Ptosis, or droopy eyelid, can happen to everyone. It occurs more frequently with the elderly because ptosis occurs normally from ageing. However, there are some cases where ptosis happens due to injuries. Ptosis surgery is done to help reshape your eyelid. Whether it’s for aesthetic purpose or functional purpose.
I have written this guide article to help you prepare yourself before proceeding in ptosis surgery. This article includes:
- Causes of ptosis
- The appropriate candidate for ptosis surgery
- Reasons why people go for ptosis surgery
- Types of ptosis surgery
- Cost, and so on.
Read more to find more information regarding ptosis surgery.
What are the causes of Ptosis?
Generally, Ptosis is caused by the inelasticity of, or damage to, your eyelid muscle (also known as the levator muscle). This elastic muscle relaxes and stretches to control the opening of your eyes and can become less elastic as you age.
There are 5 main causes of Ptosis:
Aponeurotic ptosis occurs when your muscle has lost its elasticity due to excessive rubbing of the eyelid as well as ageing. This type of ptosis commonly occurs among the elderly as an involutional disorder.  This can also occur in adults who often wear contact lenses.
Mechanical ptosis occurs when there is excessive skin or fat that weighs down the eyelid. This can also be caused by tumours in the eye area that cause your eye to appear droopy. A few other common causes for mechanical ptosis are: 
- Swelling (Edema)
- Dermoid cysts
This specific type of Ptosis is caused by accidents or injuries to the upper eyelid. The scar from the trauma can weaken your upper eyelid’s muscle. If not treated sooner, the droopy lid can get worse as you age. 
Neurogenic ptosis occurs when the nerves of your eyelid muscle are not functioning normally. This type of ptosis can also occur due to injuries. The effect of an injury can affect brain function and damage the nerve. 
Myogenic ptosis occurs when your eyelid muscle does not function normally. This causes the eyelid to be poorly formed. This type of ptosis is commonly passed down from generation to generation. 
Who is suitable for Ptosis surgery in Singapore?
Even though ptosis commonly occurs to the elderly, it can affect people of any age. If not treated sooner, it can interfere with your sight as you age. Therefore, a correction needs to be done even at a young age.
Some conditions you have to meet for surgery are that you: 
- Have upper eyelid asymmetry or malposition with excessive coverage of the iris
- Have excess skin or fat around the eyelid area
- Have loose or sagging skin that affects the eyes
- Understand what the surgery can and cannot accomplish
- Are generally healthy
Why do people go for Ptosis surgery in Singapore?
There are different reasons as to why people go for ptosis surgery. Some patients go for aesthetic reasons and some patients do it to improve their sight.
Aesthetic reasons include helping people:
- To look fresh and awake
- To enlarge the eyes
- To define or redefine eyelid crease
Functional reasons include helping people:
- To improve vision
- To ease seeing process
- To minimise headaches due to excessive use of forehead muscles
What are the types of Ptosis surgery in Singapore?
There are 3 main kinds of surgical techniques:
Suture Ptosis Eyelid Correction
This technique is done by stitching your eyelid tissue without making an incision to adjust your eyelid muscle. This method is suitable if you have mild ptosis and asymmetrical eyes. 
Incisional Ptosis Eyelid Correction
This technique is done by making a small incision to create the crease using the extra skin that you have on your eyelid. This technique is advised if you have mild ptosis. 
Frontalis Suspension Technique
This technique is commonly done to treat severe ptosis as it is a surgical procedure. Your eyelid is being ‘pulled’ to the eyebrow with various materials to help the muscle support the eyelid. 
What are the costs of Ptosis surgery in Singapore?
Generally, the cost for ptosis surgery ranges between $5000-$12000. However, the price can be different, depending on: 
- How complex your ptosis case is
- The type of procedure done
In simpler cases, there are also surgeries that cost around $5000-$9000 because the procedure uses light sedation.
There are also other factors that affect the cost:
- Procedure fee
- Anaesthetist’s fee
- Operating facilities fee
- Surgical consumables
- The need for stitch removal
Is it Medisave claimable?
Ptosis is considered a medical condition so treatment is Medisave and insurance claimable. However, you need to undergo tests like the margin reflex distance (MRD) 1 test to determine the severity of your ptosis. See the section below for more information.
How do doctors determine the severity of Ptosis?
There are 3 degrees of ptosis "severity". Severity is classified based on the distance measured from the pupillary light reflex to the upper eyelash point.
A normal upper eyelid has an opening distance from the pupil of 4mm or more.
- Good eyelid function means there is a distance of 4mm or more
- Moderate eyelid function would imply a distance of 2-4mm
- Poor eyelid function is reflected as less than 2mm
To be classified as moderate ptosis for it to be medically indicated for correction, the MRD1 has to be 2mm or less. 
What happens during Ptosis surgery?
During ptosis surgery, your surgeon will make an incision to open the skin of the upper eyelid. This procedure is done under local anaesthesia. After the incision is made, your surgeon will manipulate a small muscle that raises the eyelid. Then, the skin will be closed using stitches.
In certain cases, part of the eyelid muscle is removed, and the eyelid tissue is repositioned upwards to give that desired lift. Afterwards, your surgeon will assess your eyelid opening.
Finally, the wound is then stitched to blend into your existing crease or to form into a double eyelid crease. 
Are the results after Ptosis surgery permanent?
In most cases, the result of ptosis surgery is permanent, though you can make small revisions in the future. However, your eyelid can still develop ptosis as you age. The result of ptosis surgery usually lasts for around 5-7 years. For the lower eyelid, the surgery usually only needs to be done once. 
"Will other people be able to tell that I had Ptosis surgery?"
Correcting a mild ptosis will result in a subtle improvement, and people around you would probably notice that you look fresher and more awake.
Once the scar has healed completely, it will blend into your existing wrinkle or double eyelid crease, which makes it hardly visible.
Failed ptosis surgery--what are the chances?
Just like any other surgery, this particular surgery can fail. Misdiagnosis and faulty surgical techniques are the two common causes of ptosis surgery failure. These occur because some doctors are not trained to perform the surgery. Side effects include:
- Abnormal scarring: caused by the failure in handling the incision, therefore the scarring appears visible.
- Bleeding and infections: caused by improper technique. Make sure your surgeon is extra careful when performing the surgery!
- Suture breakage: if the suture or stitches is not done properly, it can loosen and cause breakage.
How do I get the best result from Ptosis surgery?
In order to achieve the best result from ptosis surgery, you need to make sure:
You get a proper assessment and diagnosis
Determining which procedure to undergo is important to minimise the risk of failure. Good assessment will allow your surgeon to choose the best procedure in order to achieve the desired height and balance the aesthetic portion to get the best result.
Your surgeon explains the procedure to you
By performing the procedure correctly, it allows your surgeon to correct different severity of ptosis and elevate your eyelid muscle.
Your surgeon explains any alternatives and explains their choice
If your surgeon is highly skilled and trained, they will be able to choose the right method and perform the procedure using the most appropriate technique.
Your surgeon has effective surgical experience
Highly trained and skilled surgeons mean shorter surgical duration. It means less bruising and faster recovery.
What if I’m not satisfied with the result?
Sometimes, the result of a ptosis surgery can be unsatisfactory. For certain types of ptosis surgery, small adjustments can be done quickly especially during the early recovery period.
There are some other problems that can be corrected through further surgery. For instance: 
- Excessive double eyelid fold
- Excessive removal of eyelid fat
- Asymmetrical double eyelid
- Eyelid being too high
How long will I take to recover?
Generally, recovering from ptosis surgery takes about 1-3 months until you can see the full result. The recovery also comes in stages: 
- During the first week, you can ice the skin around the eye area. You also need to clean the eyes area for 4 to 6 times depending on your doctor’s instructions until the stitches are removed.
- About a week after surgery, the stitches are usually removed. Even though you no longer have stitches, you still have to rest. Usually, people take up 10 days off work.
- You can start exercising on the third-week post-surgery.
- There will still be some minor swelling until your skin starts to heal in the third month.
How can I achieve the best results after Ptosis surgery?
Before you undergo the procedure, you need to take note of certain things to minimise complications. For instance: 
- Know your surgeons. Make sure that you are being handled by a trained surgeon.
- Pay attention to your eyes’ contour. You want it to have a nice shape, not too high or too low.
- Mark the highest lid, so you can still see the highest eyelid point even during swelling.
- Don’t force an eyelid correction if your eyes are dry. It is an expected side effect that your eyes become dry after surgery, but do not overcorrect if your eyes are already dry from the beginning.
In order to smoothen your recovery process and achieve the best results, you also need to ensure you: 
- Avoid swimming, straining, or heavy lifting until you are off-stitches to make sure there are no loose stitches that can lead to infection.
- Avoid smoking
- Avoid rubbing your eyes as it can hurt your eyes
- Use a sunscreen or dark-tinted sunglasses to prevent your eyes from the sun and the wind. This also helps in minimising the chance of discolouration and helps with light sensitivity.
- Apply cool compresses to reduce swelling
- Try to avoid taking medicines like ibuprofen, naproxen, and other herbal medicine that can cause bleeding.
How to find the best doctor in Singapore for my Ptosis surgery?
To find the best doctor in Singapore, there are a few things that you need to take note:
Ask around, research online, compare surgeons or ask for recommendations from your doctor. That way you will have an idea of which surgeon to choose. Make sure your surgeon is highly trained in the field.
Ask for before and after photos
By looking at before and after photos, you will see the surgeon’s portfolio. You will then be able to choose which style suits your aesthetic appeal the most.
Consult with an experienced plastic surgeon
Before proceeding in the procedure, having a few consultations with surgeons can give you options of which doctors that suits you better.
The process of doing ptosis surgery can seem complicated. There are a lot of things that you need to consider, especially because the eye area is a very delicate area. Although the chances of surgery failure in Singapore is considerably low, you still need to prepare yourself if things go wrong. I would like to stress that research is a very important step in choosing your surgeon and minimising further complications.
Dr Samuel Ho is a plastic surgeon at Allure Plastic Surgery. He has worked alongside top plastic surgeons at plastic surgery centres in Korea, such as the Hanyang University Hospital, 101 Plastic Surgery Clinic and BIO Plastic Surgery Clinic. Aside from regular work, Dr Samuel is a supporter of a not-for-profit medical volunteer organization that provides reconstructive facial surgery to young children in Indonesia.