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Ptosis Surgery in Singapore

Diagnose & Correct Your Ptosis Condition & Droopy Eyelid

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What is Ptosis?

Ptosis is a medical term that refers simply to a droop. For example, if the eyebrow is droopy upper eyelid, the proper medical term is blepharoptosis.

But, as droopy user eyelids are much more common than droopy brows, when eye doctors use the term ptosis, they are generally referring to a droopy upper eyelid.

In the specific definition of ptosis, the distance between the light reflex in the centre of the eye(the reflection in the centre of the pupil when light is shone at the eye) and the upper eyelid margin must be less than 2mm. The normal upper eyelid margin lies about 3 to 4mm from the centre of the pupil.

Causes of 2 Types of Common Ptosis Conditions.

These are the 2 common types of ptosis conditions, however there are other less common types of ptosis, please consult our ophthalmologists 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 of 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 corrected surgically.

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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 but certain trade-offs are inherent in this surgery and parents have to be counselled on these prior to 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 blepharosphimosis 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 is performed most commonly to correct aponeurotic ptosis. It essentially involves the re-attachment of the LPS to the tarsal plate with or without slight shortening of the LPS.

Although a functional surgery as it helps clear the superior visual field, it is often mistaken by lay persons as cosmetics surgery as an elevation of the upper lid resting position gives a pleasant improvement in appearance as well.

To add to the confusion, this surgery may be employed in cosmetics surgery when the surgeon and patient wish to have a slight lift to the upper eyelids.

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

While it achieves this, it comes with an inability to close the eye fully and a higher position of the operated lid in down gaze. Patients and their families must be informed of these offs prior to surgery.

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 specially in the sub-specialty area of Oculoplastic Surgery are qualified and able to perform good ptosis repair surgery.

Ptosis repair surgery is considered a challenging surgery as anatomically, the structures in the eyelid may show varying degrees of degenerative or wear and tear changes and also 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 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 surgery done 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 as well, these are rarely a big problem.

Patients undergoing ptosis surgery must be informed specifically 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 be seen. 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

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.

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.

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.

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.