast today. It was super fun learning all about oculoplastics from you and,

Jennifer:

Thank you for having me. I appreciate the opportunity.

Kerry:

yeah, so it was a lot of fun. So tune in next week, everybody for next week's episode. And thank you once again. We'll put everything in the show notes.

Jennifer:

Thank you.

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Dr. Kerry Reller

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