While many people may think drooping eyelids are simply a cosmetic issue, it can actually be a medical condition. The term for this is ptosis, and it can happen to anyone. The severity of the drooping of the upper eyelid varies among my patients. Some patients want to undergo surgery for aesthetic reasons, but for many ptosis can greatly affect their daily lives by obstructing their vision. In this post, I hope to help you understand the causes of ptosis, how to seek treatment in Singapore, and the factors that affect the cost of correction surgery.
Ptosis is caused by issues with the levator muscle, the muscle that controls the eyelid. The muscle is like a rubber band that stretches and contracts to allow you to open your eye to varying degrees. This muscle can weaken over time and become less elastic. There are five main reasons for this:
- Aponeurotic – The muscle becomes detached due to ageing or excessive rubbing and pulling of the eyelid.
- Mechanical – The eyelids are weighed down by an extra skin, fat, or a tumour on the upper eyelid.
- Traumatic – Injury to the upper eyelid weakens the levator muscle.
- Neurogenic – The nerves controlling the muscle are not functioning properly.
- Myogenic – The muscle itself is not working properly.
In my own experience, the most common causes of ptosis are aponeurotic – when people rub or pull at their eyelids too much, or simply muscle deterioration due to ageing.
Ptosis can affect people of any age, though it is more common in older age groups. Sometimes children are born with congenital upper eyelid ptosis and need correction surgery at a young age. Many of my patients seek treatment entirely for functional reasons such as improving their vision by removing an obstruction, eliminating the need to raise their eyebrows or tilt their head back to see, and reducing headaches caused by overusing their forehead muscles. Some patients seek treatment for aesthetic reasons, including larger-looking eyes, a more defined eyelid crease, and looking more awake and alert. Your doctor will customize your treatment based on the severity of the ptosis and your desired visual results.
The cost of ptosis correction surgery in Singapore is usually quoted anywhere between $5,000 and $12,000. This does not include the cost of operating facility charges or anaesthesia. The real cost of the procedure will also depend on the severity of the ptosis and the techniques used. In less complex cases that require less anaesthesia, the cost will be on the lower end of the spectrum. Other factors that will drive up the cost are:
- Procedure fee
- Anaesthetist’s fee
- Operating facilities fee
- Surgical consumables
- Stitch removal
Below I have provided answers to some common questions I receive about ptosis surgery.
Is ptosis correction surgery covered by insurance/Medisave?
As ptosis is a medical condition, the surgery qualifies for Medisave and insurance claims in Singapore. However, I require my patients to undergo a margin reflex distance (MRD) 1 test in order to see if they qualify for Medisave claims.
The MRD 1 test is what I use to assess the severity of the ptosis. There are three degrees of severity: good, medium, and poor. These are determined by how far the eyelid can move from closure to maximal opening, without needing to move the eyebrow. A normal person without ptosis can open their eyelids 12mm or more.
The eyelid’s movement is defined by these conditions:
- Good eyelid function is a movement of more than 10mm
- Medium eyelid function is movement between 5 to 10mm
- Poor eyelid function is movement between 0 to 5mm
In order to be classified as ptosis and qualify for Medisave, the MRD has to be less than 2mm.
What types of surgery are available in Singapore?
There are three main techniques to correct ptosis with surgery: suture, incisional, and frontalis suspension. The suture technique involves using stitches to secure the eyelid tissue as high as is needed to see clearly and without obstruction. This is usually the type I recommend to my patients with mild ptosis. During incisional correction, an incision is made along the eyelid crease (or where an eyelid crease will be created) to access the levator muscle and remove any extra fat or skin. Frontalis suspension is best for patients with severe ptosis when the eyelid muscle is too weak to be fixed by the other methods. Sutures are put in place to anchor eyelid tissue to muscles above the brow, much like a bridge held up by suspension cables.
Is there a way to treat ptosis without surgery?
Unfortunately, there is no other way to completely get rid of ptosis. The levator muscle controls the drooping of the eyes, and the only way to tighten this muscle is through surgery.
Is the surgery painful?
If you are worried about pain, ptosis surgery is done under local anaesthesia or sedation for patients with a low pain threshold. You shouldn’t feel any pain while under anaesthesia, and more anaesthetic can be injected throughout the surgery to prevent pain. If you opt to be sedated, you will need to be awakened to assess eyelid height after the surgery is performed.
Are the results of the surgery permanent?
For most cases, the surgery is permanent. About 10% of patients require post-surgery revision, but if your eyelid doesn’t droop and stays symmetrical a few months after the operation, then the results will likely be permanent and you won’t have to go in for a revision surgery.
What are the risks involved with this procedure?
Like any kind of surgery, there are always risks involved with ptosis correction. I once had a patient come in for a consultation because their previous ptosis surgery left them with one eye appearing much larger than the other. The surgeon who performed their surgery claimed he “was only responsible for lifting up the eyelid, not for making it look nice”.
Other complications from ptosis surgery include misdiagnosing the cause and thus performing the wrong procedure, abnormal scarring, sutures breaking, excessive bleeding or swelling, and infection. Any of these complications can interfere with the healing process and might result in the ptosis remaining or even worsening, as well as causing aesthetic damage. In my experience, patients who experience these problems were treated by doctors who weren’t properly trained to perform these procedures. The levator muscle is fragile and if proper care is not taken it can become even more damaged, so it is essential to find a good doctor who is trained to treat ptosis before committing to the surgery.
To ensure the best results from your surgery, your surgeon will need to be able to properly assess the severity of your ptosis and diagnose the real cause of it. The surgical technique used depends on the severity, so it is important that your doctor know which procedure is suitable for your specific case. Make sure you are seeking out an experienced and well-trained surgeon who can perform the operation quickly and efficiently to leave you with less bruising and a faster and more comfortable recovery.
How will my eyelid look post-surgery?
During your initial consultation, you’ll want to discuss with your doctor the desired appearance of your eyelid. This includes the height of the double crease as well as if you prefer it to be parallel or tapered towards your nose. While ptosis is a medical condition, the correction procedure also has aesthetic consequences so it is important that your doctor knows what you want.
Many patients ask me how noticeable the correction is post-surgery. A mild ptosis correction is a subtle improvement and will make you appear more awake and fresh. Once the incision has healed completely, the scar blends into the eyelid crease or existing wrinkle, and is hardly noticeable.
At the beginning of your recovery, your eyelid may appear asymmetrical due to uneven swelling, but this should fade as you heal. This is why I recommend waiting around one month for the swelling to disappear fully before reassessing your condition. Most patients are satisfied with the results of their surgery, but some do require further surgery to correct mistakes. Additional surgery is needed if you want to adjust the height of the eyelid, symmetry of the crease, or the presence of excess skin or fat. While human bodies are never perfect and often asymmetrical, I believe in making every effort to make the eyes as symmetrical as possible, though it will never be absolutely perfect.
How long is the recovery period and what can I do to ensure I heal properly?
You may have bruises for a few weeks after surgery. Most patients resume normal activity a week after surgery, but it may take up to three months for your eyes to reach the desired appearance. In order to achieve your best results, do not rub your eyes after surgery. Apply cold compresses regularly on the first day after your surgery to reduce swelling, and apply warm compresses on the second day to stimulate blood circulation and reduce bruising. When sleeping, elevate your head above your heart. You should also complete a course of oral antibiotics to reduce the risk of infection.
How do I find the best surgeon for my procedure in Singapore?
Always do thorough research when looking into an important surgery like ptosis correction. If you know people who have had the procedure done, ask them about their experience and which doctor they saw. Look at before and after photos of a surgeon’s past patients to see what results they can provide. If you have friends in the medical field, ask for their recommendation. No doctor would risk their reputation to recommend an unqualified surgeon, so you can trust their suggestions. Even if you are consulting with a reputable plastic surgeon, make a point to ask questions to ensure they can properly diagnose and treat your individual needs.