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Ptosis Correction

Ptosis, characterised by the abnormal drooping of the upper eyelid, can affect one or both eyes and may interfere with vision and appearance.

This condition often results from weakness or dysfunction of the levator muscle, which is responsible for lifting the eyelid. Detailed knowledge of eyelid anatomy allows for effective ptosis correction through surgical intervention, restoring both eyelid function and symmetry.

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Dr Terence Goh

MBBS

MMed

MRCS

FAMS

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Ptosis Correction

My Philosophy

“Eyelid surgery is best done correctly the first time to reduce the risks of revision surgery, unnecessary scars and asymmetry. Ptosis surgery is more complex than upper eyelid skin surgery as we will be operating on the fine muscles of the eye.

Being able to do the surgery with the patient awake under local anaesthesia allows us to examine the eyelid level and make the necessary correction during surgery. This reduces the risk of asymmetry.”

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Who Needs Ptosis Surgery?

Patients may seek ptosis surgery if they experience:

  • Drooping eyelids that block vision
  • Uneven eyelid height
  • Tired or sleepy appearance
  • Strain or discomfort when raising the eyebrows

Common Causes of Ptosis

Ptosis can develop for various reasons and may occur on one or both sides. It is usually caused by stretching or thinning of the tendon between the levator muscle and the eyelid. When the tendon is stretched, the muscle has to work harder to lift the eyelid. This can lead to symptoms such as eyelid heaviness, forehead fatigue from over-compensation, and headaches. Recognising these helps in determining the most appropriate treatment approach.

  • Nerve Conditions

    Neurological disorders such as Horner’s syndrome or third nerve palsy can significantly impair eyelid function by interrupting the neural pathways that control muscle movement, leading to partial or complete inability to raise the eyelid.

  • Congenital Ptosis

    Present at birth, this condition occurs when the levator muscle responsible for lifting the eyelid fails to develop completely, leading to a drooping appearance from early childhood and potentially impacting visual development.

  • Trauma

    Physical injuries to the eyelid or surrounding orbital structures can cause direct damage to the levator muscle mechanism, disrupting its ability to lift the eyelid properly.

  • Age-Related Degeneration

    As individuals age, the levator muscle naturally weakens, causing gradual stretching of the muscle and resulting in a progressive drooping of the upper eyelid.

  • Pseudoptosis

    An apparent eyelid drooping caused by secondary factors like excessive skin, the presence of an underlying mass, or significant volume loss in the periorbital area.

Benefits of Ptosis Correction

Correcting ptosis provides both functional and aesthetic improvements, depending on the severity and cause of the condition.

  • Restoration of Vision

    Ptosis can obstruct vision when the upper eyelid covers the pupil. Surgical correction improves the field of vision by addressing the visual obstruction, alleviating issues such as eye strain.

  • Relief from Physical Discomfort

    Surgery alleviates forehead strain and headaches caused by compensatory muscle activity, such as raising the eyebrows to lift drooping eyelids, common in severe ptosis due to levator muscle weakness.

  • Refreshed Appearance

    In patients with mild or subclinical ptosis, surgical correction can improve eyelid symmetry and balance, making the eyes appear larger and more proportionate.

  • Prevention of Secondary Complications

    Timely intervention reduces the risk of associated conditions, such as amblyopia in children or persistent eye fatigue in adults.

Classification of Ptosis

Ptosis is categorised by the severity of eyelid drooping, which influences its functional impact and treatment options:

Classification of Ptosis – Mild

This level typically does not obstruct the pupil. While mild ptosis can be corrected for aesthetic reasons, these procedures are done for an aesthetic objective and are not covered by insurance.

Classification of Ptosis – Moderate

Characterised by partial pupil obstruction, moderate ptosis can affect vision, causing visual strain and difficulties with daily tasks such as reading or driving.

Classification of Ptosis – Severe

This condition results in significant pupil obstruction, impacting superior field vision and daily activities like driving. Severe ptosis may also lead to secondary symptoms such as headaches or neck strain due to compensatory behaviours, such as raising the eyebrows or tilting the head back. Surgical intervention is necessary to address these functional challenges, as the condition will not improve without treatment.

Techniques for Ptosis Correction

Precise analysis and diagnosis are the foundation for ptosis correction. The procedure is specifically designed for patients with a weak levator mechanism and is not necessary for individuals with sufficient eye muscle strength.

Because eye muscle strength differs between individuals, ptosis correction must be customised for each person and each eye. If a fair amount of muscle strength is present, a non-incision method may be suitable. However, if the muscle strength is lacking and the eyelids cover more than half of the pupil, incision methods will be required.

Suture Correction of Ptosis

Commonly combined with suture blepharoplasty, this minimally invasive method uses sutures to create or adjust an eyelid crease while addressing drooping. It is best suited for mild ptosis, and used for cosmetic enhancement.

Under-Through Method (Levator Plication)

Ideal for milder cases of ptosis, this approach involves folding the levator muscle to elevate the eyelid. The shorter surgical duration translates to a quicker recovery, but it may not provide sufficient correction for more severe drooping or patients with poor levator function.

Levator Advancement Surgery

This technique offers reliable results by shortening and reattaching the levator muscle to lift the eyelid. It is particularly effective for patients with good levator function. While it requires slightly longer surgical time and recovery compared to minimally invasive methods, it allows for accurate adjustment of eyelid height and contour.

Frontalis Suspension

Designed for severe ptosis with poor levator function, this procedure uses a sling to connect the eyelid to the forehead muscle, enabling eyelid elevation through brow movement. While it provides significant functional improvement, patients may experience incomplete eyelid closure post-surgery, necessitating careful eye lubrication and extended follow-up care.

How Ptosis Surgery Enhances Eye Shape and Function

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Even with double eyelids, eyes lacking sufficient muscle strength will not achieve an ideal shape or proper pupil exposure.

Double eyelid surgery and ptosis correction are distinct procedures, each addressing different concerns. While achieving an ideal eye shape is aesthetically more significant than simply creating a double eyelid crease, these surgeries often complement each other when needed.

Ptosis correction strengthens the eye-opening muscles (levator muscles), helping to enhance or create the ideal eye shape. It is particularly suitable for patients with weak levator muscles who struggle to fully open their eyes or rely on their forehead muscles, leading to fatigue and headaches.

Double eyelid crease creation surgery forms a fibrous connection between the skin and the levator muscle. This procedure is ideal for patients with no existing crease but strong eye-opening muscles. For those with absent creases and weakened levator muscles, combining ptosis correction with double eyelid crease creation provides the best outcomes.

Ptosis Correction for Male Patients

In male patients, ptosis correction requires careful consideration of aesthetic principles specific to the masculine facial features as most males do not wish to feminise their appearance with eye surgery. The surgical approach is modified to create a low or hidden eyelid crease that preserves the patient’s original eyelid type whilst making changes that accentuate the patient’s masculine eye characteristics. The goal is to achieve a moderate increase in eye aperture that enhances the eye’s appearance without feminising its shape.

Revision Ptosis Correction

Revision ptosis correction may be necessary in cases where initial surgery did not achieve the desired results. This can include the correction of asymmetry between the eyelids, particularly in cases with undiagnosed Hering’s phenomenon, which can cause uneven eyelid positioning. Revision may also address under-correction, where the eyelid drooping persists after the initial procedure, or over-correction, which can lead to lagophthalmos, a condition characterised by the inability to fully close the eye.

Rediscover clearer vision and confidence with personalised ptosis correction.

Schedule your personalised consultation today and let us help you achieve natural, balanced eyelid correction.

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Preparing for the Procedure

Consultation

The consultation includes a comprehensive assessment of your condition and discussion of desired outcomes. Techniques such as real-time simulations with a stylus are employed to visualise potential results and refine surgical planning. This ensures personalised and realistic surgical goals based on your anatomy and functional requirements.

Medical Evaluation

A detailed medical review assesses your overall health, including previous surgeries, current medications, and any allergies or conditions that could influence surgical safety or recovery. Vision and eyelid function evaluations are also conducted to determine the severity of ptosis and its impact on your daily activities.

Pre-Surgical Tests

Specific tests, such as visual field assessments and measurements of eyelid position, help confirm the need for surgery and guide treatment planning.

Pre-Surgical Guidelines

To ensure optimal recovery and minimise complications, stop smoking two weeks before surgery and avoid alcohol, aspirin, non-steroidal anti-inflammatory drugs, blood thinners, and supplements one week prior. Discontinue contact lens use three days before, and on the day of surgery, remove all eye makeup, false lashes, glue, or eyelid tape.

Step-by-Step Process

1. Anaesthesia Administration

Ptosis correction surgery is generally well tolerated with local anaesthesia or light sedation. This approach helps assess eyelid symmetry during the procedure, minimising the need for revisions. While the initial injection may cause slight discomfort, the area quickly becomes numb. Any mild discomfort at the injection site is brief and subsides quickly, ensuring a more comfortable experience.

2. Incision Placement

An incision is made along one of the natural eyelid creases to ensure a discreet and hidden scar. The use of loupe magnification ensures accurate identification and handling of delicate anatomical structures, reducing the risk of scarring and enhancing surgical outcomes.

3. Adjustment of Muscles or Tissues

The levator muscle or other structures are adjusted using techniques tailored to the severity of the ptosis. Gentle tissue handling is emphasised to minimise post-operative swelling, scarring, and the risk of asymmetry. This stage ensures proper elevation of the eyelid while maintaining its natural movement and function.

4. Suturing

Fine Ethilon 7/0 sutures are meticulously used to secure the adjustments made to the muscles or tissues. These sutures provide stability to the eyelid position and promote proper healing.

Post-Surgical Care and Recovery

A well-structured recovery plan is key to ensuring optimal healing and achieving successful outcomes after ptosis correction surgery.

Initial Recovery

Ptosis surgery is done as a day surgery. Patients may experience soreness, tightness, and swelling, with maximum swelling typically occurring 48 to 72 hours post-surgery. Cold compresses should be applied every hour during the first 48 hours to minimise swelling. Clean the eyelids gently with gauze and sterile saline three times daily and apply antibiotic ointment to the incision line to prevent infection. Pain relievers should be taken as prescribed to manage discomfort.

Activity Restrictions

To ensure proper recovery, refrain from smoking, alcohol consumption, strenuous exercise, and upper eyelid makeup for at least 2 weeks. Contact lens wear should also be stopped for 2 weeks. Avoid eye or facial massages and any activity that could put pressure on the eyes during this period.

What to Expect During Recovery

  • Mild swelling and bruising (subsides within 1-2 weeks)
  • Temporary dry eyes or blurry vision
  • Most patients can return to work within 5-7 days
  • Full recovery typically takes 4-6 weeks
Ptosis Correction

Insurance and Medisave Options

Patients may be eligible for insurance or Medisave coverage for ptosis correction if the condition significantly obstructs vision. During the consultation, the surgeon will assist with documentation required for claims, including an ophthalmologic exam to measure the Margin Reflex Distance (MRD-1), a visual field test to assess vision loss with and without eyelid elevation, and photos of the eyelid position in primary and downward gaze. Additionally, patient complaints regarding difficulty with vision-dependent tasks, such as reading or driving, will be documented to support the claim.

Frequently Asked Questions (FAQ)

What causes my ptosis, and am I a good candidate for surgery?

Ptosis can result from ageing, muscle weakness, nerve dysfunction, or trauma. Surgery is typically recommended for those with significant vision obstruction. A thorough exam will assess severity, eye health, and suitability for surgery. Patients with Hering’s phenomenon will need careful evaluation to avoid asymmetry.

What is the surgery like, and what techniques will be used?

The surgery is usually performed under local anaesthesia or light sedation. Most cases are treated with levator advancement, while more severe cases may require Müller’s muscle resection or frontalis sling. Local anaesthesia is advised to allow for real-time symmetry checks, with surgery lasting 1 to 1.5 hours for simple cases and 1.5 to 2.5 hours for complex ones.

What results can I expect, and will it look natural?

Patients can expect a significant improvement in eyelid position and symmetry. A moderate result is recommended for a natural look, avoiding over-correction and a high crease, which can lead to an unnatural appearance. Improving the eye aperture will remove visual obstruction, enhancing both appearance and quality of life.

What is Hering's Phenomenon?

Hering’s Phenomenon refers to the equal neural innervation of both eyelids. If one eyelid droops, the brain may increase neural input to elevate both eyelids. After surgical correction of the ptotic eyelid, the unaffected eyelid may experience slight drooping, leading to potential asymmetry. This adjustment can result in apparent asymmetry, but it usually resolves as the brain balances the eyelids.

What are the potential complications of ptosis correction?

While rare, complications may include bleeding, infection, scarring, mild asymmetry, or temporary issues like dry eyes and allergic reactions. Excessive bleeding or infections may need medical treatment, and scarring can be managed with creams or sunblock. Revision surgery may be required for aesthetic concerns or after swelling subsides.

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Dr Terence Goh

Choosing to combine the intricate skills of microsurgery with aesthetic surgery, Dr Goh specialises in gynaecomastia, surgery of the Asian face, particularly Asian eyelid surgery and rhinoplasty.

Blending the precision of microsurgery with the artistry of aesthetic surgery, Dr Goh has a special interest in gynaecomastia, facial procedures, including ptosis and eyelid surgery, as well as rhinoplasty.

He also offers a full range of body contouring procedures such as mummy makeovers, breast augmentation, liposuction, and body sculpting—designed to help patients feel more confident and comfortable in their own skin.

Beyond aesthetics, Dr Goh remains active in reconstructive microsurgery, with expertise in breast reconstruction, head and neck reconstruction, and lower limb salvage—restoring both form and function where it’s needed most.

  • Bachelor of Medicine, Bachelor of Surgery, National University of Singapore
  • Master of Medicine, National University of Singapore
  • Member of the Royal College of Surgeons
  • Fellow of the Academy of Medicine, Singapore (Plastic Surgery)
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