A Plastic Surgeon’s Guide On Ptosis Eyelid Surgery In Singapore
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A Plastic Surgeon’s Guide On Ptosis Eyelid Surgery In Singapore

Dr Vincent Yeow, Medical Director of Dream Singapore addresses a comprehensive list of FAQs on Ptosis Correction as well as insights into the procedure itself and if it can be covered under your personal insurance.

“One of the questions I am frequently asked as a plastic surgeon is whether droopy eyelids is a cosmetic consideration, or a medical condition.“

The condition affects one or both eyes, may be present at birth or develop over a few years, and may change a person’s appearance without affecting health or vision. In some cases, it can be a warning sign for a serious underlying condition affecting the nerves, muscles, eye socket, or brain.

If you are researching more on this procedure, We hope this article will give you some useful insights on the procedure.

This article will discuss everything you need to know about Ptosis – what it is, the causes, treatment, correction, surgery, and the recovery time for droopy eyelid treatment.

In this article, I will cover the following topics:

What is Ptosis? 

Ptosis, also called drooping eyelids or blepharoptosis, is when the upper eyelid’s border falls to a lower position than normal. This condition can sometimes interfere with vision when the droopy eyelid covers all or part of the pupil. The drooping of the upper eyelid (ptosis) is largely classified as a medical condition.

no droopy eyelids

What Causes Droopy Eyelids?

Why the upper eyelid “droops” is directly related to the function of the eyelid muscle, also known as the levator muscle. The levator muscle stretches and relaxes to control the opening and closing of your eyelids, functioning much like a rubber band.

This muscle can weaken and become less ‘elastic’ over time.

Because the eyelids are delicate, there may be many other potential droopy eyelid causes ranging from muscular problems, neurological conditions, eye trauma, botox injections (often by inexperienced injectors), eyelid tumors and cysts, Horner’s syndrome, drowsiness, and trauma.

Ptosis eyelid

Aging 

Ptosis is most commonly observed in older adults due to the natural aging process. As you age, the levator muscle responsible for naturally lifting the eyelid begins to stretch, which causes the eyelid to droop or fall.

Habits 

Individuals who wear contact lenses, apply eye make-up frequently, or have a habit of rubbing the eye excessively, are more likely to experience droopy eyelids. These habits speed up skin aging and muscle laxity on the eyelids, contributing to an earlier onset of ptosis compared to those who abstain from such habits.

Congenital

People of all ages can be affected by ptosis. Some babies are sometimes born with it, though it is a rare condition. The most common cause of congenital ptosis is that the levator muscle does not develop properly in babies. Children with ptosis may also develop amblyopia, a condition commonly known as a lazy eye. This disorder can also restrict or delay their vision.

Trauma

Trauma to the eye area can cause damage to the eyelid muscles and result in ptosis eyelid. Standard LASIK or cataract surgery can sometimes cause ptosis due to the tendon or muscle being stretched. In certain cases, nerve, tendon, or muscle injury may cause ‘temporary’ droopy eyelid conditions and it may recover on its own. However, if it does not resolve over time, one may require Ptosis Correction Surgery.

Related to other medical conditions 

In more severe cases, ptosis may be caused by serious medical conditions such as brain tumors, stroke, or cancer of the muscles or nerves. Neurological disorders that affect the muscles or nerves of the eyes such as myasthenia gravis can also cause ptosis. Ptosis or droopy eyelid surgery is often recommended to restore the eyelid function and one’s vision.

Can Droopy Eyelids Be Prevented?

Whether droopy eyelids can be prevented or not depends on the actual cause. It is difficult to prevent the development of congenital ptosis. Moreover, acquired ptosis may develop in patients due to numerous causes that are hard to also hard to avoid. For example, senile ptosis occurs due to the physiological aging process that weakens the eyelid muscles. Other causes, such as eye trauma, muscle problem, nerve damage, and surgery, can also be challenging to prevent.

On the other hand, lifestyle and habits such as excessive eye rubbing, eyelid tapes and wearing contact lenses is associated with an increased risk of droopy eyelid. Conclusively, not using contact lenses for extended periods, minimize and tugging on the eyelids and avoiding rubbing eyes excessively can help prevent the development of acquired ptosis.

Categorically, because ptosis can interfere with your vision, it should be taken seriously. Identifying and treating the root cause of ptosis promptly can help prevent the condition from getting any worse. Therefore, visit your healthcare provider immediately if you observe initial signs of ptosis development in your eyes or any of your family members.

Types of Ptosis

  • Aponeurotic – When the muscle is detached because of aging, excessive rubbing or pulling of the eyelids.
  • Mechanical – When the upper eyelid is weighed down by excessive skin, fat or the presence of a tumor, which contributes to the appearance of a droopy eyelid.
  • Traumatic – When the eyelid muscle is weakened after an injury.
  • Neurogenic – When the nerves to the muscle stop functioning normally.
  • Myogenic – When the muscle is not functioning normally.

Who is Most Susceptible to Developing Ptosis? 

Anyone can develop droopy eyelids, and there is not much difference in the prevalence rate between men and women or between different ethnicities.

Though it is mostly seen in older individuals, the condition can also be seen in people of all ages. There is no significant evidence attributing it to a particular gender or race.

Ptosis in children (Congenital Ptosis)

Ptosis in children ( Congenital Ptosis )

Droopy eyelids can occur at birth, and this is called congenital ptosis. This is usually caused by the muscle that lifts the eyelids. The journal, Ophthalmology, points out that congenital ptosis occurs in one out of every 842 births. This shows an occurrence level in children higher than what we think.

Sometimes, children born with droopy eyelids have other eye-related problems, including eye movement issues, tumors, and eye muscle diseases.

Ptosis in adults

Ptosis in adults 

Ptosis occurs in adults when the levator muscle of the eye stretches away from their eyelids. This is usually caused by an eye injury or aging and can also occur as a side effect of certain eye surgeries. In rare instances, diseases or tumors can affect the eye muscle, leading to droopy eyelids.

If you want to undergo ptosis surgery in Singapore, the ptosis surgeon or ophthalmologist will determine your condition’s cause in a move to deliver suitable treatment.

Symptoms of Ptosis

Besides sagging or drooping of one or both upper eyelids

  • may have extremely watery or dry eyes
  • face may look tired or weary
  • experience frequent migraines or headaches when the eyes are strained for long hours
  • may need to tilt their heads back to see properly, even while having a conversation.

In persistent droopy eyelids cases, a doctor will attempt to first rule out any other underlying conditions before ascertaining if ptosis surgery is right for you.

What are the Danger & Risks of Having Ptosis?

When droopy eyelids start to affect one’s vision, it can cause inconvenience to a person’s daily life. Poor vision can make one more susceptible to falls or affect the ability to look out for danger. The risk of falls and injury with a compromised vision tends to be higher among elders.

Other functional issues include:

  • Headaches from excessive use of forehead muscles to open eyes
  • Tilting head back to see
  • Obstructed vision

Benefits of Ptosis Correction

Functional Improvements after ptosis surgery:

  • Unobstructed vision
  • No need to raise eyebrows or to tilt the head back to see
  • No more headaches related to excessive use of forehead muscles to open the eyes

Aesthetic Improvements after ptosis surgery:

  • Appearance of looking more awake and “well-rested”
  • Bigger-looking eyes
  • Creation or redefinition of eyelid crease
  • Patients may also choose to undergo surgery for aesthetic reasons.

Any ptosis treatment will be customized based on:

 

  • The severity of the ptosis
  • Your desired aesthetic outcome

Severity of Ptosis

ptosis condition mild

ptosis condition moderate

ptosis condition severe

Ptosis correction depends on the underlying cause of the condition as well as the severity of the drooping. The recommended treatment or droopy eyelid surgery technique will be recommended based on individual needs.

Temporary Ptosis Eyelids

Certain medical conditions may cause temporary ptosis conditions. In such cases, there are specialized glasses that hold up the eyelids. These are known as a ptosis crutch and can be a droopy eyelid correction option in less severe ptosis cases.

This treatment, though, is usually only recommended if the condition is temporary. Glasses are also recommended if you are not the right candidate for ptosis surgery.

Mild Ptosis Eyelids 

In the initial onset of ptosis, it may present itself as an aesthetic concern more so than a functional issue. At this stage, non-invasive treatment options such as Botox injections to selected muscle groups around the eyes can help to lift the eyelids.

While the results are temporary, this is recommended for those who are not prepared to undergo droopy eyelid surgery. Individuals who prefer a more long-term solution can consider ptosis correction as a treatment option.

Milder ptosis conditions may not disrupt a person’s vision, but in more severe cases, it is possible to affect a person’s ability to see and that will require ptosis correction surgery.

Moderate to Severe Ptosis Eyelids

In cases of moderate to severe ptosis where a person’s vision is affected, doctors are likely to recommend ptosis surgery. During ptosis surgery, the levator muscle is tightened. This procedure serves as ptosis correction as it lifts the eyelid into the correct position. For children with ptosis, doctors may recommend ptosis surgery to prevent the onset of amblyopia or lazy eye.

ptosis severity diagram

How Much Does Ptosis Surgery Cost in Singapore?

Ptosis surgery costs range from $5,000 to $12,000 in Singapore, not including anesthetist and operating facility charges.

The actual cost depends on:

  • The surgical technique used
  • The complexity of the case

In straightforward cases where light sedation is sufficient, the total cost of the procedure should fall between $5,000 – $9,000.

Other factors affecting the cost of ptosis surgery includes:

  • Procedure fee
  • Anaesthetist’s fee
  • Operating facilities fee
  • Surgical consumables
  • Medication
  • The need for stitch removal
  • Medication

Drooping Eyelids Correction Techniques

There are 3 main surgical techniques:

1. Suture Ptosis Eyelid Correction 

A small incision is made into the skin of the upper eyelid and the levator muscles are tightened using a suture. Downtime for the surgery is relatively short.

This is recommended for patients with mild ptosis.A scarless suture technique is often used in the correction of mild upper eyelid ptosis.

suture ptosis correction surgery singapore

2. Incisional Ptosis Eyelid Correction 

An incision is made to access the eyelid muscle where a double eyelid crease is desired to be created (The levator muscles are shortened and pinned upwards).  Any excess skin and fat which may be weighing the eyelids down can be removed along with parts of the resected eyelid muscle.

This is recommended for patients with moderate ptosis conditions.

3. Frontalis Suspension Technique

Should the eyelid muscle be too weak, sutures can be used to anchor eyelid tissues to the muscles above the brow. This way, they act like suspension cables of a bridge, harnessing of the frontalis (forehead) muscles in order to assist the elevation of the upper eyelid. This technique is usually recommended in very severe cases of ptosis and very weak levator function.

Read More: Which Ptosis Eyelid Surgery Techniques Work The Best For Droopy Eyelids?

Are There Non-Surgical Procedures to Fix Ptosis? 

There are no non-surgical procedures available to fix ptosis. The condition of the levator eyelid muscle is what causes eyelids to droop, and the tightening of the muscle can only be done surgically.

What Happens During Ptosis Surgery? 

How the ptosis surgery will be depends on how the ptosis has been graded, the plastic surgeon, the technique used, and other factors.

Eyelid Surgery

A scarless suture technique is often used in the correction of mild upper eyelid ptosis.

Moderate to severe droopy eyelid require surgery. The procedure typically involves an incisional cut done on the eyelid crease under local anesthesia. This is then followed with the stimulation of the levator muscle that lifts the upper eyelid.

Dr. Vincent Yeow performs ptosis surgery using a modified ‘under through’ levator application technique and has been getting successful results for years.

If an incisional technique is recommended, an incision is made along the upper eyelid crease. This exposes the eyelid tissues and muscles for adjustment. In some cases, part of the eyelid muscle may be removed, and the eyelid tissue positioned upwards to achieve a lifting effect.

Your doctor might ask you to sit up to assess the amount of eyelid opening. This is to check the symmetry of both eyelids. Minimal adjustments may be made if required.

Finally, the wound is sutured either to blend into your existing eyelid crease, or to form a double eyelid crease, if that is requested.

Surgical procedures can be done under local anesthesia. If you have a very low pain threshold, sedation is also an option. While in sedation, you’ll feel little to no pain. However, do note that you will be woken up to complete the eyelid height assessment afterwards.

Risks of Ptosis Surgery

surgery theater and recovery area at dream plastic surgery singapore

Dr Vincent Yeow have treated patients who had done ptosis surgery elsewhere and resulted in an eye bigger than the other. Unfortunately the previous surgeon refused to take responsibility, saying that he was “only responsible for lifting up the eyelid, not for making the eyelid look nice”.

“Personally, I believe that upper eyelid ptosis correction is more than just a medical procedure. It is an aesthetic choice as well. Hence, the person best trained to help you achieve best results is a surgeon who is well-trained in upper eyelid ptosis correction surgery and appreciates not just the eyelid function but also its beauty.”

Common ptosis surgery failures I’ve seen in Singapore include:

  • Misdiagnosis of the cause of ptosis, leading to the wrong procedural choice
  • Poor surgical technique – patients who have been unsatisfied with their droopy eyelid corrections had their surgery done by doctors who were not trained to perform the procedure.

Risks include:

1. Abnormal scarring 

Stitching techniques vary greatly between plastic surgeons and surgeons from other specialties; this sets us apart when it comes to managing scars.

A less skilled surgeon may leave obvious or additional scars when closing incisions along the eyelid. Keloid scars can also form along the incision site if stitches are not expertly completed.

2. Suture breakage

Poor surgical technical also leads to a tendency for sutures to break or to come loose.

 3. Bleeding and infection 

In poorly handled procedures, excessive bleeding or swelling are potential problems that can disrupt or prolong droopy eyelid repair and recovery.

Dr Vincent Yeow’s Approach To Ensure the Optimal Results

There are a few important points to bear in mind when approaching ptosis surgery:

1. Proper assessment and diagnosis

It’s important to determine the real cause, as well as severity of the ptosis. A good assessment informs the plastic surgeon on what he/she should do to achieve the desired eyelid height while balancing aesthetic considerations, for better satisfaction.

2. Correct surgical procedure

Each surgical technique is tailored based on ptosis severity; each technique affords a different level of access to the levator muscle. Applying the correct surgical procedure ensures that the correct level of muscle correction is made.

3. Proper surgical technique and dissection

Given the limitations of each surgical technique, an experienced surgeon adapts their approach based on each patient’s unique problem areas, and knows how best to make and stitch up incisions.

4. Minimal surgical duration

A quicker surgery means less bruising and a more comfortable experience. It also means that recovery will be faster, resulting in a better surgical outcome.

Important Details to Ask Your Droopy Eyelid Plastic Surgeon During Consultation

Our surgeon Dr. Vincent Yeow will help you get the details you need to help you get ready and prepared for the procedure in our clinic.

Some of the essential details he will discuss with you during consultation include;

Before and After Pictures of Ptosis Surgery

Viewing this will help you know what is obtainable and give you a better picture of the procedure’s final result.

The Procedure’s Detailed Pathway

Every ptosis surgeon in Singapore has a different approach to Ptosis Surgery. Our surgeon discusses his approach’s benefits and gives you the information you wish to know about the procedure and how it works.

A Breakdown of the Ptosis Surgery Cost

Ptosis surgery cost is usually high. Thus, it is usual to find out the breakdown of the surgery fee to help you understand what is involved in the price you are to pay. This will help you make your budget right.

The Pre and Post-Surgery Care 

Taking care of the eye before and after the surgery is crucial towards the success of the procedure; it’s as important as the surgery itself. It’s essential to know the best ways to take care of your eyes before and after the surgery to ensure you get optimal results.

Patients in our clinic are welcome and encouraged to address any of their concerns or questions regarding their droopy eyelid issues so that they can make a confident decision about undergoing ptosis surgery in our Singapore clinic.

Things to Note Before and After Droopy Eyelid Surgery 

Here are some prerequisites you should take care of before getting a ptosis surgery;

Before the day of surgery

  • Avoid any medications that thin blood or potentiate the bleeding tendency of a person, e.g. aspirin, naproxen, ibuprofen, other NSAIDs, etc, for at least 2 weeks before the surgery.
  • Avoid vitamin E, herbal, and fish oil supplements for 2 weeks.
  • Refrain from smoking as it may interfere with the healing process.
  • Steer clear of alcohol consumption for 2 weeks – etc

On the day of surgery

  • Do not drink or eat anything from midnight till the time of surgery.
  • Do not apply makeup, lotion, or any other facial cosmetic product.
  • Don’t wear contact lenses.
  • Arrange someone to take you home from the hospital or facilitation center as it is not recommended to drive after getting ptosis surgery for at least 24 hours – etc

Droopy Eyelid Surgery Aftercare Tips

To ensure the best possible outcomes:

  • Don’t rub the eyes after surgery.
  • On the first day of your post-surgery recovery, apply a cold compress regularly to reduce swelling.
  • From the second day, apply a warm compress to enhance blood circulation, and reduce bruising/swelling.
  • Elevate your sleeping position. Swelling moves in a downward direction. When you place your head above your heart level, you counteract nature’s gravitational pull and recover faster.
  • Make sure to complete your course of oral antibiotics.

What Is The Average Recovery Period for Ptosis Surgery?

After surgery, bruising may be present for about 2 weeks.

Most people are able to return to their daily activities about a week after the surgery. The appearance of your eyes will continue to get better for the next 1 – 3 months.

Am I A Candidate for Ptosis Correction? 

Our surgeon, Dr. Vincent Yeow, will conduct a test to determine whether you are a candidate for ptosis or droopy eyelid correction.

This is called the margin reflex distance (MR1) test. Doctor will measure the distance from your pupil’s center to the upper eyelid.

This is also used to determine whether a candidate is eligible for insurance or Medisave claim.

How do doctors determine if my ptosis surgery is Medisave claimable?

There are 3 degrees “severity” when we describe ptosis. This is defined based on how much the eyelid moves from when the eye is closed to when the eye is fully open, without moving the eyebrow.

A normal upper eyelid has at least 12 mm of lid opening excursion.

  • Good eyelid function: movement of more than 10mm
  • Medium eyelid function: movement between 5 to 10mm
  • Poor eyelid function: movement between 0 to 5mm

To be classified as ptosis, lid opening must have a Marginal Reflex Distance (MRD) of less than 2mm.

When the distance is below a certain level, ptosis correction is required.

Candidates who are not suitable for surgery or have temporary droopy eyelids are often given a prescription of glasses (ptosis crutches) that hold the eyelids up.

We always recommend consulting with us before surgery.

Get your droopy eyelids corrected 

If you are experiencing droopy lids causing them to look inattentive, sleepy or angry. 

Book your consultation today to learn more about ptosis surgery and how this treatment will benefit you! During the consultation, Dr. Vincent Yeow’s will make an eyelid assessment to find out if yours is a ptosis condition and the suitable method to regain better vision and physical appearance.

ptosis droopy eyelid causes treatment surgery

About Dream Aesthetics and Plastic Surgery

Bespoke surgical for cosmetic or medical reasons is what Dream covers to bring out the beauty in every individual. Going beyond the aesthetics and working on physical anomalies are what we value the most in leading our patients to cherish self-improvement and confident lifestyles.

Derived from Associate Professor Vincent Yeow’s long-standing experience performing plastic surgery in Singapore, our treatment plans deliver physical remodelling in our patients’ favour. One of the notable remodellings is droopy eyelid correction. The ptosis surgery used for treatment eventually fixes drooping eyelids, improves vision and enhances appearance.

Most importantly, as a trustworthy plastic surgery and aesthetic clinic, we treasure positive and natural outcomes for each individual. We will ensure to deliver the beauty refinement of your dream without compromising your safety and privacy.