One of the more common question I get from my patients is whether their drooping eyelids are a medical condition, or if it’s considered a cosmetic issue.
To a large extent, Ptosis (the medical term for drooping of the upper eyelid) is a medical condition.
Ptosis can happen to people of any age, and the severity of it varies. Some of my patients undergo ptosis surgery because it's affecting their daily activities, but there are also patients whose motivations are more aesthetic-driven.
Occasionally, there are also children who are born with congenital upper eyelid ptosis and require surgical correction at a young age.
I've decided to write this post to help you understand:
- The causes of ptosis
- How to treat ptosis in Singapore, and
- The factors that affects the cost of ptosis surgery in Singapore
"How come I've got droopy eyelids?"
The medical term for droopy upper eyelids is “ptosis of the upper eyelids”. Ptosis means “drooping”.
The cause of droopy eyelids is directly related to the function of your eyelid muscle (also called the levator muscle).
This muscle acts like a rubber band that stretches and relaxes to control the opening of your eyelids.
Your eyelid muscle can weaken over time and become less ‘elastic’. There are 5 main causes for this:
- Aponeurotic – When the muscle is detached due to ageing, excessive rubbing or pulling of the eyelids.
- Mechanical – When the eyelids are weighed down by excessive skin, fat or presence of a tumour on the upper eyelid which contributes to the appearance of a droopy eyelid
- Traumatic – When the eyelid muscle is weakened due to past accidents or injury to the upper eyelid.
- Neurogenic – When the nerves to the muscle are not functioning normally
- Myogenic – When the muscle is not functioning normally
From my experience, the most common causes of ptosis in Singapore among my patients are due to:
- Excessive eye rubbing, or
- Pulling of the eyelids
Who needs to have Ptosis surgery in Singapore?
Ptosis can affect people of any age.
Even though it's more common amongst the older age group, I've also seen children born with ptosis and require surgical correction at a young age.
Patient with worse ptosis on the right more than left ptosis
Congenital ptosis patient
Why do people go for ptosis surgery in Singapore?
Some of my patients do it purely for functional reasons, but there are also patients whose motivations are more aesthetic-driven.
Functional Improvements after ptosis surgery:
- Reduce vision obstruction
- Eliminate the need to raise eyebrows or tilt the head back to see
- Eliminate headaches related to excessive use of forehead muscles
Aesthetic Improvements after ptosis surgery:
- Look more awake and "well-rested"
- Larger-looking eyes
- Definition of eyelid crease can be created or redefined in the same procedure
Your ptosis treatment will be customised based on:
- The severity of the ptosis and
- Your desired aesthetic outcome
How much does Ptosis surgery cost in Singapore?
Generally, the cost for Ptosis surgery in Singapore ranges from $5,000 to $12,000, not including the anaesthetist and operating facility charges.
The actual cost depends on:
- the surgical technique used, as well as
- The complexity of the case
In less complex 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
- The need for stitch removal
Are there any subsidies or Medisave claims available for Ptosis surgery?
Yes - ptosis surgery in Singapore qualifies for Medisave and insurance claims as it's classified as a medical condition.
Having said that, I do require my patients to go through the margin reflex distance (MRD) 1 test to determine whether their condition is eligible for Medisave claims (more explained below).
After which, the Ministry of Health in Singapore states that certification of upper eyelid ptosis needs to be done by an ophthalmologist.
How do doctors grade the severity of ptosis and determine if it is Medisave claimable?
There are 3 degrees of ptosis "severity". Severity is classified based on how much the eyelid moves from eyelid closure to maximal eyelid opening without moving the eyebrow.
A normal upper eyelid has 12mm or more of lid opening excursion.
- Good eyelid function is movement of more than 10mm
- Medium eyelid function is movement between 5 to 10mm
- Poor eyelid function is movement between 0 to 5mm
To be classified as ptosis, the MRD1 has to be less than 2mm.
What techniques are available for Ptosis surgery in Singapore?
There are 3 main surgical techniques:
- Suture Ptosis Eyelid Correction
This technique works by stitching the eyelid tissue as high as required for unobstructed vision. I usually recommend this for patients with mild ptosis.
- Incisional Ptosis Eyelid Correction
The eyelid muscle is accessed through an incision made along the double eyelid crease, or where the crease is suppose to be created.
Unnecessary tissues such as fat and skin may be removed along with parts of the resected eyelid muscle. In some cases where excising is not required, eyelid tissue is stitched even higher.
- Frontalis Suspension Technique
If the eyelid muscle is too weak, sutures which act like suspension cables of a bridge are used to anchor eyelid tissue to the muscles located above the brow.
Can I get rid of the Ptosis of my eyelid without surgery?
No, you cannot. The levator eyelid muscle is the main thing that causes the eyelids to droop, and the tightening of the muscle has to be done surgically.
What happens during Ptosis surgery?
Firstly, an incision is made along the upper eyelid crease to expose and adjust the eyelid tissues and muscle.
In certain cases, part of the eyelid muscle is removed, and the eyelid tissue is repositioned upwards to give that desired lift.
Next, your doctor will get you to sit up to assess the amount of eyelid opening.
Finally, the wound is then sutured to blend into your existing eyelid crease, or to form a double eyelid crease.
"Ptosis surgery sounds super painful!"
The surgery can be done under local anaesthesia.
You'll only feel the pain at the start of the operation when you are getting the injection.
As the surgery progresses, more local anesthetic will be injected to prevent you from experiencing pain during the surgery.
If you have a very low pain threshold, I'd recommend sedation to make the surgical experience more comfortable.
When you're asleep, you'll feel little to no pain. However you will have to be awakened for eyelid height assessment afterwards, be it whether it's performed under local anaesthesia or sedation.
Are the results after Ptosis surgery permanent?
In most cases, the results after ptosis correction are more or less permanent, even though there might be a small group of patients who may require revision in future.
Usually, we're looking at a revision rate of about 10%. That means that about 10% of patients will need to have a repeat surgery performed if the eyelid droops again, or if it becomes asymmetrical.
If your eyelid remains symmetrical 1 to 2 months after surgery, it means that the correction is likely to be permanent.
Can Ptosis surgery fail?
Yes, like any other surgery, there's a chance of failure with Ptosis surgery.
I've once treated a patient who had one eye bigger than the other after ptosis surgery. To my horror, the previous surgeon denied all responsibility as "he was only responsible for lifting up the eyelid, and not for making the eyelid look nice".
Other common causes of ptosis surgery failures I've seen in Singapore include:
- Misdiagnosis of the cause of ptosis, and the wrong procedure performed
- Poor surgical technique
From my experience, patients who were unsatisfied with their ptosis correction had their surgery done by doctors who were not trained to perform ptosis correction.
When proper care is not taken when handling the eyelid muscle, the muscle may be weakened or damaged, affecting the patient’s ability to raise the eyelid.
- Abnormal scarring
The stitching technique plastic surgeons adopt are very different from others and that sets us apart when it comes to managing scars.
When the incisions along the eyelid are not handled properly, it can result in an unsightly scar which may appear more obvious, or leave additional scars.
In certain cases, keloid scars may also form along the incision site if they are not handled properly.
- Suture breakage
If the surgeon is not careful or if the suture is weakened due to poor handling or surgical technique, there is a tendency for the suture to break or come loose.
- Bleeding and infection
If the surgeon is not careful enough, he can cause excessive bleeding or swelling which will disrupt the ptosis repair.
How can you ensure the best results from a Ptosis Surgery in Singapore?
There are a few important points to ensure the best results after ptosis surgery:
- Proper assessment and diagnosis of the problem
It's important to determine the real cause, as well as the severity of the ptosis.
A good assessment allows the plastic surgeon to determine what he/she should do to achieve the desired height as well as balance the aesthetic portion for better results.
- Correct surgical procedure done to correct the ptosis
Each surgical technique is catered for ptosis of different severity, because they give different level of access to the levator muscle. This also allows for different levels of muscle correction.
- Proper surgical technique and dissection
An experienced surgeon would know which area to dissect, as well as to choose the right method to address each individual’s ptosis on a case by case basis.
- Adequate surgical experience
Shorter surgical duration = less bruising = more comfortable experience = faster recovery and better surgical outcome.
"Do I have any say in my eyelid appearance?"
You can discuss with your doctor:
- the desired height of the double eyelid crease, and
- whether you prefer it to be nasally tapered or parallel during the consultation
Personally, I believe that correction of upper eyelid ptosis is not only a medical procedure, but also a cosmetic procedure.
The person best trained to do this is a surgeon who well trained in upper eyelid ptosis correction surgery, and can appreciate not only eyelid function but also its beauty.
"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.
"What if I'm not satisfied with the results of my Ptosis surgery?"
In early stages of recovery, uneven swelling on both sides of the eyelid can often cause the crease to look asymmetrical.
Hence, its best to reassess only after the swelling has gone down completelely. This takes around 1 month.
Surgeons will be able to assess you much more accurately once the swelling has improved.
While some imperfections can be addressed easily, others may require further surgery. For example, if you are dissatisfied with:
- Height of eyelids
- Asymmetry in eyelid crease
- Presence of excess skin
- Presence of excess fat
Our human body is inherently asymmetrical, and I believe that every effort must be taken to make the eyes as balanced as possible. However, it is not possible to make them 100% symmetrical.
"How big will my scar be after Ptosis surgery?"
The scars are usually hidden along the patient’s existing upper eyelid crease.
If you don't not have an existing crease, the scar will be positioned to appear as a double eyelid crease.
What is the recovery period after a Ptosis surgery?
After surgery, bruising may be present for about 2 weeks.
Most people are able to return to their daily activtivies about a week after the surgery. The appearance of your eyes will continue to get better for the next 1 - 3 months.
How can you achieve the best results for your Ptosis surgery?
- Don’t rub the eyes after surgery.
- On the first day of your post-surgery recovery, you should apply cold compress regularly to reduce swelling
- From the second day of your post-surgical recovery, apply warm compress to enhance blood circulation. This helps to reduce bruising and swelling.
- Elevate your sleeping position. When you place your head above your heart level, it helps to speed up your recovery from swelling and bruising due to nature’s gravitational pull.
- You will also need to complete a course of oral antibiotics
How to find the best doctor for your Ptosis surgery in Singapore?
- Do your research - Get more information from people who have gone for ptosis surgery. They are a living specimen of the surgeon’s work.
- Ask to view before and after photos - Pictures of a surgeon’s past work is a good way to assess their skills.
- Ask a doctor friend for recommendation - No doctor will want to harm their reputation by recommending a collegue who is not qualified or reputable.
- Consult an experienced plastic surgeon - An experienced plastic surgeon will be able to address both the functional and aesthetic aspects of ptosis surgery.
Dr Por Yong Chen has a philosophy of taking a holistic approach in patient care. He takes extra care when it comes to designing each patient’s customised treatment plan, choosing the safest surgery techniques in order to reduce the visibility of scarring, optimise a faster recovery process and to achieve the longest-lasting result possible.