Does health insurance pay for surgery on hooded eyelids?

When the finding is functionally relevant. The most common and clearest evidence for that is a restriction of the upper visual field — the correction is then a medical service and goes through basic health insurance. There are also rarer functional reasons that can likewise count as treatment of an illness: lashes pressed onto the cornea or turned into the line of sight, chronic inflammation of the skin in the lid crease, a mechanical obstruction of the lid, or a true ptosis. Demonstrating the restriction of the visual field is a standardised measurement, once in the starting state and once with the lid held up, together with photographic documentation. We submit these documents before the procedure as an application for cost approval; the decision is made by your insurer, not by us. If there is no functional restriction, the correction is an aesthetic service and therefore self-pay; in the medical case the deductible and co-payment apply as with any other procedure.

How long does the result of eyelid surgery last?

As a rule many years — but nobody can give you a date in good faith, and anyone who does is guessing. The skin that has been removed does not come back; the tissue nevertheless goes on ageing, and how fast depends on predisposition, the nature of your skin, sun exposure, smoking and marked fluctuations in weight. The result appears shorter-lived above all when a second finding has been missed: a low-sitting brow or a true ptosis quickly pushes the old impression back into the picture, even though the skin was removed correctly. That is exactly why we measure beforehand what is actually drooping.

Are there scars after hooded eyelid surgery?

Yes. Every incision in skin leaves a scar — the question is not whether, but where and how noticeable. The incision is placed in the natural lid crease, where it lies hidden when the eye is open. In the first weeks the line is reddened and somewhat firm, after which it fades over months; sun protection during this time helps. If your skin tends towards noticeable scarring, or earlier scars have shown that, we tell you before the procedure and not after.

How long am I out of action after the procedure?

Expect one to two weeks in which the procedure is visible on you. Swelling and bruising are at their worst in the first few days and are often unequal between the sides; the fine sutures are usually removed after about a week. Office work is often possible again after a few days; sport, heavy lifting, sauna and sunbeds should be put off for around two weeks. Eye make-up only once the wounds have closed. So do not plan the appointment shortly before an occasion at which you will be photographed.

Is it done under local anaesthetic, or does it need a general one?

Upper eyelid surgery is usually done as an outpatient under local anaesthetic. You are awake and responsive; what you feel is the injection of the anaesthetic, and after that, as a rule, a sensation of pressure or pulling. Anyone who is very tense can also be given a light sedative — we discuss that beforehand, not in the procedure room. A general anaesthetic is needed only in particular situations, for example with extensive combined procedures or where a local anaesthetic is not an option for you.

What is the difference from a cosmetic surgeon?

The difference lies in the perspective and in the training, not in any judgement about colleagues. We come from surgery of the eye and treat the lid as a functional organ: before any lift we measure the function of the lid-lifting muscle, eyelid closure, the tear film and the corneal surface, because those are precisely the things that can cause trouble after the procedure. In doing so we also recognise when the skin is not the problem but the lid-lifting muscle or the brow — and then operate on something else, or not at all. And if an eye is dry or irritated afterwards, you are with the same people who treat that.

Can hooded eyelids be removed without an operation?

Removing them in the literal sense: no — skin that is surplus can only be removed surgically. Concealing them, on the other hand, is perfectly possible, and that is a legitimate decision. With eye make-up, matt rather than shimmering eyeshadow helps, a thin line of eyeliner close to the lash line, and a brow shape that does not take away more height; an eyelash curler gains a few millimetres of field of view. Lid tapes and adhesive strips lift the fold mechanically for a few hours — they pull on very thin skin and are better suited to an occasion than to everyday use. Which of the advertised methods beyond these achieve nothing, and which we expressly advise against, is on this page in the section 'What you can save yourself'.

Eyelid malpositions

Hooded eyelids: when it is about sight — and when about appearance

'My eyes look tired, and yet I am rested.' Or: 'I raise my forehead without noticing when I read.' For some people hooded eyelids are a question of appearance, for others one of sight. That distinction is the whole difference — it decides which procedure helps at all, and who pays for it. We measure it rather than assert it.

Call now — have your eyelid findings assessed book an appointment online

What a hooded eyelid is

Almost everyone describes the same thing: a fold of skin on the upper lid that settles over the lid crease and covers the lash line partly or completely. In some people the skin eventually settles onto the lashes, presses them downwards and can take away part of the field of view at the top. In others it does not get that far, with the fold swallowing the eyeshadow and the gaze appearing heavier.

The medical name for it is Dermatochalasis — literally 'slackened skin'. Hooded eyelid and dermatochalasis mean the same thing; one term appears in the medical report, the other in conversation. Neither says anything, to begin with, about whether the finding needs treatment.

It has come about through several things at once: the skin of the lid is the thinnest on the body and loses elasticity over the years, the fine connective tissue behind it becomes more yielding, and fatty tissue from the eye socket can bulge forward. How early and how markedly this happens is to a good extent a matter of predisposition — there are pronounced hooded eyelids at thirty and hardly any at seventy. Smoking, years of heavy sun exposure and marked fluctuations in weight speed the development up.

A hooded eyelid is therefore, to begin with, a change and not an illness. It becomes a medical matter only where it costs function. And whether it does cannot be decided in the mirror, only measured.

One point that is easily lost: not every heavy eyelid area is excess skin. Swelling in thyroid disease, allergies, kidney or heart disease, as well as chronic inflammation of the eyelid margin produce a similar picture but call for an entirely different treatment. Anyone whose lids become thick overnight or in episodes rarely has a hooded eyelid.

When a hooded eyelid restricts the field of view

The upper lid is the upper boundary of the visual field. If skin settles over it, the upper edge of the field of view is the first thing to go — the part where the next line lies when you read, the traffic light in the car, the top step on the stairs. The loss comes on so slowly that hardly anyone experiences it as worsening vision. What gets noticed instead is what the body does about it:

The forehead joins in. The brows are raised without your noticing — often all day, often for years already.
Tension in the forehead and headaches that get worse towards evening
More tiring in the evening than in the morning, because the forehead muscles can no longer keep up with holding the brow, and the brow sinks as the day goes on. If instead the lid margin itself visibly drops the longer the day lasts, that is something else — see the section 'Telling them apart'
Reading and screen work are a strain, even though your glasses are right
The head tips slightly back, in order to see out under the fold
Lashes in the field of view or lashes pressed downwards
The impression of looking tired, even though you are rested

This is where the line runs at which, in Switzerland, the cost question is also decided. What makes eyelid surgery a medical service is not the impression in the mirror but a documented functional restriction. The most common and clearest evidence for that is a loss in the upper visual field that demonstrably improves when the lid is raised. There are also rarer functional reasons that can likewise count as treatment of an illness — lashes pressed onto the cornea, for instance, chronic inflammation of the skin in the lid crease, or a true ptosis. Which of these applies to you we tell you after the examination. What cannot be replaced under any circumstances is the finding itself: a well-worded justification without a measurement does not carry the application.

We can carry out this measurement and document it. Your health insurer decides on it. After the examination we tell you honestly what your findings look like — including when they are below the threshold and the answer is 'aesthetic, therefore self-pay'.

The comparison with the lid held up answers a second question along the way. If the loss remains even with the lid raised, the cause does not lie in the lid. We then go on to assess the optic nerve, the retina and the intraocular pressure — a missing upper edge of the visual field can also come from glaucoma, from the retina or from the optic nerve, and eyelid surgery would change nothing about that.

A lid that droops suddenly is something else. If a suddenly drooping lid comes with double vision, unequal pupil sizes or severe head or neck pain, this is not a case for an ophthalmology practice: call the ambulance (144) or go straight to the nearest emergency department — a vascular disorder can be behind it, one in which hours count. If an upper lid drops over hours or days, without pain and without these accompanying signs, call us the same day: +41 44 500 69 00; outside our consulting hours the ophthalmic emergency service applies. A hooded eyelid develops over years; anything that happens quickly needs assessing at once.

Our rule on advice

We do not operate on a lid because a procedure can be sold. If the measurement shows an unobstructed visual field, that is exactly what we tell you — and you decide, unhurried, whether the appearance is worth the procedure to you. And if a finding is not carried by basic health insurance (OKP), you hear that from us beforehand and not later from your insurer.

Hooded eyelid, ptosis or brow ptosis — telling them apart

From the outside, three very different findings look almost the same: the eye appears smaller, the gaze heavier, the lid lower. Surgically they have almost nothing to do with one another. If the wrong one is operated on, the result is technically faultless and disappointing all the same.

Hooded eyelid (dermatochalasis)

Too much skin, but the lid margin itself sits where it belongs. The simplest self-check: lift the fold of skin slightly with your finger, close above the lashes, without moving the brow. If the view opens up immediately and the eye appears open, excess skin is the issue. It is treated by removing exactly that skin — no more and no less.

Ptosis (a drooping lid margin)

Here it is not that there is too much skin, but that the lid itself sits too low: the muscle that lifts the lid, or its fine tendon at the lid, has lost power or its attachment. This happens with age, after eye operations, after years of wearing hard contact lenses, occasionally from birth. It is recognisable from the lid margin sitting lower over the cornea than it used to or than on the other side — with a pronounced ptosis, as far as over the pupil — and from the lid crease often sitting higher than on the other eye. Tightening the skin alone changes nothing about that — it leaves the lid margin exactly where it was. What is treated instead is the lid-lifting muscle itself.

Two situations do not belong in the waiting time for a consultation: A lid that droops within hours or days and comes with double vision, unequal pupil sizes or severe head or neck pain is not a case for an ophthalmology practice but for the ambulance (144) or the nearest emergency department. A vascular disorder can be behind it, one in which hours count. If instead the lid drops on its own, painlessly and without these accompanying signs, call us the same day. And a lid that varies markedly over the course of the day and sits much lower in the evening than in the morning can point to a disorder of the transmission between nerve and muscle and has to be assessed — if difficulty swallowing or breathing, a weak voice or double vision come with it, then immediately and as an emergency. Both are rare. Both are too important to be decided on a website.

Brow ptosis (a dropped brow)

The third possibility is the one most often missed. Over the years the brow sinks, particularly in its outer third, and pushes tissue ahead of it onto the lid. What then lies above the lashes is not excess lid skin at all, but displaced forehead skin. The test for it: lift the brow with your finger. If the fold largely disappears when you do, the brow is sitting too low.

The difference has consequences. If only the lid is lifted when the brow sits low, a great deal of skin has to be removed, the distance between lashes and brow gets smaller, the brow can sink further — and the result appears operated on rather than awake. Here the brow lift is the procedure that addresses the cause.

This distinction is not academic. It decides which procedure helps at all, how much skin may be removed — and whether basic health insurance is responsible in the first place. An overview of the other eyelid findings we treat can be found on the page Eyelid malpositions.

How we examine

The eyelid consultation takes longer than a routine follow-up, and there is a reason for that: here things are measured rather than estimated. What ends up on paper decides the surgical planning and the cost question alike.

Examination at the slit lamp. The lid margin, the position of the lashes, whether the lid closes completely, the tear film and the corneal surface. A dry eye or an inflamed lid margin is treated first, not operated on alongside.
Eyelid measurement. Distance between the light reflex on the cornea and the upper lid margin, excursion of the lid-lifting muscle, height and definition of the lid crease, amount of excess skin, distance from lid margin to brow. These figures separate dermatochalasis, ptosis and brow ptosis from one another — looking alone does not.
Visual field measurement. Standardised, and twice: once as you come to us, and once with the lid held up. The difference between the two measurements is the evidence that the coverage question turns on.
Photographic documentation. Standardised images in the same head position and lighting. They form part of the application to your insurer and later the only fair comparison with the starting state — memory of one's own face is remarkably unreliable.
History and general health. Medicines, blood thinners in particular, thyroid function, allergies, earlier lid or eye operations, smoking, a tendency to noticeable scars.

By the end of that appointment you know three things: which finding you have, whether it is functionally relevant, and who would pay for the procedure. If you want time to think afterwards, that is the normal case and not a retreat — a hooded eyelid changes slowly, and a decision may take its time.

How a hooded eyelid is treated

Excess skin does not go back on its own. If it is treated, it is treated surgically — and here it is an oculoplastic procedure even when the reason is purely aesthetic.

The reason for that can be read off the mistake that costs most on the upper lid: If too much skin is removed, the eye no longer closes completely. And what is not closed is not moistened — the cornea dries out, the eye burns, and in the extreme case the surface is damaged. It is precisely the three values we measure before every procedure — whether the lid closes completely, the tear film, the corneal surface — that therefore determine how much skin has to be left. That limit runs in the range of millimetres, and it is the reason we measure every eyelid lift and mark it up separately for each side rather than estimating it. On the lid, the beautiful result is the by-product of a functioning one — never the other way round.

Upper eyelid surgery

The standard procedure for a hooded eyelid. Through an incision that lies in the natural lid crease, the excess skin is removed, and where needed a narrow strip of muscle and bulging fatty tissue. The procedure is usually done as an outpatient under local anaesthetic; the suture material is very fine and is removed after about a week. How much skin has to be left so that the eye closes completely is the real art here — not how much can be taken away.

The procedure, preparation and aftercare are described in detail on the page Upper eyelid surgery — the procedure, preparation and aftercare. If a true ptosis is present as well, this procedure is not enough: the lid-lifting muscle then has to be dealt with too, otherwise the lid margin stays, after the lift, exactly where it was before.

Combining with a brow lift

If the brow sits too low, tightening the lid alone is the wrong answer. The brow lift raises the brow again — how far depends on the findings and on the technique chosen; only then does it become clear how much lid skin is still surplus at all — usually markedly less than it looked beforehand. Depending on the findings the two can be combined in one session or planned one after the other. Which route is the calmer one depends on the extent, on your history, and on how much downtime you can set aside in one block.

The region below the eye follows its own rules: there it is about bulging fatty tissue and slackening, not about a fold of skin over the lashes — for that there is Lower eyelid surgery. An overview of both procedures and their aesthetic side is given on the page Eyelid surgery. The eyelid findings are assessed at all three locations in Zurich, Wetzikon and Meilen; the aesthetic treatments of the eye area we offer at our Zürich location.

What is realistically possible — and what is not

What upper eyelid surgery can achieve:

The excess skin above the lashes is removed, and the lid crease becomes visible again
The upper edge of the visual field is clear — given the corresponding baseline findings
The forehead no longer has to hold up constantly; tension from this cause often eases
The gaze should appear more open and more awake, without fundamentally changing your expression
Eye make-up can be applied again without the fold of skin smudging it

What it cannot achieve — and we would rather say that before the procedure than after:

Fine lines in the lid skin and crow's feet do not disappear
Dark rings and shadows under the eyes remain; they sit elsewhere
Bulges on the lower lid are a different region and a different procedure
A dropped brow is not raised — that needs a brow lift
Differences between the sides cannot be evened out completely. No face is symmetrical, and what was unequal before usually stays so, to a smaller degree
Ageing is not halted; the tissue goes on changing

The risks include swelling and bruising over one to two weeks, temporarily dry or burning eyes, eyelid closure that is incomplete at first, temporary altered sensation along the scar, and differences between the sides while the swelling settles. Less common are post-operative bleeding, infection and problems with wound healing; very rare are serious complications up to and including an impairment of vision. No procedure on the eye is without risk, and we discuss these points openly with you beforehand.

What the result ends up looking like depends, in qualitative terms, on several things that are settled before the procedure: on the baseline findings, on the nature and thickness of your skin, on the position of the brow, on the state of the tear film and on whether something besides the skin is drooping as well. Percentages and before-and-after promises are therefore not to be found on this page.

What you can save yourself — and when waiting is right

A great deal is offered for hooded eyelids that cannot remove any excess skin: firming creams and serums, lid tapes and adhesive strips, eye patches, rollers, massage techniques, face yoga. Most of it is harmless and pleasant for some; none of it changes the amount of skin. Anyone who is content with it should carry on — only nobody should put off an assessment on account of it that would show the visual field to be restricted.

The plasma devices marketed in the cosmetics sector — often announced as 'a lid lift without a scalpel' — we advise against. They produce small, point-like injuries to the surface of the skin; in the thin skin around the eye, shifts in pigmentation and noticeable scars are possible, and reliable data on benefit and safety are largely lacking. We do not offer it.

And the piece of information that rarely appears on a clinic's page: A hooded eyelid does not have to be treated. If the measurement shows an unobstructed visual field and you live with the look well enough, doing nothing is a full and proper decision. The finding develops slowly, and there is no moment you could miss. Come back when it bothers you — or not at all.

If you would like to have it assessed, that can be done by phone on +41 44 500 69 00, Mon–Fri 08:00–12:00 / 13:00–17:30, or online through the booking page.

Costs & health insurance

What does the insurer pay for — and what not?

With a hooded eyelid the answer hangs on a single point: whether a functional restriction has been demonstrated — usually through the visual field, less often through another finding on the lid. Everything else follows from that; what it means in practice is set out here.

Service	Coverage	What this means for you
Ophthalmic assessment of the eyelid findings	Basic health insurance, where symptoms are the reason	If you come with symptoms — tired eyes, tension in the forehead, a restricted field of view — the assessment is treatment of an illness; the deductible and co-payment apply as at any doctor's appointment. If you want a purely aesthetic correction from the outset, the preliminary examination belongs to the cost estimate.
Visual field measurement with and without the lid held up, photographic documentation	Same as for the assessment	The evidence that everything turns on. Where the assessment is done because of symptoms, it is covered even when it shows that there is no functional restriction — it is not tied to a particular result.
Upper eyelid surgery with a demonstrated functional restriction (functional procedure)	Basic health insurance, after cost approval	We submit the findings, the measurement and the photographs to your insurer before the procedure. The decision is made there. We operate only once the written approval is in — so that you do not receive a bill afterwards that you had not reckoned with.
Upper eyelid surgery without functional restriction (aesthetic procedure)	Self-pay	You receive a written cost estimate before the procedure. Supplementary insurance as a rule does not cover purely aesthetic procedures; whether your policy makes an exception is something only your insurer can tell you.
Combined procedure — functional part plus aesthetic additional service	split billing	The medically justified part goes through basic health insurance, the part beyond that through you. What belongs to which we set down in writing before the procedure, not after.
Follow-up checks, suture removal and aftercare	Same as for the procedure itself	Aftercare follows how the operation is classified. With a functional procedure it goes through basic health insurance; with an aesthetic one it is included in the cost estimate.

There are deliberately no amounts here: what is involved depends on the findings, and a figure without an examination would be a guess. You receive the cost estimate in writing after the assessment, before you have to decide.

A tax point that surprises many: with purely aesthetic procedures VAT is added; with medically indicated treatment it is not. That too is in the cost estimate.

Related conditions

Eyelid malpositions Upper eyelid surgery Dry eyes

Medically reviewed by PD Dr. med. Andrea von Rückmann

Your ophthalmologistPD Dr. med. Andrea von RückmannView profile

Frequently asked questions

: When the finding is functionally relevant. The most common and clearest evidence for that is a restriction of the upper visual field — the correction is then a medical service and goes through basic health insurance. There are also rarer functional reasons that can likewise count as treatment of an illness: lashes pressed onto the cornea or turned into the line of sight, chronic inflammation of the skin in the lid crease, a mechanical obstruction of the lid, or a true ptosis. Demonstrating the restriction of the visual field is a standardised measurement, once in the starting state and once with the lid held up, together with photographic documentation. We submit these documents before the procedure as an application for cost approval; the decision is made by your insurer, not by us. If there is no functional restriction, the correction is an aesthetic service and therefore self-pay; in the medical case the deductible and co-payment apply as with any other procedure.
: As a rule many years — but nobody can give you a date in good faith, and anyone who does is guessing. The skin that has been removed does not come back; the tissue nevertheless goes on ageing, and how fast depends on predisposition, the nature of your skin, sun exposure, smoking and marked fluctuations in weight. The result appears shorter-lived above all when a second finding has been missed: a low-sitting brow or a true ptosis quickly pushes the old impression back into the picture, even though the skin was removed correctly. That is exactly why we measure beforehand what is actually drooping.
: Yes. Every incision in skin leaves a scar — the question is not whether, but where and how noticeable. The incision is placed in the natural lid crease, where it lies hidden when the eye is open. In the first weeks the line is reddened and somewhat firm, after which it fades over months; sun protection during this time helps. If your skin tends towards noticeable scarring, or earlier scars have shown that, we tell you before the procedure and not after.
: Expect one to two weeks in which the procedure is visible on you. Swelling and bruising are at their worst in the first few days and are often unequal between the sides; the fine sutures are usually removed after about a week. Office work is often possible again after a few days; sport, heavy lifting, sauna and sunbeds should be put off for around two weeks. Eye make-up only once the wounds have closed. So do not plan the appointment shortly before an occasion at which you will be photographed.
: Upper eyelid surgery is usually done as an outpatient under local anaesthetic. You are awake and responsive; what you feel is the injection of the anaesthetic, and after that, as a rule, a sensation of pressure or pulling. Anyone who is very tense can also be given a light sedative — we discuss that beforehand, not in the procedure room. A general anaesthetic is needed only in particular situations, for example with extensive combined procedures or where a local anaesthetic is not an option for you.
: The difference lies in the perspective and in the training, not in any judgement about colleagues. We come from surgery of the eye and treat the lid as a functional organ: before any lift we measure the function of the lid-lifting muscle, eyelid closure, the tear film and the corneal surface, because those are precisely the things that can cause trouble after the procedure. In doing so we also recognise when the skin is not the problem but the lid-lifting muscle or the brow — and then operate on something else, or not at all. And if an eye is dry or irritated afterwards, you are with the same people who treat that.
: Removing them in the literal sense: no — skin that is surplus can only be removed surgically. Concealing them, on the other hand, is perfectly possible, and that is a legitimate decision. With eye make-up, matt rather than shimmering eyeshadow helps, a thin line of eyeliner close to the lash line, and a brow shape that does not take away more height; an eyelash curler gains a few millimetres of field of view. Lid tapes and adhesive strips lift the fold mechanically for a few hours — they pull on very thin skin and are better suited to an occasion than to everyday use. Which of the advertised methods beyond these achieve nothing, and which we expressly advise against, is on this page in the section 'What you can save yourself'.

Measure first, then decide.

In the eyelid consultation we establish in a single appointment which finding is present, whether your visual field is restricted and who would pay for the procedure. You decide afterwards — not before.

Call now — appointment at the eyelid consultation

+41 44 500 69 00 — Mon–Fri 08:00–12:00 / 13:00–17:30. Or book an appointment online.