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 ptosis causes ranging from muscular problems, neurological conditions, eye trauma, botox injections (often by inexperienced injectors), eyelid tumours 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 surgery is often recommended to restore the eyelid function and one’s vision. ptosis example 2

Ptosis on the left, resulting to asymmetrical eyelids

Types of Ptosis

  • Aponeurotic – When the muscle is detached because of ageing, excessive rubbing or pulling of the eyelids.
  • Mechanical – When the upper eyelid is weighed down by excessive skin, fat or the presence of a tumour, 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 )

Drooping 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 ptosis have other eye-related problems, including eye movement issues, tumours, 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 tumours can affect the eye muscle, leading to sagging 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 customised 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 ptosis 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 ptosis 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 ptosis 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 eyes require surgery. The procedure typically involves an incisional cut done on the eyelid crease under local anaesthesia. 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 anaesthesia. If you have a very low pain threshold, sedation is also an option. While asleep, 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 from different surgeons who came out of ptosis surgery with one 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 ptosis 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 ptosis repair and recovery.

Dr Vincent Yeow’s Approach To Ensure the Best 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 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?

plastic surgery recovery singapore 

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 correction.

This is called the margin reflex distance (MR1) test. Doctor will measure the distance from your pupil’s centre 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 12mm 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 ptosis are often given a prescription of glasses (ptosis crutches) that hold the eyelids up.

We always recommend consulting with us before surgery.

How To Find The Best Doctor For My Ptosis Surgery in Singapore?

1. Ask around – Get more information from people who have done the surgery. They are living specimens of a surgeon’s work.

2. Ask to view before and after photos – Looking at pictures of a surgeon’s past work is a good way to assess their skills.

3. Get a doctor’s recommendation – Doctors will be more likely to recommend reputable surgeons with good track records

4. Consult an experienced plastic surgeon – An experienced plastic surgeon will be able to address both the functional and aesthetic aspects of ptosis surgery.

Ptosis is a medical condition and can be treated 

Even though droopy eyelids are usually harmless and require no cause for alarm, certain instances need you to take action.

If you notice a droopy eye that is accompanied by stroke symptoms like blurred vision, facial, arms, and legs muscle weakness, several headaches, and/or trouble sleeping, you may have to consult your doctor.

If you experience a droopy eyelid that appears suddenly or develops rapidly over a short period, you may also have to consult your doctor.

Furthermore, if you experience eye redness and/or pain, along with a fever and difficulty moving the eye, we recommend you see a doctor.

Parents should also observe their baby’s eyes for signs of ptosis. When noticed, it’s crucial to see an eye doctor.

In all situations, with proper consultation, an eye care professional or plastic surgeon can discuss treatment options and establish whether ptosis surgery is right for you.

ptosis droopy eyelid causes treatment surgery

 

FAQ - Other Common Questions Asked By My Patients

During your consultation with your doctor, you may discuss:

  • Your desired height of the double eyelid crease
  • Whether you prefer it to be nasally tapered or parallel

Correcting mild ptosis will result in a subtle but discernible improvement. The people around you will probably notice that you look fresher and more awake as a result of having eyes that open bigger than before.

When you have healed completely after surgery, your scar will blend into your existing eyelid creases, making it barely visible.

In the early stages of recovery, you may experience uneven swelling on both sides of the eyelid, making it appear asymmetrical. It is best to assess results only after the swelling has gone down completely, usually after a month.

If imperfections remain after complete recovery, these can be addressed easily, though on occasion some may require further surgery. Some examples requiring further surgery:

  • Height of eyelids
  • Asymmetry in eyelid crease
  • Presence of excess skin
  • ∙Presence of excess fat

It is important to remember that the human body is inherently asymmetrical. I believe that every effort should be taken to make the eyes as balanced as possible, but it is not possible to make them 100% symmetrical.

Scars are usually hidden along the patient’s existing upper eyelid crease. Even you don’t have an existing crease, a good surgeon will position the scar so that it appears as a natural double eyelid crease.

In most cases, the results after ptosis correction are more or less permanent. There is a small chance (in about 10% of patients) that revision may be required in future. This is when the eyelid droops again, causing asymmetry.

If your eyelid remains symmetrical 1 to 2 months after surgery, there is a high chance that the procedure has resulted in a permanent change.

Even though there is no total prevention for ptosis conditions, some lifestyle and habitual adjustments can help to slow down the onset of aging. Making an effort to avoid rubbing your eyes excessively, reducing any pulling or tugging from contact lenses application, and go easy on the eyelids during make up application helps to preserve the eyelid’s condition at its best.

Individuals with ptosis conditions can stop it from getting worse by seeking early treatment. It should be taken seriously because it can affect your vision as the eyelid muscles deteriorate over time. Getting regular eye checkups and a better understanding of your ptosis condition from your doctor can help you plan your treatment journey and decide if ptosis surgery is necessary.

Yes. Ptosis surgery in Singapore can be classified as a medical condition, and that qualifies for both Medisave and insurance claims.

Having said that, I recommend that my patients complete the Margin Reflex Distance (MRD) 1 test to confirm their eligibility for Medisave or insurance claims. The MRD 1 is administered by an ophthalmologist and is a requirement by the Ministry of Health in Singapore to certify that you do have ptosis condition.

References
  • Satariano N, Brown MS, Zwiebel S, Guyuron B. Environmental factors that contribute to upper eyelid ptosis: a study of identical twins. Aesthetic surgery journal. 2015 Mar 1;35(3):235-41.
  • King M. Management of ptosis. The Journal of clinical and aesthetic dermatology. 2016 Dec;9(12):E1.
  • Lemke, B. N., & Stasior, O. G. (1982). The anatomy of eyebrow ptosis. Archives of Ophthalmology, 100(6), 981–986. https://doi.org/10.1001/archopht.1982.01030030989019
  • Fox, S. A. (1980). Surgery in ptosis. Archives of Ophthalmology, 98(1), 186–186. https://doi.org/10.1001/archopht.1980.01020030188025
  • Gorelick, P. B., Rosenberg, M., & Pagano, R. J. (1981). Enhanced ptosis in myasthenia gravis. Archives of Neurology, 38(8), 531–531. https://doi.org/10.1001/archneur.1981.00510080093017
  • Kao, S. C., Tsai, C. C., Lee, S. M., & Liu, J. H. (1998). Astigmatic change following congenital ptosis surgery. Zhonghua yi xue za zhi = Chinese medical journal; Free China ed, 61(12), 689–693.