What is Ptosis?
Ptosis is a condition that is also known as droopy eyelids, when the upper eyelids droop downwards. A person who has ptosis can appear as if they are always sleepy and tired-looking. This is because the upper eyelid sags or covers the pupils, which creates a constantly fatigued appearance.
Ptosis can occur because of trauma, genetics, ageing or other medical disorders.
When ptosis affects only one eye, it is called a unilateral ptosis. Ptosis that affects both eyes is called bilateral ptosis.
If you are reading this article, you might be curious about getting rid of your ptosis or simply wondering whether it can be treated naturally. Whether you are looking for a cure or just finding a trusted doctor for your droopy eyelids, I hope that this article gives you a clearer understanding of ptosis and what can be done.
Causes of Ptosis
Ptosis can be a result of a congenital condition or be acquired over time.
- Congenital: Congenital ptosis or ‘lazy eye’, can be present at birth, or develop later in the first year of life. This condition is usually isolated and not related to any systemic health conditions.
- Genetics: Ptosis can be a result of genetics. Hereditary ptosis can run in the family. If one or more family members have ptosis, it is likely that you will have ptosis.
- Acquired: Acquired ptosis happens over time and develops later in life. There are five main subtypes of acquired ptosis:
- Aponeurotic ptosis (Ageing): This happens when there is stretching due to age. As we age, our muscles begin to weaken or loosen. This is known as weakened muscle elasticity. Weak muscle elasticity can cause our eyelids to droop. Many patients who come to me for ptosis treatment are because of age-related causes.
- Traumatic ptosis (Trauma) When there is direct impact or trauma to the eye region, the muscle that lifts the eye (levator aponeurosis) can become weakened or severed. This can result in the drooping of eyelids.
- Mechanical ptosis: Mechanical ptosis happens when there is a tumor or growth on the eyelid. The weight of the growth stretches the levator muscle. Routine LASIK or cataract surgery can also cause ptosis because of a stretched muscle or tendon.
- Myogenic ptosis: Myogenic ptosis is linked to multiple muscular disorders. This includes muscular dystrophy.
- Neurogenic ptosis: Neurogenic ptosis is when the nerves that control eyelid movement are affected. This can happen because of conditions such as Horner Syndrome, myasthenia gravis or third nerve palsy. Patients who have suffered from a stroke or have a brain tumor can also develop ptosis.
Risk Factors of Ptosis
The truth is that it is possible for anyone to have drooping eyelids. However, incidences of ptosis increase with the following factors:
- High Body Mass Index (BMI): A person with a higher BMI or unhealthy BMI is more likely to have a higher level of fat deposits under the skin of the eyelids. This can cause the eyelids to sag, droop or appear puffy.
- Lighter skin tone: A person with a lighter skin tone is more susceptible to droopy eyelids because of the higher likelihood of damage from UV-radiation from the sun on the skin. UV-radiation accelerates the skin aging process, which can cause weakened eye muscles that can lead to ptosis.
- Male gender: Although there is no clear reason why the male gender is more likely to have ptosis than women, it appears that men are twice more likely to have ptosis than women.
- Age: Ageing causes skin to slowly lose its elasticity. This can affect underlying structures around the eyes that can cause sagging and drooping.
- Botox: There are instances when ptosis occurs after a Botox injection. This happens because of incorrect site injections, as well as the lack of medical experience and skill from the doctor. When using Botox as treatment, the Botox is injected at the mid-forehead or above. Failure to administer at the correct site can lead to ptosis.
Can ptosis affect my vision?
Regardless of age or cause, it is possible that ptosis can affect your vision. In fact, if you are reading this article right now, you might be wondering whether ptosis is the primary contributing factor for your blurred vision.
The droopy eyelid can partially or completely cover your vision, which results in either blurred vision, obstructed peripheral vision, or double vision. In some cases, it is entirely possible that vision is entirely restricted.
Ptosis in children can lead to a condition known as ‘lazy eye.’ While the condition is treatable, delayed or untreated ‘lazy eye’ can cause permanent loss of vision.
When ptosis is affecting your vision, it is best to seek medical assistance immediately. Where treatment is considered medically necessary, it is possible to use Medisave or insurance to cover the cost of your ptosis surgery.
Is it possible to prevent ptosis?
It is currently not possible to prevent ptosis, especially when it is congenital. The best way to combat ptosis is to be aware of the symptoms and get help when it happens. I often tell my patients that ptosis is not a scary condition, but simply one that requires attention should it begin affecting one’s quality of life.
Symptoms of Ptosis
The symptoms of ptosis are simple to watch out for: One or both eyelids droop. Unlike tooth pain that can be an indicator of dental caries, the symptoms of ptosis are usually not painful. They can, however, block your sight and affect your quality of life.
Patients who have ptosis sometimes tell me that they decided to come for a consultation after having to tilt their head back to see better. In some cases, they are forced to arch their eyebrows to lift their eyelids.
When should I visit a doctor for ptosis?
You should visit a doctor for ptosis if you find that your eyesight has been affected. It would also be wise to pay a visit to the doctor should ptosis develop suddenly or get worse with time. In situations like this, there might be underlying medical conditions to why ptosis has developed.
When you visit a doctor, you will most likely be asked about your medical history as well as undergo a physical examination. Some questions that your doctor will ask you are:
- How long have you had droopy eyelids?
- How often do your eyelids droop?
- Have you noticed any vision problems because of your eyelids?
Your doctor will then run some tests to determine the cause of your ptosis.
Testing for ptosis
Some tests that your doctor might run for you include the following:Slit lamp exam
During the slit lamp examination, a doctor will take a high intensity light to take a look at your eyes. Some slight discomfort may be expected as your eyes will be dilated during the test.Tensilon exam
Your doctor might inject Tensilon, a drug that is known generically as edrophonium, into one of your veins. After injection, you might be asked to sit up and down, as well as cross and uncross your legs several times. You will then be monitored to see whether Tensilon has helped increase your strength.
Can ptosis go away naturally?
Unfortunately, it is not possible for most cases of ptosis to go away naturally because of the nature of the condition.
If a brand or company promises you natural remedies, an exercise regimen or firming devices that can get rid of ptosis, it is always best to be wary of their claims. While most of these solutions are relatively harmless, some of them can cause more damage than good.
Listed below are some common solutions that have been plied as natural ptosis correctors by their vendors:
Using cold compresses on eyes: Cold compresses might be effective on swollen or puffy eyes, but will do nothing to improve ptosis. This is because ptosis is a result of muscle tone weakening and not a result of enlarged blood vessels.
Consumption of healthy foods: Eating healthy whole foods can lead to better eye health, but does not help with the neuromuscular cause of ptosis.
Taking supplements like B12 or lutein: There is no scientific evidence behind the consumption of supplements and ptosis correction.
Wearing eye patches: Eye patches can be prescribed by an ophthalmologist for a condition called amblyopia. However, it is not recommended to wear eye patches outside of their prescribed uses. Prolonged wearing of eye patches can negatively affect your vision and cause further damage to your eyesight.
Undergoing Ayurvedic treatments: Yoga and a process that uses warm herbal medicated oils are prescribed for people with ptosis. While yoga and medicated oils are excellent ways of calming down and relaxing, there is no scientific evidence that it can correct saggy eyelids.
Will glasses get rid of ptosis?
Glasses cannot get rid of ptosis. The only way that can get rid of ptosis is through surgery.
If you are afraid of surgery as some patients are, and your condition does not necessitate surgical intervention, you can use a ptosis crutch, which is a mechanical aid that can help relieve ptosis.
Can I use a ptosis crutch to treat ptosis?
Yes, it is possible to use a ptosis crutch to alleviate the symptoms of ptosis. A ptosis crutch is a small bar that rests on the upper and inner side of your eyeglasses that can support your droopy eyelids. It is a simple and inexpensive way to treat ptosis that is non-permanent or that does not require surgery.
Will exercising help with ptosis?
There is no scientific evidence that exercising will improve ptosis or treat it. While working the facial muscles can help improve appearance of certain target areas, surgery is the sole way to ensure that ptosis is completely cured.
The treatment for ptosis varies according to how severe your ptosis is and what is the cause of your ptosis.
In the event that your ptosis is a result of age or a congenital cause, there are no immediate next steps that you will need to take as ptosis will not be a health risk to you. Should you wish to continue with ptosis treatment for aesthetic purposes, you can opt for plastic surgery to reduce drooping and enhance the appearance of your eyes.
For ptosis that is caused by an underlying health condition, you will be treated for that. Doing so will stop your eyelids from drooping.
If your ptosis has resulted in blocked vision, you will most likely be recommended to proceed with ptosis surgery. The surgery will lift the eyelid up to a desired position and your visual fields will be restored. Some patients have also reported improved symptoms of less headaches and eye strain.
There might be some people who are not suitable for ptosis surgery. For such cases, it is possible to use a ptosis crutch, which are glasses that can hold up your eyelids. Ptosis crutches are often used when the ptosis that a patient has is temporal.
What is the ptosis correction procedure like?
If you are considering heading in to a plastic surgeon for a ptosis consultation, I might be able to give you some insights into the common patient journey of ptosis correction in Singapore.
Before the procedure
The distance from the centre of your pupil to the upper eyelid is measured during the consultation. This distance is known as the marginal reflex distance. If the distance is below a certain level, ptosis correction is required.
During the procedure
Should you qualify for ptosis correction surgery, your levator muscle will be tightened during the procedure. Doing the surgery will lift your eyelid to an ideal position that can both enhance the way your eye looks as well as return your full vision. Ptosis correction surgery is sometimes recommended for children to prevent ‘lazy eye.’
After the procedure
Ptosis correction is a common procedure that is done outpatient in Singapore. After the correction procedure, you can be discharged with antibiotic creams for the eyes. You will not need any padded dressing for your eye. Whilst your eyes will be swollen and your vision may be affected, you should be able to read and see without problems. . The swelling would usually peak by the 3rd day and most of the swelling will come down by the 5th day. That is also the day when we remove the stitches. The remainder swelling will gradually come down and it can take a few weeks to months to settle.
Surgical options for Ptosis
This open technique is suited for all grades of Ptosis as it allows the surgeon full control on adjusting the strength of the levator muscle. With the incision method, the surgeon can clearly observe the strength of the muscle and do the necessary fine adjustments to correct the ptosis. The surgeon is given more control regarding the amount of excess skin and fat that can be removed to achieve the ideal double eyelid crease.
This method of correction is only suitable for patients with mild ptosis that do not require any skin excision. The force of the suture is used to shorten the levator mechanism, lifting the upper eyelid without an incision. Non-incision correction can be as effective and consistent, with less operating and recovery time. However, due to the less invasive nature of this method, the surgeon will not be able to adjust the control of muscle tension as effectively.
Ptosis correction recovery time
It takes about a week or two for minor bruising and swelling around the eyes to subside. Patients who have undergone ptosis correction usually do not have any visible scarring post-surgery.
Will I need to take time off work after ptosis correction surgery?
As with any other surgical procedure, it is highly recommended to avoid overexertion immediately after the procedure.
Whilst the recovery period after ptosis correction surgery is minimal and most patients head back to work soon afterwards, it is dependent on how you feel as an individual. Some patients choose to work from home after the procedure. If you work in a role that requires heavy physical activity, it is recommended that you give yourself ample time to recover before heading back to work. I advise most of my patients to take about 5-7 days off work and about 2 weeks off any major social events.
Can I wear makeup after ptosis surgery?
You can usually wear makeup 10-14 days after surgery. This is highly dependent on how fast you have healed.
Can I use Botox to treat ptosis instead?
In certain cases where ptosis is mild or micro, Botox can be used to provide cosmetic enhancements to the eyes. The Botox is administered to the pretarsal orbicularis oculi muscle to manage small eyelid margin asymmetries.
Can ptosis treatment fail?
Similar to any other treatments, ptosis correction can fail for multiple reasons:
- Inexperienced doctor
- Poor technique and skill
- Excessive swelling post-surgery
- Post-operative bleeding
- Poor tissue strength
- Asymmetries that cannot be addressed with surgery
The success rate of ptosis surgery is more than 95% which makes it one of the safest surgeries, but there are still risks and complications that can happen and that you should be aware of.
Will I need repeat treatment after ptosis correction surgery?
It is difficult to predict whether ptosis might return after having ptosis correction surgery. Droopy eyelids can happen again at any point due to many reasons. Up to 85% of patients do not have to have repeat treatment after their first ptosis surgery.
What are the risks of ptosis surgery?
Despite being extremely rare, the risks of ptosis surgery are:
- Post-surgical swelling
- Post-surgical bruising
- Infection of the surgical site
- Dry eyes
- Asymmetric eyelid height
- Over or under-correction
- Changes in vision
Most of these risks can be avoided by having a skilled and experienced surgeon that can help you navigate through your ptosis treatment.
Cost of Ptosis Treatment
The average cost of ptosis treatment in Singapore can range from $7,000 - $20,000. The costs of treatment is because of:
- The expertise of the plastic surgeon
- Anaesthetic fees
- Operating facility fees
- Medication issued
Why is ptosis treatment in Singapore so expensive?
Ptosis treatment in Singapore can be costlier than places like Thailand or South Korea because of the standard of care that is given to patients. While this does not mean that doctors in Thailand or South Korea do not provide proper care and professionalism to their patients, you can rest assured that all board certified Plastic Surgeons here have to adhere to strict regulatory guidelines in Singapore, ensuring the utmost quality in service and patient care. You can proceed with your surgery with a peace of mind knowing that all accredited clinics in Singapore have a strict industry standard to uphold. Additionally, factoring other costs such as flights, follow up appointments, and potential returns for corrective surgery or complications, the pros of doing your surgery in Singapore far outweigh the initial cost benefits you may have saved.
Is ptosis Medisave or insurance claimable?
Yes, ptosis surgery is Medisave claimable if the severity of ptosis reaches a certain benchmark. Moderate to severe ptosis is considered a medical condition, which is considered a legitimate claim by Medisave or insurance.
To get subsidised by Medisave or covered by insurance, you would have to undergo an official visual assessment by an ophthalmologist based on the guidelines that are stipulated by the Ministry of Health (MOH) Singapore.
Ptosis Repair vs. Blepharoplasty (Cosmetic Eyelid Surgery)
There is a simple difference between ptosis repair and blepharoplasty. Ptosis repairs are considered a functional procedure. They are often done to restore full vision and prevent further damage to the vision of a patient. Blepharoplasty, on the other hand, is a cosmetic procedure. They are done to remove excess skin and tissue and lifted to energise and refresh the eyes.
Finding The Right Doctor for Ptosis Treatment
When it comes to selecting the right doctor to treat your ptosis, there is a simple set of guidelines that I would like to share with you. With these guidelines, I hope that you are able to seek out the correct help for your condition.
A board certified plastic surgeon can be likened to receiving a stamp of excellence for contributions to the field. Getting a board certified plastic surgeon ensures that you are obtaining treatment from a doctor who has been trained extensively in their field of expertise and is capable of successfully delivering on complex cases. In Singapore, only plastic surgeons, oculoplastic, and facial surgeons are able to do ptosis surgery. Board certified plastic surgeons are at the top of their profession, have immense technical expertise, and will be able to guide you through the entire process clearly and with due diligence. This reduces the risks of complications and unnecessary revisions.
Asking a doctor about their previous case loads and success rates can help you determine whether or not to proceed with the treatment, and whether the doctor is right for you.
A well maintained clinic facility is imperative in ensuring a positive surgical experience, as well as reducing unnecessary complications from infections. An accredited clinic must be equipped with up to date and appropriate technology. Usage of the latest technology also helps to minimise chances of medical errors.
Consultations, Pre and Post surgery Care
Most importantly, pick a surgeon that you are comfortable with, who is able to answer all your queries to your satisfaction. Prior to surgery, a comprehensive assessment should be carried out. Post-surgery follow up should be conducted to ensure that there are no complications and that the results are optimal. These processes are all equally as important as the surgery itself.
Ptosis is not a condition that causes immediate harm to your health. However, if you find that ptosis is blocking your vision and impeding your quality of life, you should seek professional medical help as soon as possible.