Ptosis Surgery in Singapore – Advice by a Plastic Surgeon

Ptosis surgery alone costs roughly about $6,000 to $18,000 at private surgeons. The range is very large as there are fewer than 40 private plastic surgeons in Singapore and each one is free to determine their own rates. Costs are much higher than in public hospitals but they are fully claimable via insurance (Ptosis is considered a legitimate medical concern by MOH). This excludes the cost of the anaesthesiologist, additional medications, post-operation treatments, and other clinical fees among others, which can amount to an additional $2,000 to $6,000.

Ptosis or droopy eyelids is a condition that affects the muscles responsible for lifting the eyelids. You can easily identify people with this existing condition as they often have a drowsy look on their face, as a result of their semi-closed eyes.

There are several causes of ptosis. Some develop this through age, while others are born with it. Ptosis can also be caused by external factors done to the eyes such as tugging and extreme rubbing.

As we are already talking about the causes, let’s delve further on other aspects that can contribute to ptosis.

A Closer Look on the Eyelid

The eyelid serves as a cover to the eye. This thin line of flesh has a muscle, called the levator muscle, which functions like an elastic band enabling the eyelid to open by stretching and lifting, thereby exposing the eye. The levator muscles can be affected by the body’s ageing. When this happens, it loses its ability to flex. The table below shows the five triggers for this occurrence:

Of course, if there’s a cause there should be an effect. How does ptosis affect a person suffering from this condition?

Due to the weakened levator muscles, the eyelids are not able to open fully. This means that people who have ptosis may not be able to see clearly because of this impediment. Doctors measure the severity of a patient’s ptosis according to the eyelid’s maximum capacity to open. Below is the classification of this condition’s seriousness:

Normally, the top eyelid can stretch open at 12mm.

Can ptosis affect any person?

Depending on the cause, anyone can develop ptosis at any given time. Children can be born with this condition (congenital ptosis). However, the age that is generally affected with droopy eyelids belong to the older bracket of adulthood.

Ptosis can pose a hindrance to one’s daily activities. For severe droopy eyelids, this can be dangerous, too. Patients usually opt to have their eyelids corrected because of the inconveniences as a result of having droopy eyelids.

Unfortunately, there is no other way to correct this condition other than surgery. The only way that the levator muscles can be strengthened is by operating on and tightening them.

Ptosis Surgery

Ptosis can be corrected using any of the three methods enumerated below:

• Frontalis Suspension Method
• Incisional Ptosis Eyelid Method
• Suture Ptosis Eyelid Method

The Frontalis Suspension method uses sutures to connect the eyelid tissue to the muscles located over the eyebrows.¹  The Incisional Ptosis Eyelid method is done by cutting through the droopy eyelid in order to reach the levator muscle. This method is normally done on eyelids that are droоping due to excess fats or skin. Lastly, the Suture Ptosis Eyelid method operates on the levator muscle and uses stitches to enable the tissue to lift the eyelid accordingly.²

Ptosis Surgery Procedure

Ptosis surgery can be done while the patient is awake or asleep. At the start of the procedure, local anaesthesia is injected into the eyelid to numb the area from pain. For patients who do not wish to feel the surgery being done, sedatives can be administered for them to sleep throughout the operation.

An opening is made on the droopy eyelid by creating a slit, revealing the levator muscle and flesh beneath the skin. After this, the patient will be asked to sit in order for the doctor to evaluate the opening that the eyelid is able to do. Patients who are sedated will be roused for this step. If the evaluation goes well the incision is stitched closed. The suture can create the crease for eyelids that have none initially. As for patients with existing eyelid crease, the scar from the surgery will naturally blend in.³

Note that, depending on the seriousness of the condition, some eyelids may need the removal of excess fats or skin. In cases like this, the tissue of the eyelids is corrected to be capable of proper lifting.

Ptosis Surgery Recovery and Aftercare

One week is the recommended recovery period for patients of ptosis surgery. Expect to see bruises on the operated eyelids, which can last up to 2 weeks. The eyes’ full recovery will extend up to 3 months.

It is important that the eyes are given the proper care after the surgery to ensure complete healing. The doctor will prescribe some medications, such as antibiotics. Avoid touching or rubbing the eyes during the recovery period. An icepack should be administered to it on the first day following the surgery to lessen the wound’s inflammation. 

Second day post-procedure, Dr Samuel Ho from Allure recommends using a warm compress to promote the circulation of blood around the operated area. Prop your head on pillows whenever you sleep. Ideally, the position of the head should be higher than the heart to reduce swelling and quicken the eyes’ healing.

As the eyelids recover, it is normal for the eyes to appear uneven at first. The first postoperative evaluation is usually done after a month when the inflammation of the eyelids has subsided. The eyelids are in a much better state during this time, so the surgeon or doctor can give a much more precise evaluation on the eyelids’ status.

This evaluation is the best time for the patient to voice out any concern regarding the appearance of the eyelids as certain conditions may require additional surgery. It is important to take into consideration that our body is not symmetrical; hence your eyelids may not appear exactly the same. Of course, doctors who want the best results for their patients will aim to make their patient’s eyes look almost, if not exactly, the same.

When your eyelids have healed fully and are able to function successfully, people may notice the difference, as your eyes will look bigger and brighter. The improvement will be more obvious for patients with moderate to severe ptosis conditions.

Ptosis Surgery Risks

Risks involved in ptosis surgeries are inevitable. There are cases when patients need to have another round of surgery done to correct a botched operation.

Here are some risks involved in ptosis surgery:

As mentioned above, it is very crucial to have a doctor that is well versed in handling ptosis surgeries. There are a lot of competent surgeons trained in ptosis correction across Singapore. It is best to do extensive research and comparisons prior to settling with one doctor. When coming in for a consultation, do not hesitate to ask about the experience of the doctor in performing the operation. Ask for some photos of the results of surgeries they have done in the past so you can gauge their work. Your best bets for this kind of procedure are plastic surgeons.

Ptosis Surgery Results

Results of ptosis surgery are generally permanent. Eyelids that successfully heal and continue to be in symmetry one to two months following the surgery are highly expected to be permanent. The success rate of most ptosis surgery is at 90%. However, some eyelids may need another round of surgery if the condition recurs.

The best results of your ptosis surgery will depend on a few factors:

1. Correct evaluation and accurate findings of the eye condition
2. Appropriateness of the method used for droopy eyelids correction
3. Accurate incision on the eyelid and execution of the operation
4. Doctor’s experience in performing the procedure

Basing on the four factors, you will notice that the result of the ptosis surgery is at the mercy of the medical practitioner handling your case. The evaluation of your condition is crucial as this is when the seriousness of the ptosis is diagnosed. In addition, the eyelid height and aesthetic feature are both determined by your doctor during this time.

When the doctor has determined the severity of your ptosis condition, a surgical method will then be recommended. It is important to have the right method administered, as the procedure and result of each technique is specific to the severity of a patient’s ptosis. At the same time, a doctor who has ample experience should be an expert in executing the procedure. Each step of the operation should be properly calculated and done with extreme care. In addition, an operation that is done in a swift but sure and safe manner will ensure faster healing, minor injuries, and optimal outcome.

Ptosis Surgery Costs

There are different things contributing to the cost of ptosis surgery in Singapore. Take into consideration the method used in the surgery and the severity of a patient’s ptosis condition.

Ptosis surgery alone costs roughly about $6,000 to $13,000. Surgery for mild cases needing minimal sedatives will cost around $6,000 to $10,000. This is excluding the charges of the anaesthesiologist, additional medications, postoperative treatments, and other clinical fees among others.

I am glad to note that the costs can be reduced as Medisave and insurances treat ptosis surgery as a medical condition. However, Medisave only qualifies conditions that are below 2mm. To determine this measurement, patients will have to undergo a test called margin reflex distance 1 (MRD1). If a patient is eligible for Medisave, a certification issued by the Ministry of Health in Singapore confirming that a ptosis correction for the upper eyelid is needed to proceed to the surgery.

In Conclusion

People suffering from ptosis are never without options for correcting their eyelid condition. Always remember that this surgery is critical and should be handled by a surgeon that is well trained and exceedingly experienced in performing the operation to ensure the permanence of the eyelids’ functionality. Good luck!

This article is medically reviewed by Dr Samuel Ho from Allure Plastic Surgery on 15 October 2021.

References

1. Takahashi, Y., Leibovitch, I., & Kakizaki, H. (2010). Frontalis suspension surgery in upper eyelid blepharoptosis. The open ophthalmology journal, 4, 91–97. https://doi.org/10.2174/1874364101004010091
2. Lee, E. I., & Ahn, T. J. (2014). Mild ptosis correction with the stitch method during incisional double fold formation. Archives of plastic surgery, 41(1), 71–76. https://doi.org/10.5999/aps.2014.41.1.71
3. Kwitko, G. M., & Patel, B. C. (2021). Blepharoplasty Ptosis Surgery. StatPearls [Internet].