You may have heard the term ptosis surgery and wondered what it actually means or whether it is a procedure you might need. If droopy eyelids have been affecting your vision or making you look more tired than you feel, you are not alone. Many people experience eyelid drooping for different reasons, from natural ageing to underlying medical conditions, without realising that there is a specific treatment available.
This guide is here to help you understand ptosis and what ptosis surgery involves. We will walk you through the symptoms, causes, and surgical options, and explain how seeking expert care in Singapore can make a real difference. Whether you are exploring treatment for medical or cosmetic reasons, knowing what to expect can help you make a confident, informed decision.
What is ptosis?
Ptosis refers to the abnormal drooping of the upper eyelid, a condition also known as blepharoptosis. The droopy eyelid can partially or fully cover the pupil, affecting both vision and appearance. This condition may be congenital (present at birth) or acquired later in life due to ageing, trauma, or systemic illnesses.
Ptosis surgery corrects droopy upper eyelids by tightening or repositioning the levator palpebrae superioris muscle or its surrounding tissues to raise the eyelid margin. While many undergo ptosis correction to restore peripheral vision or relieve eye strain, others pursue it for aesthetic reasons, such as achieving a more symmetrical look or a more awake and alert appearance.
Because ptosis surgery can also create or enhance an eyelid crease, it is sometimes mistaken for upper blepharoplasty or double eyelid surgery. However, these are distinct procedures. Blepharoplasty is primarily a cosmetic operation that removes excess skin and fat to rejuvenate the eye appearance. It could also be performed specifically to create a double eyelid crease. Blepharoplasty does not lift a drooping lid unless ptosis repair is performed at the same time. Ptosis surgery, on the other hand, specifically targets the muscle responsible for eyelid elevation and is essential for cases where functional correction is needed.
Types of ptosis
Understanding the different types of ptosis can help determine the best treatment approach:
- Aponeurotic (involutional) ptosis: Caused by stretching or dehiscence of the levator aponeurosis, commonly seen in older adults.
- Congenital ptosis: Present at birth due to levator muscle dysgenesis, often requiring early intervention if vision is threatened.
- Neurogenic ptosis: Resulting from nerve palsies (e.g., third cranial nerve palsy) or systemic conditions such as myasthenia gravis.
- Myogenic ptosis: Associated with primary muscle disorders such as myopathies or oculopharyngeal muscular dystrophy.
- Mechanical ptosis: Due to physical factors weighing the upper eyelid down such as upper eyelid tumours.
- Traumatic ptosis: Following injury to the eyelid structures or nerves.
Recognising symptoms
Early signs of ptosis include:
- A visibly lower upper eyelid
- A “sleepy” or tired look
- Increased brow elevation to lift the eyelid
- Eye strain or headaches
- Obstructed upper field of vision
In some cases, ptosis may worsen throughout the day due to muscle fatigue. If you notice any of these symptoms, especially if they come on suddenly, it is essential to seek evaluation by an oculoplastic eye specialist.
Diagnostic process
Diagnosis begins with a thorough consultation and physical exam conducted by an oculoplastic surgeon. Important evaluations include:
- MRD1 (Marginal Reflex Distance 1): Measures the distance from the corneal light reflex to the upper eyelid margin.
- Levator function test: Measures eyelid movement from a downward to an upward gaze.
- Visual field testing: Determines whether the drooping eyelid is affecting peripheral vision.
- Eyelid photography: Captures pre-operative and post-operative changes for documentation.
In Singapore, ptosis surgery may be Medisave-claimable or covered by insurance if it is severe enough to impact on one’s visual field. The distinction can only be made by an oculoplastic surgeon.
Surgical options
Based on the type and severity of ptosis, surgeons choose from several techniques, such as:
1. Levator resection or advancement
This technique shortens or tightens the levator aponeurosis to elevate the eyelid, ideal for patients with moderate to good levator function (typically >4 mm). The external approach allows direct visualisation of the muscle and precise adjustment of eyelid height and contour.
2. Müller’s muscle-conjunctival resection
Also known as the Putterman procedure, this targets the Müller’s muscle – responsible for 1–2 mm of eyelid lift – by shortening or excising a segment via a conjunctival approach.
3. Frontalis sling procedure
Employed in severe ptosis or poor levator function (<4 mm), a sling material (autologous fascia lata or silicone) connects the eyelid to the frontalis muscle, allowing eyebrow elevation to lift the lid.
Preparing for surgery
Before surgery, patients are scheduled for a comprehensive pre-operative assessment. This includes:
- Medical history review and physical examination
- Blood tests and anaesthesia evaluation
- Suspension or adjustment of blood-thinning medications
- Smoking cessation to optimise healing
- Detailed discussion about the chosen technique, risks, recovery, and expected results
Patients may be asked to stop wearing contact lenses after the procedure as contact lens wear poses a risk for recurrence of eyelid droop.
Recovery and aftercare
Post-operative care involves cold compresses to reduce swelling, head elevation at rest and preservative-free lubricating drops to prevent dry eye. Patients typically resume non-strenuous activities within 5 to 7 days, with suture removal around 1 to 2 weeks post-surgery. Full resolution of bruising and final eyelid position may take up to 2 to 3 months. In most cases, a natural look can be achieved within a few weeks.
While complications are uncommon, they can include asymmetry, under- or over-correction, lagophthalmos (incomplete eyelid closure), and transient dry eye. Prompt follow-up is essential to address any concerns and ensure optimal healing.
Beyond improving vision, the benefits of undergoing ptosis correction surgery can also enhance facial harmony and self-confidence in daily interactions.
Choosing expert care in Singapore
Singapore is home to leading oculoplastic specialists practising at centres such as Ava Eye Clinic. These centres offer state-of-the-art operating theatre facilities, dedicated day surgery suites and comprehensive pre- and post-operative support. When selecting a surgeon, consider the following:
1. Surgeon qualifications
Ensure that your chosen surgeon is trained in oculoplastic surgery, ideally with fellowships or additional training in this subspecialty. Look for board certifications and affiliations with professional bodies such as the Singapore Medical Council.
2. Experience and specialisation
Seek out surgeons with a track record of performing ptosis correction. Specialisation in eyelid procedures ensures that they are familiar with both functional and aesthetic aspects of surgery.
3. Patient reviews and testimonials
Online reviews and patient feedback can offer valuable insights into the clinic’s professionalism, patient care, and surgical outcomes. Reputable clinics often have testimonials available.
4. Before-and-after photos
Viewing the surgeon’s previous results helps set realistic expectations and showcases the surgeon’s aesthetic approach. In Singapore, these photographs are only allowed to be shown to patients in clinic premises.
5. Technology and facilities
Modern equipment and an accredited surgical facility contribute to safer, more efficient procedures and recovery. Look for clinics that offer advanced diagnostic tools and sterile, hospital-grade operating rooms.
6. Consultation process
A thorough consultation should include detailed explanations, open discussion of your concerns, and personalised recommendations. A patient-first approach builds trust and ensures you are well-informed.
7. Aftercare support
Post-surgical follow-up is crucial. Opt for clinics that provide clear recovery guidelines, multiple review appointments, and access to your surgical team in case of concerns.
Conclusion
If droopy eyelids are affecting your vision or self-confidence, ptosis surgery may be the solution you need. With modern techniques and expert care available, patients can enjoy not just clearer vision but also enhanced appearance and comfort.
At Ava Eye Clinic, our experienced oculoplastic surgeon is committed to helping you achieve the best results safely and confidently. We offer customised treatment plans, advanced facilities, and gentle aftercare to guide you through every step of your ptosis correction journey.
Contact us today to book a consultation and learn how ptosis surgery can transform your daily life, both functionally and aesthetically.