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Ptosis correction, also known as droopy eyelid surgery, is a medical procedure performed to correct ptosis - upper eyelids that are sagging and obstructing vision.
Ptosis can be congenital in nature or can come about later in life when the levator muscles in the upper eyelids weaken.1 These muscles are responsible for holding the eyelids up.
The weakened eye muscles result in a ‘droopy’ look where a portion of the eye is concealed by the eyelids pervasively. This is why patients with droopy eyelids often are called out upon for looking sleepy and lethargic. This might not necessarily be the case as these patients suffer from droopy eyelids.
What are the causes of ptosis?
There are two different types of ptosis that are caused by different factors:
- Involutional or Aponeurotic ptosis typically affects older adults and is commonly caused by muscle dysfunction near the eyelids. It happens when the levator muscles separate from the eyelids or begin to slacken. This typically affects the elderly as our muscles deteriorate as we age. It can affect one or both eyes.2
- Congenital ptosis (literally meaning present at birth) is more prevalent in children and is caused by problems in their levator muscles that result in the inability to properly lift the upper eyelids.3
What are the symptoms of ptosis (droopy eyelids)?
The symptoms of ptosis (droopy eyelids) include:
- Drooping eyelid or eyelids
- Tilting of the head backwards in order to compensate and see better
- Upper eyelid creases that are uneven on both sides
Some of the other conditions that may develop from untreated ptosis (droopy eyelids) are as follows:
- Misaligned eyes
An ophthalmologist can conduct a medical procedure known as ptosis correction for you to significantly reduce the prominence of your condition. Local anaesthesia is administered on the eye and the eyelid area around it prior to the procedure.4
In cases where the levator muscles retain some muscular function, a levator resection can be performed. This means that the levator muscles are tightened in order to maximise their ability to properly lift the upper eyelid.
However, if the levator muscles fail to exhibit any function and are extremely weakened, a levator resection will be inadequate to correct the condition. Instead, a frontalis suspension will be performed. Small strands of silicone are positioned in the space between the eyelid and eyebrow, and the silicone strands will be tightened to lift the eyelid.
In some cases, excess skin and/or fat may be removed from the eyelid to allow the levator muscle to work more effectively.
The patient will have to rest for 1 to 2 weeks post-surgery and any non-dissolvable stitches near the eyelid crease will be removed 3 to 5 days after the procedure.
What should I expect after ptosis surgery?
An antibiotic ointment will be provided to you to prevent your eye from drying out which will result in some serious side effects. It is essential that you apply the ointment for 1 to 2 weeks in order to keep your eyes lubricated.
You will notice that your operated eyelid will be swollen and feel heavier than usual. You will be provided with cold compresses to use for 3 to 4 days followed by warm compresses. This is for helping with the swelling. You should also take note to keep your head elevated for as much as possible.
Although minimal discomfort and pain are expected with droopy eyelid surgery, you will still be prescribed painkillers to deal with any minor pain that you may feel post-surgery.
What are the risks involved with ptosis surgery?
As with all surgical procedures, there are risks involved with ptosis surgery that the patient needs to be aware of. It is highly encouraged that the patient weighs the risks against the benefits in order to make an informed decision with regard to ptosis surgery.
There are two types of ptosis surgery risks:
Risks common to surgery in general
During ptosis surgery, anaesthesia will be required to ensure the patients do not feel unbearable pain. There are two kinds of anaesthesia that are typically used called local anaesthesia and general anaesthesia.
Other risks that are involved in ptosis surgery include excessive bleeding, a risk of infection and swelling.
Risks specific to ptosis surgery
Risks involved that are specific to ptosis surgery are typically aesthetic in nature. There is always a possibility of under-correction (eyelid still sags after surgery), over-correction (eyelid remains open after surgery) and disagreement of cosmetic appearance.
It is vital that patients discuss with the surgeon PRIOR to the surgery to avoid cosmetic complications post-surgery to ensure maximum satisfaction with the results.
Is surgery really necessary? Are there other methods of correcting ptosis?
As ptosis is affected and caused by physical factors such as the levator muscle of the eyelid, surgery is the best option available to correct ptosis for most patients.
However, for patients with special cases, a non-invasive and non-surgical option is available, though this is extremely rare. Special eyedrops can be used to temporarily and briefly lift the Mueller’s Muscle.
This is usually done to make the eye appear fuller and bigger for a short period of time for aesthetic purposes in photography. In summary, in order to meaningfully treat ptosis, surgical methods are the best option.
Will my ptosis be permanently corrected after surgery?
Assuming all goes well, the outcome of your ptosis surgery will be long-term. Your eyelids should look normal. However, there is the possibility that you will require a follow-up surgical procedure depending on numerous factors.
- The type of ptosis present
- Your tissue elasticity near your eyelid area
- Any changes that happen due to ageing
- The age that you have the procedure
To elaborate, a child that had ptosis surgery before the age of six may require to undergo the procedure again once he has matured into an adult. Similarly, an adult that has aged may, in a similar vein, require to undergo ptosis surgery in order to correct the condition. Discuss with your surgeon or doctor to best know if you would require follow-up surgical procedures in the future.
Follow-up consultation with the doctor
A clinic appointment will be scheduled for a week after your surgery. The doctor will see you to check on the condition of your eyelid area and eyelid crease.
Some things that he will look out for includes:
- The lubrication of your eye
- Whether or not you are able to shut your eyelids
- How you are adjusting to the changes
Your next and final appointment (assuming there are no complications) with the doctor will be 4 to 6 weeks after this post-surgery evaluation.
It is advised that you take 5 to 10 days off work after your ptosis correction surgery to recuperate. This is especially the case if your work involves physical activity. It is best to stay put at home as you do not want to aggravate the wound.
You will experience some bruising around the affected area that should last no longer than 5 days after surgery. However, if the bruising is more significant, it can take up to 2 weeks to subside.
As for the swelling in the eyelid, it should subside within 10 days or so.
It is advised that you take note of the following to alleviate the swelling:
- Avoid caffeinated drinks as it may cause the blood vessels to dilate which will lead to further swelling
- Keep your head elevated when lying down; prop yourself up with 3-4 pillows
What to avoid
In order to speed up the healing process after droopy eyelid surgery, take note of the following:
- Refrain from rubbing your eyes. If you worry that you might do so in your sleep, you can use protective eye shields.
- Apply your eye drops or antibiotic ointment as prescribed by the doctor to prevent your eyes from drying out.
- Avoid any vigorous activities for 2 weeks. This includes swimming which can cause infection in the wound.
- Refrain from applying eye makeup until the stitches have been removed or absorbed
- Do not wear contact lenses until 3 to 4 weeks post-surgery.
- If you require spectacles, wear them lower down on your nose to prevent from pulling on your eyelids.
As with any other surgical procedures, it is important to adhere to the post-surgery guidelines and any advice given by your doctor to speed up the healing process and prevent any other complications.
Ptosis correction surgery in Singapore
As ptosis is considered a medical condition, The Ministry of Health allows the use of Medisave can be used to cover the costs of the surgery. The Ministry of Health also approves most insurance plans to provide coverage for the procedure.
The actual cost of ptosis correction surgery depends on the severity of the condition which can only be determined after a consultation with an Ophthalmologist. The average cost of ptosis correction in Singapore is between SGD$2,000 to $4,000 per eye.
The cost of having ptosis repair in Singapore is less than in countries like the United States (USD$2,000 to USD$5,000) and South Korea (USD$3,000 to USD$5,000), and is comparable to clinics in Japan where the price range per eye is between USD$2,5000 to USD$3,500.
- Ahmad, K., Wright, M., & Lueck, C. J. (2011). Ptosis. Practical neurology, 11(6), 332-340.
- Deady, J. P., Morrell, A. J., & Sutton, G. A. (1989). Recognising aponeurotic ptosis. Journal of neurology, neurosurgery, and psychiatry, 52(8), 996–998. https://doi.org/10.1136/jnnp.52.8.996
- Marenco, M., Macchi, I., Macchi, I., Galassi, E., Massaro-Giordano, M., & Lambiase, A. (2017). Clinical presentation and management of congenital ptosis. Clinical ophthalmology (Auckland, N.Z.), 11, 453–463. https://doi.org/10.2147/OPTH.S111118
- Koka, K., & Patel, B. C. (2019). Ptosis correction.