Comprehensive Guide to Ptosis (Droopy Eyelid)
Ptosis, or droopy eyelid, occurs when the upper eyelid falls lower than usual, potentially obstructing vision and altering facial appearance. It may be congenital (present at birth) or acquired later in life. In Singapore, ptosis is treatable, with procedures available to improve both function and aesthetics.
Types and Causes of Ptosis
Ptosis is classified based on when it develops:
Congenital Ptosis
Present at birth due to poor development of the levator muscle. It often affects one eye and, if untreated, can impair visual development. Causes include genetics, muscle malformation, or complications during delivery (e.g. forceps use).
Acquired Ptosis
The second type, acquired ptosis, develops later in life and is further classified by cause:
- Involutional (Aponeurotic) Ptosis – Most common; due to age-related weakening of the levator muscle.
- Neurogenic Ptosis – Caused by nerve dysfunction from conditions like oculomotor nerve palsy, Horner’s syndrome, or myasthenia gravis.
- Myogenic Ptosis – Results from muscle disorders such as muscular dystrophy or myopathies.
- Mechanical Ptosis – Eyelid is weighed down by tumours, swelling, or scarring.
- Traumatic Ptosis – Due to injury to eyelid muscles or their nerve supply.
Ageing, diabetes, and hypertension are also associated with increased ptosis risk.
Signs and Symptoms of Ptosis
Common signs and symptoms of ptosis include:
- Drooping of one or both upper eyelids
- Vision obstruction or blurry vision
- Eye fatigue, strain, and headaches from compensating muscle use
- Asymmetrical or tired-looking eyes
- Head tilting (especially in children)
- Difficulty reading or driving, especially at night
How Is Ptosis Diagnosed?
Diagnosis involves reviewing your medical history and conducting a physical exam. Key tests include:
- Visual Acuity and Visual Field Testing – Assesses how much the droopy eyelid blocks vision.
- Eyelid Examination – Measures eyelid height and levator muscle function.
- Pupil Testing – Pupil size, shape, and reaction to light are examined to identify potential neurological causes.
- Slit-Lamp Examination – Evaluates eye and eyelid structures to detect any abnormalities.
- Neurological and Muscle Testing – Diagnoses neuromuscular causes like myasthenia gravis.
- Imaging Studies (MRI, CT scan) – Used when orbital or neurological issues (such as tumours or trauma) are suspected.
Ptosis Treatment in Singapore
In Singapore, ptosis is primarily treated through corrective surgery, medically known as blepharoplasty, which aims to strengthen the levator muscles responsible for lifting the eyelid. It may also involve removing excess skin or fat. This improves both visual function and appearance.
Ptosis correction offers significant functional and aesthetic benefits, enhancing both your vision and appearance:
- Restored upper visual field
- Relief from eye and forehead strain
- Reduced need to tilt the head or lift brows
- More symmetrical, youthful appearance
- Defined eyelid creases and larger-looking eyes
Ptosis Correction Procedure
Ptosis corrective surgery typically involves a small incision in the eyelid crease to access and adjust the levator muscle.
Several approaches may be used:
- Anterior Approach (External Method) This approach utilises an incision along the eyelid crease to directly adjust the levator muscle. It is suitable for moderate to severe ptosis or patients needing concurrent blepharoplasty.
- Posterior Approach (Internal Method) A minimally invasive technique through the inner eyelid (conjunctiva) to shorten Müller's muscle. Ideal for mild to moderate ptosis with good levator function. Offers faster recovery and hidden scars.
- Adjustable Sutures Adjustable sutures are utilised in both approaches to fine-tune eyelid height post-surgery. This allows minor adjustments within 24 hours, improving symmetry and reducing revision risk.
What to Expect Before the Procedure
A comprehensive assessment is done to evaluate eyelid function and determine your suitability for surgery. Candidates typically have ptosis that affects vision or quality of life.
Your surgeon may recommend lifestyle adjustments—such as quitting smoking, pausing certain medications, or improving general health—to minimise surgical risks.
What to Expect During Ptosis Surgery
For adults, surgery is usually done under local anaesthesia with sedation. Children or complex cases may require general anaesthesia. The procedure lasts 1–2 hours, depending on whether one or both eyelids are treated.
What to Expect After the Procedure
Post-surgery, expect some swelling, bruising, and discomfort for 1–3 weeks. Recovery guidelines include:
- Using cold compresses
- Keeping the head elevated
- Avoiding eye rubbing and strenuous activities
If adjustable sutures were used, final eyelid position may be adjusted during early follow-ups. Most people resume normal activities in 1–2 weeks, though complete healing may take up to 3 months.
Seek prompt medical attention for sharp pain, significant bleeding, or vision changes.
Are There Potential Complications with Ptosis Surgery?
Ptosis surgery is generally safe, but like any surgical procedure, it carries potential risks. Understanding these helps patients make informed decisions and recognise when to seek medical attention.
Common General Surgical Risks
- Swelling and bruising – Common and temporary
- Infection – Rare but treatable
- Dry eyes – May occur due to altered eyelid closure
Ptosis Surgery-Specific Risks
- Asymmetry – Uneven eyelid levels may require revision.
- Overcorrection – Eyelid lifted too high, causing dryness or closure issues
- Undercorrection – Eyelid remains droopy, often requiring reoperation.
In the hands of a skilled and experienced surgeon, oculoplastic surgery can help achieve the best functional and aesthetic outcomes while significantly reducing the risk of complications.
Why Choose Our Clinic for Ptosis Treatment?
Our team includes oculoplastic surgeons and ophthalmologists experienced in treating all types of ptosis, from mild to severe, including congenital cases. Our clinic upholds the highest standards of safety and care, employing modern surgical equipment and maintaining a sterile environment to minimise risks and support healing. We prioritise clear communication, ensuring you understand your diagnosis, treatment options, and expected outcomes, with specialists who address your concerns and set realistic expectations.
Contact our eyelid surgery specialist today to schedule a consultation and take the first step toward clearer vision and a refreshed look.
Frequently Asked Questions About Ptosis Correction Surgery
How much does ptosis surgery cost in Singapore?
The cost of ptosis surgery in Singapore varies based on factors such as the surgeon’s expertise, the complexity of your condition, and whether one or both eyelids are being treated. Additional costs may include anaesthesia, facility fees, and post-operative care. Your surgeon will provide a detailed breakdown during your consultation.
Will insurance cover ptosis surgery?
Yes, if the condition significantly affects vision and meets the MOH’s criteria for medical necessity. A certified visual assessment is required. Cosmetic-only procedures are not covered.
Can ptosis go away on its own?
Mild congenital cases may remain stable, but most types, especially acquired ptosis, do not resolve without treatment and may worsen over time.
Is ptosis correction surgery the same as double eyelid surgery?
No. Ptosis correction addresses eyelid muscle function to lift droopy lids, while double eyelid surgery creates or enhances an eyelid crease for cosmetic purposes.
Can I wear contact lenses after my ptosis surgery?
Yes, but it is recommended to wait until the eyes have fully healed, usually a few weeks post-surgery. Follow your surgeon’s advice on when it is safe to resume contact lens use to avoid irritation or infection.
Is the result of droopy eyelid correction permanent?
Ptosis surgery results are generally long-lasting and considered permanent. However, ageing or underlying conditions may cause some recurrence or changes over time.
Can ptosis recur after surgery?
Recurrence is possible but uncommon. Factors such as the severity of initial ptosis, surgical technique, and healing process influence the risk. Some patients may require revision surgery if ptosis returns or if eyelid symmetry is not optimal.
Our Eyelid Surgery Specialist
MBBS(S'pore), MMed(Ophth), FRCS(Edin), FAMS
Ophthalmologist
Dr Elaine Chee Wen Ling is a recognised oculoplastic surgeon specialising in ptosis correction and other eyelid surgeries. She is a Partner and Senior Consultant at Eye & Retina Surgeons and also serves as a Visiting Consultant at the Singapore National Eye Centre. With extensive training in ophthalmology and advanced subspecialty expertise in oculoplastics and reconstructive surgery, Dr Chee has over a decade of experience treating a wide range of eyelid conditions, including droopy lids (ptosis), eyelid malpositions, and aesthetic eyelid procedures.