Dr. Steven Couch meets with a patient


Dr. Steven Couch is opening up a whole new world to patients. The Washington University oculofacial plastic surgeon at Barnes-Jewish West County Hospital performs upper and lower eyelid surgeries, correcting droopiness to expand patients’ field of vision and improve the appearance of the eyes.

An eye surgeon seeing adult and pediatric patients for general vision issues to complex plastic surgeries, Couch regularly performs blepharoplasty of the upper and lower eyelids. Patients commonly come to him with the complaint of droopy eyelids or lower eye bags that have become a medical issue of vision impairment or a cosmetic concern. “They may have a heavy, tired feeling in their upper lids, or be bothered by lower-lid puffiness,” he says.

For these patients, Couch has an answer: Blepharoplasty is a same-day outpatient procedure that can be performed in the office or the operating room. Couch completes the minimally invasive lower-lid surgery through an incision on the back of the lower eyelid, with no visible scarring. Also unique to the surgeon's lower-lid blepharoplasty procedures is the repositioning, rather than the more commonly used method of removal, of the fat tissue that is causing the issues in the lower lids. “I reposition fat into another area so it fills any cavities around the eye, improving the look of the eye and the way people function later,” Couch notes.

There are three main causes of eyelid droopiness, and specific treatments can be completed for each issue one at a time or during the same surgery, Couch explains. The issue of heavy brows pushing down on the eyelids can be remedied with a brow lift; and blepharoplasty can be used to treat the excess skin on the upper eyelids or ptosis, stretching of the muscle in the upper eyelid. Lower-lid blepharoplasty also can correct the unwanted appearance of excess fat in the lower eyelids.

As far as recovery, patients typically need a week of downtime for upper eyelid surgery, while those undergoing lower eyelid surgery with medical, as well as cosmetic procedures, may require up to two weeks.

Medicare and most insurance companies typically cover blepharoplasty on the upper eyelids when droopiness causes vision impairment, Couch notes. However, he adds that cosmetic procedures such as blepharoplasty to correct lower eyelid bags are not covered.

While the procedures are not for everyone, Couch completes a thorough general health and eye exam prior to surgery to ensure the patient is a good candidate. Additionally, he can help manage any problems before or after the procedure.

The procedures can be completed on infants to adults, with patients typically between the ages of 40 and 80. “It depends more on the severity of the findings, rather than the age of the patient,” Couch says. “It can be done on a baby who has vision impairment. And I’ve even completed these surgeries on a man who was 96.”

Following the surgeries, Couch says the majority of patients who undergo upper eyelid surgery have improved peripheral vision, relief from the tired sensation in their eyes and the appearance of a brighter world around them. “Many patients describe it as window shades being opened, and they are very happy with their ability to see afterward.”

Patients with lower eyelid surgeries report appearing less tired and more refreshed, he adds. “Because the eyes are such a focal point of the beauty of the face, most explain that their friends and family notice they appear more rested.”

This was true for Couch’s patient, David Austin. A brow lift and upper eyelid blepharoplasty fixed his blocked field of vision, and a cosmetic lowerlid blepharoplasty corrected the unwanted appearance of lower eyelid bags. “Dr. Couch is a special individual to absorb the training he had, practice it and work with patients the way he does,” Austin says. “I’m very pleased with the outcome.”


ON THE COVER: The ophthalmology department at Barnes-Jewish West County Hospital offers a range of adult and pediatric eye care, from general vision issues to complex plastic surgeries. For more information, call 996-3300 or visit barnesjewishwestcounty.org.

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