Located in front of the eyeball, the eyelids are a barrier that protects it from the effects of harmful environmental factors such as various chemical agents, ultraviolet rays, mechanical particles, and others. In addition, with each blink, the eyelids ensure the spreading of tears on the anterior surface of the eye and thus provide comfort and normal conditions for the realization of visual perception. Therefore, any change in their condition and position could lead to disease of the ocular surface and be a threat of vision loss.
The normal position of the eyelid with a calm open gaze is at the upper level of the cornea or colour circle - iris. In various conditions, the upper eyelid may cover the eye completely or partially. It's called eyelid ptosis or blepharoptosis, which means drooping of the eyelids.
In most cases, the condition does not improve and ptosis correction surgery is required.
What is ptosis?
Ptosis (blepharoptosis) is essentially the result of a condition affecting the levator muscles. Ptosis of the eyelids is a drop in the upper eyelid to a level below normal. In this way, the eyelid can close part of the pupil and this can lead to vision problems and eye strain.
Blepharoptosis can affect one or both eyes. It can be present at birth or appear later with ageing. In some cases, ptosis may not be accompanied by other complaints and may not lead to any deterioration in the patient's health. In other cases, ptosis may be a sign of a more serious disease affecting the muscles, nerves, or brain.
When diagnosing ptosis of the eyelids, it is very important to clarify the cause of its occurrence so that the underlying process can be cured, which will also lead to an improvement in the condition of the eyelids.
What causes droopy eyelids?
This medical condition can be due to various causes and is mainly divided into congenital and acquired, unilateral, or bilateral.
Congenital ptosis of the eyelids is when the child is born with this problem due to a disorder in the development of the muscles that raise the upper eyelids. In 70% of cases, only one eye is affected where bilateral ptosis surgery is required to lift the eyelid and return it to its normal position.
Acquired ptosis can be caused by external causes such as injuries and burns, as well as by age changes and diseases. The most common acquired ptosis occurs in the elderly due to the so-called degenerative tissue changes. The muscles that raise the upper eyelids weaken and "relaxes". This condition can be successfully treated with blepharoplasty or ptosis repair surgery.
Pseudoptosis or false blepharoptosis include conditions where the sagging is apparent but it is not true dropping of the eyelids. However, often the sagging and overhanging skin of the upper eyelid is considered ptosis. This is not a disease, but a natural ageing process and depends a lot on facial structures. Surgical correction is considered an aesthetic procedure and is called blepharoplasty or double eyelid surgery. Other causes of pseudoptosis can be trivial inflammation of the eyelids, as well as other various diseases.
Ptosis treatment options
Up to now, the most common and successful eyelid correction methods are blepharoplasty and ptosis repair. These are special plastic surgeries that are used for treating both - ptosis as a medical condition and pseudoptosis as a cosmetic defect.
Congenital ptosis usually required surgery. There are three operative procedures used for correcting it - levator resection by the skin approach, levator resection by the conjunctival approach, and eyebrow suspension of the eyelids.
Drooping eyelids caused by weakness of the muscle or damage of the nerves that control those muscles may not be associate with disease. Surgery can be done to improve the eyelids and milder cases if the patient wants it. In more severe cases ptosis surgery may be necessary to correct interference with vision.
Pseudoptosis around the eyelids (dermatochalasis) and drooping of the eyebrows (brow ptosis) can be also treated surgically. Excess skin can be removed by a procedure called blepharoplasty and brows can be elevated by a brow ptosis surgery.
The type of surgery that will be done depends on the ptosis as well as the strength of the levator muscle. Every individual needs unique treatment and care. If you or somebody from your family have ptosis we advise you to learn as much as possible about the latest medical treatment and approaches as well as healthy lifestyle choices. The best way to do it is to find a good specialist in Singapore who will inform you about the most appropriate treatment options for your case.
What is eyebrow ptosis and what is the treatment of it?
Quite often patients are confused about whether they have lid ptosis or brow ptosis. To treat accurately they need to know exactly which it is.
What is eyebrow ptosis? Age, heredity, and sun exposure contribute to drooping or bird eyebrows. This is usually most noticeable near the tail of the forehead (where the forehead narrows to the temple) in the area where the forehead muscle that raises the forehead is weakest.
What is the treatment? There are many surgical techniques designed to raise the eyebrows and each of them has its advantages and limitations and must be tailored to the appearance and anatomy of each individual.
Droopy eyelid surgery in Singapore
Ptosis repair is a surgery that improves the appearance of the eyelids. This is a procedure that can be performed by itself or it can be performed in combination with upper and lower eyelid surgery or brow lift, or other facial plastic procedures. There are different types of ptosis repair that can be done in Singapore:
- Internal repair. It is when the plastic surgeons shorten the eyelid muscle inside. There is no visible incision made;
- External repair. The levator aponeurosis is approached from the outside of the eyelid through the upper eyelid crease. This is suitable for people who have strong levator muscle function.
- Frontal siling fixation is performed if the patient has ptosis and poor muscle function.
The operation is usually done as an outpatient procedure under local anaesthesia. The incision is made in the crease of the upper eyelid skin or on the inside of the eyelid. One of the muscles is tightened or reattached to the upper eyelid by stitches. The final position of the eyelid depends on how the tissue heals.
When is Blepharoplasty performed?
Upper blepharoplasty (or double eyelid surgery) is a surgical procedure that aims to remove the excess skin on the upper eyelid, which forms a fold, sometimes quite large so that it almost covers it all and interferes with vision. At the same time, the fatty sacs formed under the skin and causing it to relax are removed. The point of the surgery is to repair droopy or puffy eyelids and to create a natural double eyelid crease. Most commonly the procedure is performed on patients with pseudoptosis and a large amount of excess skin.
The first step of this surgery is the very careful and precise marking of the upper eyelid crease. One of the most important parts of the operation is not removing to much skin. If it happens the eyelid won't be able to close. The procedure is normally performed under local anaesthesia that actually creates a little plane of dissection. It is called a hydro dissection where the anesthetic itself separates the skin from the underlying muscle. After that, the small incisions are made and the excess skin is removed. Then the incisions are closed again with sutures.
Double eyelid surgery is one of the most desirable procedures in Singapore.
Eyelid surgery in Singapore: consultation and preparation
The plastic surgeon himself, who will perform the operation, will assess the extent of excess skin and tissue around the eyes. This is necessary so that the surgeon can find the most appropriate method for the operation. That is why the doctor evaluates the following parameters:
- Determines the degree of excess skin on the upper eyelids;
- Evaluates the direction of the outer third of the eyelids and the degree of possible eyelid ptosis;
- Determines the condition of wrinkles in the corners of the eyes;
- Evaluates the area of eyelid depth and excess adipose tissue in the centre;
- With light pressure on the eyeball, the doctor assesses the amount of excess fat and its exact location.
The surgeon will be interested in your general health to make sure that you will tolerate the operation well and will not suffer from the worsening of chronic diseases if any. If you have diabetes or impaired blood clotting, it is better to warn your doctor, as in these diseases, performing any surgery is associated with significant risk.
Typically, recommendations for preparing for eyelid surgery include abstinence from medication and certain foods for two weeks before surgery, as well as smoking, which increases the risk of bleeding. Also, if possible, it is good to avoid exposure to direct sunlight and ultraviolet rays on the skin and eyelids.
Ptosis surgery recovery
After the operation, patients may experience minor swelling and bruise around the eyes, for several days. It is advisable to stay at home, to keep your head up when you sleep, and often to apply cold compresses. During the recovery process, do not lift heavy things. If you go out, it is advisable to use sunglasses.
It can take up to a month for the bruises and all swelling to go away. You will not be able to wear contact lenses or makeup for two weeks after the operation. Sutures are usually removed about a week after the surgery. You can return to work in a few days to a week, but you will need to avoid exercise and strenuous activities for at least two weeks.
The final result of ptosis repair or blepharoplasty can be seen 3 months after the surgery.
What are the risks of drooping eyelid surgery?
Ptosis surgery risks include under-correction where the eyelid still droops, overcorrection where the eyelid still open as well as undesirable eyelid appearance, scarring, and other causes of inflammation and infection. There are different methods for ptosis correction so it is important to discuss the post-surgery risks with your doctor and how to minimize them.
How long does ptosis surgery last?
Will the results of eyelid surgery be permanent? The results are considered long term but not permanent. This is due to the fact that the face and body continue to change throughout your life. Most facial cosmetic procedures can be estimated for last from 5 to 10 years. A healthy lifestyle, proper sun protection, and some maintenance procedure are recommended to maximize the long term benefits of the surgery.
Is it possible to treat the pathology of the upper eyelids without surgery?
Conservative treatment without surgery, which is the reception or topical application of drugs in a given pathology has virtually no effect. This can be said for gymnastics and even more so for home remedies. The only exception is the treatment in such cases of ptosis in young children and only if the muscle that raises the eyelid is only partially non-functional. But the effect of such treatment is minimal and it is more a way to prevent further lowering of the eyelid than a full treatment.
How much does ptosis eye surgery cost in Singapore?
The cost of any surgery is based on factors such as surgeon's fee, anaesthesia, facility cost, and aftercare. Ptosis surgery cost in Singapore is between $5000 and $12000. The average cost for double eyelid surgery in Singapore is $2500 to $5000.
Does insurance cover ptosis surgery in Singapore?
Ptosis has been classified as a medical condition by the ministry of health so it is Medisave and insurance claimable. However, if you are getting eyelid surgery in Singapore due to cosmetic reasons as your vision is not affected then your insurance company may not cover it.