Frequently Asked Questions

Dr. Klapper specializes in cosmetic and reconstructive services of the eyelids and face.

Cosmetic surgical services include: Blepharoplasty; Endoscopic Forehead Lifting; Botox Injections; and Dermal Filler Injections (Radiesse and Restylane & Perlane). Specialized Skin Care Products (Jan Marini and SkinCeuticals) for use around the eyes are available at Dr. Klapper's offices.

Eyelid lifting typically refers to blepharoplasty surgery.  Blepharoplasty surgery is performed to remove redundant tissue from the upper or lower eyelids.  Cosmetic blepharoplasty is performed to provide a more youthful, rested eye appearance.  Upper eyelid blepharoplasty, in some cases, may be covered by some insurance carriers or Medicare if significant visual field loss is caused by redundant upper eyelid skin.

Ptosis refers to a droopy upper eyelid where the upper eyelid margin is lower than normal and, in moderate to severe cases, may be covering part or all of the pupil.  Ptosis repair may be covered by some insurance carriers or Medicare if significant visual field loss is caused by the abnormal upper eyelid position.

Blepharoplasty surgery and/or ptosis surgery are distinct eyelid operations to correct droopy eyelids. Eyelid surgery will not correct a droopy eyebrow (referred to as brow ptosis). Brow ptosis is corrected by lifting the eyebrow through incisions in the forehead. Endoscopic forehead lifting through small incisions at the edge of the hairline is an excellent cosmetic technique to elevate the forehead and eyebrow areas. Brow ptosis correction can also be corrected by removal of skin in the middle or top of the forehead.

The amount of work missed following surgery varies from patient to patient. The type of surgery performed will influence the length of recovery but different patients may heal at different rates following the same type of surgery. Certain occupations will permit returning to work sooner than other more visually or physically intensive occupations. Most out patient surgical procedures require patients to miss atleast 3-4 days of work but some surgical procedures and patient occupations may require up to 7-10 days or more away from work. Dr. Klapper will try to help you estimate how much work may be missed once you finalize a surgical plan. Go to Postoperative Care to learn more.

Following surgery, cold compresses (ice packs) and a topical antibiotic ointment are applied for 3 to 4 days followed by warm compresses. Eye patches are not required. Discomfort is usually minimal and is typically handled by acetaminophen (Tylenol®). Aspirin containing compounds and non-steroidal anti-inflammatory products (Advil, Ibuprofen, etc.) should be avoided 1 weeks prior to surgery and a few days following surgery. Most individuals will have swelling and some degree of bruising that will gradually improve over the first 1 to 3 weeks. Swelling make take weeks or months to completely resolve. Patient healing is variable with some individuals healing much quicker than others. Makeup can be applied to help hide residual bruising, usually starting two weeks after surgery. 

For upper eyelid blepharoplasty, 3-4 days off work is average while up to 8 to 10 days may be best for those patients having both an upper and lower eyelid blepharoplasty. Patient's with occupations requiring minimal physical activity may return to work sooner. Patients may have diminished blinking and incomplete eyelid closure following eyelid surgery, particularly ptosis repair. Frequent ocular lubrication may be required for several weeks or months after eyelid surgery. Contact lens wear is typically avoided during the first 3 weeks after surgery or until adequate blinking and eyelid closure returns. After Surgery Instructions

The amount of swelling and bruising varies from patient to patient and even from the left and right sides in the same patient. Mild bruising may resolve in 2-4 days, whereas more significant bruising may last 10-14 days. Patients may wish to hold blood thinner medications (such as aspirin, ibuprofen, some arthritis medications, Plavix, Coumadin, etc.) prior to surgery in order to minimize the risk of severe bleeding and bruising. Patients should only modify their medication regimen with the advice of their primary care physician, cardiologist, or other prescribing physician. 

Eyelid and facial swelling tends to worsen the first few days following surgery. Ice packs, head elevation, and rest may help minimize swelling. Swelling (edema) will often improve considerably over the first 2-3 weeks after surgery but may take several weeks and even months to completely resolve. Go to Postoperative Care to learn more.

In most cases, patients may shower the day following surgery. Unless there is a dressing that should remain dry, then the operated areas can get wet. Hair washing can also be performed the day following surgery. if a brow lifting procedure or endoscopic forehead procedure were performed, then care should be taken to avoid scrubbing in the areas of the forehead incisions. Make-up should be avoided for 2-3 weeks near incision sites. Once scabbing and crusting has resolved then make-up may be applied to the operated areas. After Surgery Instructions

When to return to an exercise routine after surgery will depend on the type of surgery performed, the progress of healing, and the form exercise that is planned. You will need to discuss specific concerns with Dr. Klapper as each patient's circumstances will differ. Patients recovering from eyelid surgery may need to avoid most exercises for 1-2 weeks. Light to moderate exercising may be resumed at 2-3 weeks before beginning higher impact activities at 3-4 weeks. Swimming and diving should be avoided during the first 3-6 weeks after surgery. After Eyelid Surgery Instructions

Patients recovering from orbital surgery, such as fracture repair, will often need to wait up to 6 weeks or longer before resuming contact sports and significant physical activity. After Orbit Surgery Instructions

Minor office procedures do not typically require stitches (sutures). Absorbable sutures are typically used in incisional procedures of the eyelids. These sutures will dissolve in the skin over 1-2 weeks. The exposed parts of the sutures will flake off after a few weeks but may take longer. Non-absorbable sutures are more commonly used to close wounds of the cheeks and forehead. These sutures are removed in the office 5-10 days after surgery.

Medicare does not pay for everything. With Medicare, the decision to cover surgery is not made until after surgery when the claim is submitted from the doctor’s office. Medicare does not have a pre-approval (predetermination) process. Dr. Klapper will discuss with you whether your photographs and/or visual fields may, in his opinion, meet the specific criteria outlined by the local carrier for Medicare. Dr. Klapper can not, however, guarantee whether your surgery will be a covered service. Lower eyelid blepharoplasty surgery is rarely covered by Medicare and is considered cosmetic in almost all cases. A referral from your primary care physician or eye doctor does not insure that Medicare will cover your eyelid surgery. All Medicare patients considering functional blepharoplasty and/or ptosis surgery will be asked to sign Medicare’s Advance Beneficiary Notice of Noncoverage (ABN) indicating that you understand your financial responsibility if Medicare does not cover your surgery. Similarly, Medicare patients electing to proceed with blepharoplasty, ptosis, or brow/forehead lifting procedures that do not appear to meet Medicare’s criteria for medical necessity will also be asked to sign Medicare’s Advance Beneficiary Notice of Noncoverage (ABN) indicating that the procedure(s) is(are) considered cosmetic, non-covered service(s) and will not be filed with Medicare. Secondary insurance carriers generally follow Medicare guidance.  Klapper Eyelid & Facial Plastic Surgery Financial Policy

Health insurance does not pay for all medical procedures. Eyelid surgery, particularly blepharoplasty and ptosis repair, may be considered cosmetic and require pre-approval (predetermination) if you and Dr. Klapper feel that your eyelid problem is causing a substantial functional deficit. Dr. Klapper will discuss with you whether your photographs and/or visual fields may, in his opinion, meet the specific criteria outlined by commercial insurance carriers. The predetermination process takes 3-6 weeks to complete depending on the insurance carrier. Lower eyelid blepharoplasty surgery is rarely covered by Medicare and is considered cosmetic in almost all cases. Brow surgery is also frequently considered a non-covered service. A referral from your primary care physician or eye doctor does not insure that insurance will cover your eyelid surgery.

Even when eyelid surgery is covered by insurance, patients remain responsible for office copays, surgery coinsurance, and patient deductibles. Patients should contact their insurance carrier or agent if they are unsure of their insurance benefits. Klapper Eyelid & Facial Plastic Surgery Financial Policy

Office procedures are performed with local anesthesia which may include eye drops and small injections under the skin in the area requiring surgery.

Surgeries performed in an ambulatory care center or hospital are usually performed with intravenous sedation administered by an anesthesiologist. Some surgeries, such as orbital procedures, are performed under general anesthesia.

Dr. Klapper will be able to discuss anesthesia options once a surgical plan has been developed.

The expectations and risks associated with eyelid surgery may depend on the type of eyelid procedure(s) and may also vary from patient to patient. Patiet compliance with postoperative instructions is critical to achieve the most optimal surgical result. Even in the best of surgical hands, unexpected results may occur.

Excessive pain, bleeding, and infection are very uncommon. Severe loss of vision following eyelid surgery has been reported but fortunately is extremely rare (approximately 1 in 2,000 cases). It may occur if deep orbital hemorrhage (bleeding) occurs postoperatively. This typically would occur within the first 24 hours following surgery, so it important for patients to have a responsible adult with them the afternoon, evening, and day following eyelid surgery. Incomplete eyelid closure and inadequate lubrication of the eyes following surgery (ex/ upper eyelid ptosis repair) may also result in corneal scarring or infection causing vision loss. it is critical for patients to understand the signficant risks associated with eyelid surgery and recognize the role the patient will have in their recovery and follow-up. Communication with Dr. Klapper and his staff regarding any concerns, particularly relating to vision or pain, is essential to potentially reduced the consequences of unexpected events following eyelid and other oculoplastic surgical procedures.

Smoking is an established risk factor for poor postop healing. Smoking cessation prior to surgery and during recovery will help diminish the risks of infection and other complications. Diabetic patients have similar increased risks associated with surgery.

BLURRED VISION: Your vision may be blurry after surgery and it may be a hard to read small print for at least 2-3 weeks after surgery. This is may be due to the lubricating ointment and drops in your eye(s), as well as secretions from your healing wounds and reduced blinking. Patients undergoing ptosis (droopy eyelid) surgery will experience more pronounced difficulties with blurred vision. You may need to avoid certain activities (work, computer, driving, athletic activities) until your vision improves. Always check your vision with your spectacles (distance or reading) and check each eye separately with the opposite eye completely covered. Patients with severe visual loss (ex/ unable to count fingers) or any vision concerns should always contact Dr. Klapper immediately at (317) 818-1000 or (877) 818-8101 [toll-free].

PAIN: There may be some minor or moderate discomfort following eyelid surgery. Most patients will only require Tylenol. Plain or Extra Strength Tylenol, one (1) or two (2) tablets every four (4) to six (6) hours is usually adequate to control postoperative pain. If a prescription or pain medicine has been given to you, use it as directed. Most of the general discomfort due to surgery resolves after 3-4 days. Some areas, particularly the outer corners of the eyes (following lower eyelid surgery) or the scalp (areas of  endoscopic forehead surgery) will remain tender for 2-3 months. If you have severe or excruciating pain, notify Dr. Klapper immediately at (317) 818-1000 or (877) 818-8101 [toll-free].

SWELLING: Swelling and bruising may occur around the eye and operated area. The swelling should be soft to the touch. If the swelling is tense or firm, please contact Dr. Klapper’s office. Gravity will cause swelling and bruising to occur in the lower eyelids, cheeks, and rarely into the neck and chest even in patients that only had eyelid or forehead procedures. Many patients will experience swelling on the surface of the eyeball that looks like “blisters” or “bubbles”. Swelling on the eyes improves with ocular lubrication (artificial tears, lubricating eye ointment). Swelling typically worsens during the first 48-72 hrs after surgery. It should begin to improve at around 4-5 days following surgery. While much of the swelling disappears during the first month, some swelling and redness can often still be detected for up to 3-4 months or more.

REDNESS/ITCHING: Moderate redness and itching in the operated area is common in the first few weeks following surgery. Some patients experience significant itching around the 4th or 5th postoperative day. If your itching is associated with significant redness and/or worsening of your swelling, you may be experiencing an allergic reaction to your topical antibiotic drop or ointment. If this occurs, discontinue your topical medications and contact our office immediately. A small number of patients experience worsening of their itching and swelling with prolonged use of ice packs. We may also recommend that you stop your ice packs. Benadryl or other over the counter anti-histamine medications are recommended for itching that is bothersome.

IF YOU DEVELOP A FEVER, SUDDEN INCREASE IN SWELLING, PAIN, EYE PROTRUSION, OR SEVERE VISION LOSS CONTACT Dr. Klapper IMMEDIATELY 317-818-1000.

“TIGHTNESS”: Following eyelid reconstruction, cheek reconstruction, or any facial procedure involving significant tissue tightening or mobilization, you may experience a sensation of “tightness”. Eyelid and facial tissues will begin to relax and “settle” starting around 3 weeks after surgery. This relaxation generally continues up to 6-12 months or more.

SUTURE REACTIONS: Some patients may react to deep absorbablestitches and form small, red, tender pustules 4-8 weeks after surgery. This is most common in the outer corners of the eyelids following lower eyelid tightening or eyelid reconstruction. These tender bumps may also occur in the stitch line of the upper eyelid or forehead. Hot compresses will usually help this problem that typically resolves over 2 weeks. Occasionally small incisions are made to relieve significant discomfort.

SCARS: All surgical incisions cause scars. Every attempt is made in elective surgery to minimize the appearance of scars. Incisions are generally made in the natural folds of the forehead and face whenever possible. Even so, many scars will remain visible. Scars are most prominent following surgery when they appear bright red. This rednesswill begin to fade around 3-4 months and by 6 months or so most of the redness will begone. The appearance of the scar will then slowly change and often improves for up to1-2 years following surgery. If a prominent scar requires revision this is not usually recommended until at least one year after surgery.