Common Questions
What cosmetic services are available at Dr. Klapper’s offices?
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.
What is the difference between an eyelid lift, blepharoplasty and ptosis surgery?
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.
Will eyelid surgery correct my droopy eyebrow?
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.
Will insurance help pay for my surgery?
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
Restylane® and Perlane®
Natural Cosmetic Dermal Fillers
What is Restylane®?
Restylane® is a gel of hyaluronic acid generated by Streptococcus bacteria. Hyaluronic acid is a natural substance found in all living organisms. The type of hyaluronic acid in Restylane® is called NASHA (non-animal stabilized hyaluronic acid). NASHA is a patented, non-animal stabilized hyaluronic acid in clear gel form which is biosynthetically produced by a laboratory fermentation process.
Is Restylane® Safe?
Restylane® is approved by the United States Food and Drug Administration (U.S. F.D.A.) for the treatment of moderate to severe facial wrinkles and folds. It has been used by plastic surgeons worldwide since 1996. It is non-animal based and allergy testing is not required. Is has been widely studies and been shown to have a well-defined safety profile.
How is Restylane® different from Botox®?
Restylane® is a natural, cosmetic filler of skin folds and soft tissue defects. The nasolabial folds and lips are commonly treated areas. In contrast, Botox® is a purified protein that weakens facial muscle contraction to reduce wrinkles in the overlying skin. Botox® is used most frequently around the eyes and in the forehead. Many patients benefit from facial rejuvenation with both Botox® and Restylane®.
Which areas of my face might benefit from Restylane® or Perlane®?
Restylane® is approved by the U.S. F.D.A. for treatment of moderate to severe facial wrinkles and folds. The nasolabial folds are a commonly treated area. Fullness and definition of the lips can be successfully enhanced with Restylane®. Perlane® is a similar product but with larger gel particles designed for deeper injection. Dr. Klapper will help assist you in deciding which product may work best for you.
How long does Restylane®/Perlane® last?
Average treatment effects last six to nine months, perhaps slightly longer with Perlane®. Successful use of Restylane® and Perlane® may require numerous treatments over several months. Following the initial injection, semi-annual maintenance injections are typically necessary to achieve and maintain the desired volume correction. Touch-up treatments are occasionally indicated to correct irregularities. The duration of effect varies from patient to patient. Some patients may not retain the correction at all. Still others may only appreciate the results for less than six months.
What Should Patients do prior to Treatment?
Over-the-Counter medications including: Aspirin, non-steroidal anti-inflammatory medications (such as Ibuprofen), high doses of Vitamin E, fish oil, St. John's Wort, some red wines, and many herbal supplements may increase the risk of bleeding and bruising with injections. Avoidance of these medications and products the week prior to your injections may be helpful.
Prescription medications such as coumadin, Plavix, and other "blood thinners" also increase the risk of bleeding and bruising with treament. You should not stop any medication prescribed by your physician without consulting the prescribing doctor prior to holding the medication.
The Injection Procedure
Restylane® is injected into the dermal layer of skin in very small amounts through an ultra fine needle. Topical anesthetic cream applied 15 minutes prior to the procedure is helpful to limit the discomfort associated with injections of the nasolabial folds. Dr. Klapper also provides a topical cryo (freezing) spray to some of his patients that may be particularly sensitive to the injections. Some patients undergoing lip augmentation may require local anesthetic injected under the lip. Dr. Klapper will help you determine which technique may be right for you.
There are certain expectations that can be associated with this injection procedure. These may include: bleeding, swelling and bruising of the injected areas, redness of the skin, moderate discomfort at the time of injection, skin discoloration and recurrence of local cold sores. These symptoms usually resolve within 1-3 days of injection of skin areas and within 3-7 days of lip injections.
What are the Complications?
Some of the rare but possible complications include: bleeding, infection, asymmetry of the injections sites, over or under correction of the injected areas, allergic reaction, and the need for further invasive or surgical procedures. Approximately 1 in 5,000 patients experience hypersensitivity reactions that may result in swelling, redness, tenderness, and acne-like rashes in or around the injected areas. These symptoms may appear days to weeks after the injection and usually last at least 2 weeks.
How much do Restylane® and Perlane® Treatments Cost?
Costs will vary from patient to patient based on the amount of filler required to meet an individual patient’s specific needs. An average treatment session may cost approximately $600 (range $ 375-$1,100). You and Dr. Klapper can decide how much Restylane® or Perlane®will be necessary to achieve your goals and determine all of your costs prior to your procedure.
Dr. Klapper’s Experience
Dr. Klapper has extensive experience with soft tissue fillers (such as collagen and Cymetra®). Dr. Klapper has been performing cosmetic Restylane® injections since its U.S. F.D.A. approval more than 10 years ago. While administering Restylane® is not technically difficult, surgeon experience with Restylane® is critical to limit the risks of unwanted effects and to achieve optimal results.
