Drooping eyelids can affect a person’s everyday life and can be very bothersome.
This is why a lot of my patients would always ask me if their drooping eyelids are a medical concern or they are just purely aesthetic issues. My answer to this question is that upper eyelid drooping or medically known as Ptosis is a medical condition and can be treated via different medical procedures.
Just like any medical condition, the severity can vary from person to person. While I have had a lot of patients who want to get ptosis surgery for medical reasons, it cannot be denied that there are also patients who view ptosis as a cosmetic issue, so they also come to me to have it fixed.
Whatever your reasons are, this post answers the frequently asked questions about ptosis surgery in Singapore and aims to help you have a better understanding of the condition and how to deal with it.
At what age can Ptosis start to develop?
In Singapore, ptosis can be manifested in any age group and in some cases, babies are born with the condition and have to undergo surgery to correct the congenital upper eyelid ptosis early in childhood to prevent further eye complications as the child grows up.
What causes droopy eyelids or Ptosis?
When the nerves that control your eyelid muscles (levator muscles) are damaged, your eyelids can become weakened and you might develop ptosis as a result. Ptosis can occur in one or both upper eyelids.
Aponeurotic causes or excessive rubbing or pulling of the eyelids and ageing are the most common causes of ptosis in Singapore. However, the weakening of the eyelid muscle leading to the drooping appearance of eyelids can be caused by other several ways such as:
- Misfunction of muscle nerves of the eyelids (neurogenic)
- Misfunction of the eyelid muscle itself (myogenic)
- Excessive skin, fat or tumour weighing down the eyelids (mechanical)
- Injury or accidents in the eyelids (traumatic)
Why is Ptosis considered as a medical condition?
Ptosis can cause further medical complications that can harm an affected individual over time. These complications include:
- Obstruction of Vision
If left untreated, ptosis can obstruct vision. Because of this affected individual will have to raise their eyebrows and tilt their heads back just to see clearly. This action oftentimes leads to headaches and strain on the neck and forehead muscles.
- Vision loss in adults
In severe cases, ptosis can even lead to vision loss in adults.
- Amblyopia in early childhood
For children with ptosis at an early age, amblyopia, also known as the lazy eye can develop. This condition is characterized by loss of visual perception even with the aid of eyeglasses.
What is the best way to treat Ptosis?
As mentioned earlier, the weakening of the levator eyelid muscle is the main cause of drooping eyelids. To tighten this muscle, surgical procedure is required.
Other than the surgical method, there are no other proven ways to treat ptosis. Therefore, ptosis surgery is the only procedure that can treat drooping eyelids effectively.
Who can perform Ptosis surgery in Singapore?
Ptosis surgery is traditionally performed by ophthalmologists who specialize and have in eyelid surgery. An experienced and well-trained eyelid surgeon will be able to provide quality and effective results.
For aesthetic purposes of ptosis surgery, credible and experienced plastic surgeons are also able to address both the functional and purposes aspects of the procedure.
What techniques are available for Ptosis surgery in Singapore?
In Singapore, there are the 3 main techniques that are being used for ptosis surgery depending on the severity and type of ptosis that a patient may have.
- For patients with excessive tissue weighing down their eyelids:
Incisional Ptosis Correction is the most recommended ptosis surgery technique for this issue. With this technique, the excessive materials such as tissues, skin and fat are removed or excised through an incision along the doubled eyelid crease. The eyelid tissue is stitched even higher in cases where excision is not needed.
- For patients with very weak eyelid muscles:
Frontalis Suspension is the ptosis surgery technique that is mostly used for cases where the eyelid muscle is very weak. These suspensions in the form of sutures hold the eyelid tissue and the eyelid muscle together.
- For patients with mild ptosis:
Suture Ptosis Correction is the ptosis surgery technique that is usually the most recommended for patients with mild ptosis. This technique is performed by stitching the eyelid tissue as high as necessary to resolve the issue of obstruction of vision.
How can Ptosis surgery fix aesthetic-related problems caused by drooping eyelids?
Ptosis surgery can improve aesthetic-related problems by:
- Enhancing the eyelid crease and giving it more definition
- Making the eyes appear more awake
- Making the eyes appear larger and well defined
- Giving the face a more vibrant look as ptosis can make you look tired and sleepy all the time
What are things to consider before committing to Ptosis surgery?
Like any other medical procedure, a thorough consultation with your doctor is highly advised. This step enables your doctor to fully assess your condition and determine the best-suited ptosis surgery technique for you.
During the consultation, here are some important things you should keep in mind:
- Make sure your surgeon reviews your medical history and overall health first before making any recommendations.
- Tell your surgeon openly about your personal preferences, lifestyle practices and expected results.
I addition to a thorough consultation, here are other things you should consider before committing to ptosis surgery:
- Talk to others who have had that procedure before to help you have a better understanding of what you are about to undertake.
- Make yourself as informed as possible with the different types of techniques of ptosis surgery, expected results and possible risks.
What to expect during Ptosis surgery?
After the consultation, ptosis surgery is typically performed in this general order of events:
- Injection of local anaesthetics to the treatment area.
- An incision along the crease of the upper eyelid so that the muscles and tissues are exposed.
- Depending on the technique mentioned in the above section, some parts of the eyelid will be removed, repositioned or sutured to give the eyelid a more defined appearance.
- Before closing the incision, your doctor will do an assessment of the eyelid opening.
- After giving the eyelid more definition, the wound is then stitched up along the existing eyelid crease, or to form a new one in cases where double eyelid crease is absent.
Is ptosis surgery painful?
Ptosis is performed under local anaesthesia, which ensures that there is very little to no pain or discomfort during the procedure. In fact, the most discomfort that a patient will feel is at the start when the local anaesthetic is injected into the eyelid.
Over the course of the surgery, more local anaesthetic may be injected when it is needed or if it starts to wear out.
For patients with a low tolerance for pain, they may opt for sedation to make the experience more comfortable as they will be asleep during the whole procedure. You will be awakened only after the procedure for eyelid height assessment.
How long does results from Ptosis surgery last?
In most cases, the results from ptosis surgery are permanent and will last for the of your life.
Although rare, there may be a small percentage (about 10%) of patients that may need to undergo the procedure again in case the effects wear off and the eyelid droops again. Revisions are also required for patients who develop asymmetrical eyelids.
If any recurrence or complications start to manifest, it is highly advised that you call your doctor right away.
What is the recovery period after a Ptosis surgery?
You can expect swelling and some bruising right after surgery and may last up to a couple of weeks. After this time, patients have reported that they are already able to go back to their daily routines without any hassle. For best results, it will take about 4-12 weeks for the eyelids to be clearly defined and properly repositioned.
What are practical after-care tips to ensure the best results?
- Your doctor will prescribe you with a complete a course of after-care medications. Make sure you follow the regimen to prevent complications and infections.
- After surgery, avoid rubbing your eyes. If you can help it, do not rub them at all.
- The next day right after ptosis surgery, apply a cold compress to reduce the swelling and bruising.
- From the second day after ptosis, a warm compress may be applied to improve blood circulation.
- Stay away from direct sunlight to avoid irritations.
- Make sure you get enough rest and nutrition to facilitate faster recovery and healing of the wounds.
Is there a chance of failure in ptosis surgery?
There is always a risk of failure when it comes to any form of surgery, which includes ptosis surgery.
The two most important factors that can cause failure in ptosis surgery are:
- Wrong diagnosis of the cause of ptosis
- Bad surgical technique
The complications that can happen from a failure in surgery include:
- Atypical scars. Plastic surgeons utilize a different stitching technique compared to other surgeons, which are more effective in managing scars. Mishandled incisions along the eyelid can result in the appearance of an unsightly scar.
- Bleeding and infection. Improper technique can cause bleeding or infection on the eyelid. The surgeon must be extra careful that this does not happen.
- Sutures breaking. If the sutures are too loose, there may be a chance of breakage and would complicate the success of the procedure.
How much does Ptosis surgery cost in Singapore?
The cost of ptosis surgery in Singapore can cost between $4,500 up to $12,500 depending on the severity of your condition and the ptosis surgery technique required to achieve the desired results.
Factors that affect the varying prices of ptosis surgery in Singapore may include:
- Doctor’s fee
- Anaesthetist’s fee
- Operating facilities fee
- Surgical materials to be used
- After-care medications (if necessary)
- Additional procedures such as stitch removal
- Follow-up check-ups (if complications are developed)
Is Ptosis surgery subsidized by insurance or Medisave-claimable?
In Singapore, ptosis is classified as a medical condition and thus, ptosis surgery can be subsidized by your health insurance and is Medisave-claimable.
My patients are requested to go through a margin reflex distance (MRD) 1 test to be able to get a certification of upper eyelid ptosis. The Ministry of Health in Singapore requires this certification before the patient can be qualified as eligible for Medisave claims.
How is ptosis severity graded and determined if it is Medisave claimable?
Ptosis is graded into 3 degrees of severity based on how much the eyelid can move from closure to its maximal opening without movement of the eyebrow. The three degrees of ptosis are graded as follows:
- Good – eyelid movement of more than 10mm
- Medium – eyelid movement between 5 to 10mm
- Poor – eyelid movement between 0 to 5mm
For the ptosis to be Medisave-claimable, the MRD1 test has to be between 0 to 2mm.
How to find the right Ptosis surgeon in Singapore?
To achieve the best results and avoid complications in the future, a thorough dialogue with your doctor is highly advised. Depending on the severity of the ptosis and your personal preferences, an experienced and well-trained surgeon will be able to provide accurate ptosis surgery options to achieve your desired result.
To help you find the right doctor in Singapore, consider these following points:
- See to it that he/she is a qualified plastic or eyelid surgeon in Singapore who have extensive training in ptosis surgery.
- Make sure that he/she can fully help you understand the procedure you are about to undertake.
- Do not hesitate to research their track record to find out how many successful ptosis surgeries he/she has performed. Also, check how frequent ptosis surgeries are performed.
- If they are willing to show you before and after pictures of their past ptosis surgery to give you a better idea of their skills and work, that should indicate he/she is a trustworthy doctor.
- Check the clinic if they have the proper equipment to perform safe and effective ptosis surgery.
- Ask as many questions as you can until you are fully informed about the procedure, costs and expected results.