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. If you are researching more on this procedure, I hope this article will give you some useful insights on the procedure.
In this article, I will cover the following topics:
- What causes droopy eyelids
- Why is there a need to correct your ptosis condition
- How much does ptosis surgery cost in Singapore
- Can ptosis surgery be covered under Medisave or your personal insurance
- The various surgery techniques for ptosis surgery as well as an overview of what goes on during the procedure
- Can ptosis surgery go wrong
- My approach to ensure the best results from ptosis surgery
- Other common questions asked by my patients
The drooping of the upper eyelid which is also referred to as ptosis is largely classified as a medical condition. Ptosis, which is derived from the Greek word “falling”, is shorthand for blepharoptosis. This medical term therefore refers to the drooping of the upper eyelids.
Although drooping or sagging is often associated with old age, ptosis can occur at any age, and to varying degrees of severity. Sometimes, children are born with congenital upper eyelid ptosis, requiring surgical correction at a young age. When ptosis occurs later in life, patients may seek surgery because the condition hampers their daily activities.
Of course, there are also individuals who choose to undergo the procedure for aesthetic reasons.
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.
The 5 main causes for this are:
- 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.
Based on my experience, the most common causes of ptosis in Singapore are caused by:
- Excessive eye rubbing
- Pulling of the eyelids
Why is there a need to correct your ptosis condition?
While ptosis is certainly more common amongst an older age group, I’ve also seen children who have required surgical correction for congenital ptosis and patients in their 20s. Ptosis can affect people of any age.
Ptosis that is caused by ageing.
Ptosis on the left, resulting in an asymmetrical eyelid.
As you can see from the images above, patients may do it purely for functional reasons.
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
Patients may also choose to undergo surgery for aesthetic reasons.
Aesthetic Improvements after ptosis surgery:
- Appearance of looking more awake and "well-rested"
- Bigger-looking eyes
- Creation or redefinition of eyelid crease
Any ptosis treatment will be customised based on:
- The severity of the ptosis
- Your desired aesthetic outcome
How much does ptosis surgery cost in Singapore?
Ptosis surgery costs range from $5,000 to $12,000 in Singapore, not including anaesthetist 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
- The need for stitch removal
Can ptosis surgery be covered under Medisave or your personal insurance?
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.
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.
The various surgery techniques for ptosis surgery as well as an overview of what goes on during the procedure
There are 3 main surgical techniques:
This technique involves stitching the eyelid tissue as high as required to achieve unobstructed vision. I usually recommend this for patients with mild ptosis.
An incision is made to access the eyelid muscle where a double eyelid crease is desired to be created. Any unnecessary tissues such as fat and skin can be removed along with parts of the resected eyelid muscle. In cases where tissue removal (excising) is not required, the eyelid tissue is stitched even higher.
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. This technique is usually recommended in very severe cases of ptosis.
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?
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.
After this, your doctor will ask you to sit up to assess the amount of eyelid opening. This is for checking if the left and right eyelids look symmetrical. 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.
Ptosis surgery sounds super painful!
Surgical procedures can be done under local anaesthesia, with pain felt only at the point of injection, before any incision is made.
Local anaesthesia can be used throughout the surgery as needed.
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.
Are results permanent?
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.
Can ptosis surgery go wrong?
As with any other kind of surgery, failure is a possibility.
I have had to treat a patient 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".
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
In my experience, patients who have been unsatisfied with their ptosis corrections had their surgery done by doctors who were not trained to perform the procedure.
The eyelid muscle is delicate and so proper care must be taken in handling it, otherwise the patient’s ability to raise the eyelid can be affected. 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.
My approach to ensure the best results from ptosis surgery
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.
Other common questions asked by my patients
Can I request for a particular eyelid style or height?
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
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.
Will other people be able to tell that I’ve had ptosis surgery?
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.
What if I'm not satisfied with the results?
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.
How big will my scar be?
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.
What is the average recovery period for ptosis surgery?
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.
Any 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.
How do I find the best doctor for my ptosis surgery in Singapore?
How do I 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.
About A/Prof Vincent Yeow
I am a plastic surgeon with more than 20 years of experience and have operated on a wide range of plastic surgery and reconstructive procedures. Apart from caring for my patients, I have also trained other plastic surgeons in my former role as the Head of Department of Plastic, Reconstructive & Aesthetic Surgery at Singapore KK Women’s and Children’s Hospital.
In addition to juggling professional duties at my private practice, I am also passionate about giving back to the community. Being a volunteer in cleft surgical missions abroad for over a decade has inspired me to start Smile Asia— a non-profit organisation that helps the less fortunate suffering from facial deformities. Through this organisation, I lead medical teams on voluntary missions with a unified goal: to change lives and bring smiles to children’s faces.