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Adult Ptosis Surgery

Ptosis Eye Surgery in Singapore

Diagnose & Correct Your Ptosis Condition & Droopy Eyelid

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What is Ptosis?

Examples of ptosis concerns prior to surgery 

 

Ptosis is a medical term that refers simply to a “droop”. “Ptosis” is often used interchangeably with the proper medical term “blepharoptosis” which refers to a drooping upper eyelid.

Eyebrows can droop too. But the term “brow ptosis’ is used to distinguish between droop of the eyelid (“ptosis”) and droop of the eye brow (“brow ptosis”).

Ptosis can be measured by assessing the distance between the light reflex in the centre of the eye and upper eyelid. If the distance between the light reflex and upper eyelid is lower than 2mm, it can be considered ptosis. A normal upper eyelid margin tends to be 3 to 4mm from the centre of the pupil.

Causes of 2 Types of Common Ptosis Conditions.

These are the two common types of ptosis conditions. However, there are other less common types of ptosis. Please consult Dr Looi for an accurate medical diagnosis.

Aponeurotic Ptosis

Aponeurotic ptosis is usually due to daily wear and tear and is more common in older individuals.

This type of acquired lid droop is due to stretching the terminal end of the elevating muscle of the eyelid (levator palpebrae superioris / LPS) or complete detachment of the LPS from the tarsal plate, a firm structure within the eyelid which supports the eyelashes. Aponeurotic ptosis can be resolved through ptosis correction surgery.

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Congenital Ptosis

Congenital ptosis is where a child is born with a lid droop. This may be present on one side or both sides. It is due to the LPS not developing in the normal way.

Surgery for this is available in Singapore, but inevitable trade-offs are inherent in this surgery, and parents must be counselled on these prior to the droopy eyelid correction surgery. Sometimes, the lid droop is associated with a wink, and the surgical options have to be carefully considered.

Congenital ptosis may occur as part of a syndrome known as blepharophimosis syndrome. In this situation, other abnormalities are present and have to be considered together with the ptosis problem.

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Type of Ptosis Correction Procedures

Levator Palpebrae Superioris Repair

Levator Palpebrae Superioris Repair is droopy eyelid correction surgery performed most commonly to correct aponeurotic ptosis. It involves the re-attachment of the LPS to the tarsal plate with or without slight shortening of the LPS.

This surgery helps clear the superior visual field making it a functional surgery. However, laypersons in Singapore often mistake droopy eyelid correction surgery for cosmetic surgery as the elevation of the upper eyelid resting position also gives a pleasant appearance.

This droopy eyelid correction may also be employed in cosmetic surgery by surgeons when patients wish to lift the upper eyelids slightly, which further adds to the confusion.

Levator Resection

Levator Resection is employed in less severe cases of congenital ptosis to lift the upper eyelid. The LPS is significantly shortened to achieve the lift.

While this ptosis eye surgery achieves the lift in the upper eyelid, it comes with an inability to close the eye fully and a higher position of the operated lid in the downward gaze. Patients and their families must be well-informed of these trade-offs before proceeding with eyelid correction surgery.

Frontalis Suspension

The Frontalis Suspension surgery involves the use of a sling material (either from one’s own thigh tissue or silicone material) to connect the eyelid to the frontalis muscle above the brow so that the frontalis muscle can be used to elevate the eyelid.

This is employed in more severe cases of congenital ptosis and comes with the same trade-offs as levator resection.

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Diagnose & Correct Your Ptosis Condition

Ophthalmologist Doctor Profile

Dr Audrey Looi MBBS, MMed (Ophth), FRCS (Ed)

Dr A Looi is currently the Medical Director of Ava Eye Clinic.

Dr Audrey Looi trained in Oculoplastics at the Singapore National Eye Centre. She completed her fellowships in Oculoplastic, Orbital and Ocular Pathology at the University of British Columbia under the supervision of Prof Peter Dolman, Prof Jack Rootman and Prof Valerie White respectively, returning to Singapore in 2004 with a Best Fellow research prize.

She served as Head of the Oculoplastic Service as well as Clinical Director of the General Eye Clinic at the Singapore National Eye Centre from 2007 to 2016 and 2009 to 2019 respectively. She was appointed Adjunct Associate Professor at the Duke-NUS Graduate Medical School from 2012 to 2019

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Common Q&A To Be Covered During Medical Consultation

medical-diagnosis

Medical diagnosis of ptosis condition

ptosis-surgery

Before and after pictures of ptosis surgery

procedure-pathway

Detailed procedure pathway

detailed-costs

Detailed breakdown of the cost of ptosis surgery

medical-coverage

Whether patient’s ptosis condition qualifies under Medisave/medical insurance coverage (if applicable)

post-surgery-care

Post-surgery care

What qualifications or training does an Eye Doctor need to perform ptosis repair surgery?

Not all eye doctors or ophthalmologists are qualified to perform oculoplastic surgery. Only eye doctors who have trained specifically in the sub-speciality area of Oculoplastic Surgery are qualified and able to perform good ptosis repair surgery.

Ptosis repair surgery is considered challenging as, anatomically, the structures in the eyelid may show varying degrees of degenerative or wear and tear changes and because patient recovery may vary significantly. Various surgical techniques have been developed, and an ideal outcome can never be guaranteed.

Ptosis surgery performed by an experienced oculoplastic surgeon provides a greater chance of achieving an ideal outcome.

Is ptosis surgery claimable under Medisave or medical insurance?

Ptosis surgery can be claimed under medical insurance if the degree of droop is severe enough to meet the criteria set by our Ministry of Health. A trained Oculoplastic Surgeon will be able to assist you in seeing whether you meet those criteria. Visual field tests are involved in this assessment.

If you do not meet the criteria, any droopy eyelid correction surgery done in Singapore would be considered cosmetic with out-of-pocket costs.

Risks & Complications

Although general surgical risks such as infection, prolonged bruising and more prominent wound healing apply to ptosis repair surgery, these are rarely a big problem.

Patients undergoing ptosis surgery must be explicitly informed of the potential for under-correction, over-correction, asymmetry or any irregularity in lid contour.

The surgery is done awake to reduce the incidence of these problems, but occasionally, these may occur. An adjustment procedure at the one-week point often corrects this, but the problem may persist. Should this occur, a revision surgery a few months later to correct the problem would be appropriate.

Other FAQs

I understand from some firends that my eyes not close fully after ptosis surgery. It is true?

Incomplete closure of the eyes is sometimes seen after ptosis repair surgery, particularly in the first few weeks to a few months. Often, after the swelling settles, the eye closure improves and may be complete after a few weeks.

Your surgeon will help advise on how to take care of your eyes during this time.

I heard that the surgery can be painful. It is correct?

To ensure the lowest chance of needing an adjustment procedure, it is best for your surgeon to assess the extent of lift during the surgery. In order to do this, you have to be awake during the surgery.

Hence, only light sedation is employed in ptosis surgery. Deeper sedation is only provided in the early part of the surgery so that you do not feel the pain of the local anaesthetic injections. Following that, you may feel the odd  spot of discomfort as pressure sensations around the eyes are intact. Should this occur, let your surgeon know.

Your surgeon can consider topping up on the local anaesthetic. However, she will have to balance between pain relief and your ability to open your eyes during the surgery. To a certain extent, some discomfort may be experienced during the surgery but for the vast majority, this is very bearable.

Many patients have often expressed how delighted they were that the surgical process was a lot smoother than they had expected. Pre-op counselling is therefore crucial in preparing patients psychologically for a surgical journey.

Can I wear contact lenses after my ptosis surgery?

As contact lens wear can pose a risk to re-drooping of the eyelid, it is not advisable to continue contact lens wear after ptosis repair. If one does not wish to wear spectacles, one can consider refractive surgery or LASIK first prior to ptosis repair surgery.

How much does ptosis surgery cost?

The type of ptosis surgery employed depends largely on what needs to be addressed in each patient.

Where more work is required (ie. more complex and longer surgery, especially in cosmetic cases) where additional blepharoplasty work may be included or where previous surgery has been performed, the ptosis surgery cost will be higher.

Nevertheless, at Ava Eye Clinic, ptosis repair surgery costs are kept at reasonable and manageable levels.

Where the extent of ptosis meets the criteria for medical cases, eligible patients can look forward to claiming the full amount from their medical insurance or Medisave.