Droopy Eyelid Treatment
(Ptosis Correction)

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    Droopy Eyelid Surgery (Ptosis Correction)

    Ptosis (blepharoptosis) is the abnormally low (droopy) position of the upper eyelid margin due to a weakness in the lifting mechanism. This mechanism consists of muscle (levator palpebral superioris) and its soft tissue extension (levator aponeurosis)

    It must be differentiated from dermatochalasis. In this condition excessively lax upper eyelid skin causes droopy appearance rather than true weakness of the lifting mechanism of the eye.

    Blepharoptosis can also co-exist with dermatochalasis.

    Patients with blepharoptosis or dermatochalasis has tired looking eyes even though they have adequate rest. They usually use their forehead muscles to assist in lifting up the upper eyelids resulting in persistent frownlines.

    Ptosis vs dermatochalasis

    Blepharoptosis Dermatochalasis
    Diagram

    Blepharoptosis

    Dermatochalasis

    Mechanism
    Droopy lid due to weakness in the lifting mechanism of eyelid.
    Droopy lid due to excessive eyelid skin.
    What covers the limbus?
    Ciliary margin (eyelash margin)
    Skin edge of redundant upper eyelid skin
    Age group
    All age
    Older age
    Associated disorder
    Both conditions can co-exist
    Medical claims
    Considered medical condition
    Considered cosmetic condition
    BlepharoptosisDermatochalasis
    Diagram
    Blepharoptosis - Droopy Eyelid - Ptosis Correction Blepharoptosis
    Dermatochalasis - Droopy Eyelid - Differentiate from Ptosis Correction Dermatochalasis
    MechanismDroopy lid due to weakness in the lifting mechanism of eyelid.Droopy lid due to excessive eyelid skin.
    What covers the limbus?Ciliary margin (eyelash margin)Skin edge of redundant upper eyelid skin
    Age groupAll ageOlder age
    Associated disorderBoth conditions can co-exist
    Medical claimsConsidered medical conditionConsidered cosmetic condition
    *Limbus – Junction between the cornea and the sclera (the black and the white of the eye)

    LEVATOR FUNCTION – the residual lifting ability of the upper eyelid opening mechanism

    • The levator palpebral superioris is the main muscle responsible for eye opening.
    • To measure the residual lifting ability of the upper eyelid opening mechanism, the patient is asked to look downwards and then upwards while immobilizing the brow. The amount of eyelid movement is called levator excursion and this reflects levator function.
    • The levator function and degree of blepharoptosis determines the type of corrective treatment to be done.
    LEVATOR FUNCTION – The residual lifting ability of the upper eyelid opening mechanism

    Table of Levator Function Assessment

     
     
    Levator Excursion
     

    Levator Function Test – Lid Closed

     

    Levator Function Test – Lid Open

     

     

     

     

     
    Levator Function
     
    Good : >10 mm
    Fair : 5-10 mm
    Poor : 0-5 mm
    • Many surgical procedures have been described for the correction of blepharoptosis tailored according to levator function.
    • The most common procedures done by our plastic surgeon are levator plication and levator advancement.
    • The levator aponeurosis is shortened by pleating and suturing in levator plication procedure. A portion of the excess aponeurosis is removed and the free edges are overlapped and sutured together in the levator advancement procedure.
    • The incisions and scar for blepharoptosis correction is similar to conventional blepharoplasty. The scar is hidden in the eyelid crease.
    • However, the scope of surgery is vastly different. It is a very delicate surgery that require meticulous dissection of the opening mechanism of the eye and it takes longer duration than conventional blepharoplasty.
    • During the operation patient may be required to sit-up and check for symmetry of eye opening several times after correction.
    • Ptosis correction can be combined with conventional upper blepharoplasty procedure for :
      • Incisional blepharoplasty
      • Removal of excessive upper eyelid skin
      • Removal of excessive upper eyelid fat pad
    • Treatment duration: 2-4 hours
    • Day Treatment (home on the same day)
    Table of Status of Levator Function and Corresponding Ptosis Correction Procedure
    Levator Function
    Levator Function
    Excellent (> 10 mm)
    Moderate (5-10 mm)
    Poor (0-5 mm)
    Levator Function
    Type of Procedure
    • Aponeurotic surgery (Fasanella-Servat procedure, Putterman’s procedure, Mutarde’s Split Level Approach)
    • Mullerectomy
    • Levator advancement or plication
    • External levator resection
    • Levator advancement or plication
    • External levator resection
    LEVATOR FUNCTION – The residual lifting ability of the upper eyelid opening mechanism
    Table of Levator Function Assessment
    Levator Excursion Levator Function
    Levator Function Test for Droopy Eyelid - Lid Closed Levator Function Test – Lid Closed
    Levator Function Test for Droopy Eyelid - Lid Open Levator Function Test – Lid Open
    Good : >10 mm
    Fair : 5-10 mm
    Poor : 0-5 mm
    • Many surgical procedures have been described for the correction of blepharoptosis tailored according to levator function.
    • The most common procedures done by our plastic surgeon are levator plication and levator advancement.
    • The levator aponeurosis is shortened by pleating and suturing in levator plication procedure. A portion of the excess aponeurosis is removed and the free edges are overlapped and sutured together in the levator advancement procedure.
    • The incisions and scar for blepharoptosis correction is similar to conventional blepharoplasty. The scar is hidden in the eyelid crease.
    • However, the scope of surgery is vastly different. It is a very delicate surgery that require meticulous dissection of the opening mechanism of the eye and it takes longer duration than conventional blepharoplasty.
    • During the operation patient may be required to sit-up and check for symmetry of eye opening several times after correction.
    • Ptosis correction ( droopy eyelid surgery ) can be combined with conventional upper blepharoplasty procedure for :
      • Incisional blepharoplasty
      • Removal of excessive upper eyelid skin
      • Removal of excessive upper eyelid fat pad
    • Surgical duration: 2-4 hours
    • Day Surgery (home on the same day)
    Table of Status of Levator Function and Corresponding Ptosis Correction Procedure
    Levator Function
    Excellent (> 10 mm) Moderate (5-10 mm) Poor (0-5 mm)
    Type of Procedure
    • Aponeurotic surgery (Fasanella-Servat procedure, Putterman’s procedure, Mutarde’s Split Level Approach)
    • Mullerectomy
    • Levator advancement or plication
    • External levator resection
    • Frontalis suspension
    • Frontalis Orbicularis Oculi Muscle (FOOM) flap

    About DR. NG SIEW WENG
    (伍修永医生)

    Dr Ng Siew Weng is a Consultant Plastic & Reconstructive Surgeon accredited by the Specialists Accreditation Board, Ministry of Health of Singapore. He graduated from the Medical Faculty of the National University of Singapore and pursued several Post Graduate Diploma programs, two of which were in Dermatology.

    He was the first plastic surgeon from Singapore General Hospital (SGH) to receive the HMDP scholarship by the Ministry of Health to train in South Korea.

    During his training in South Korea, Dr Ng worked with world-renowned top plastic surgeons. His surgical techniques have a strong Korean influence especially in popular procedures like breast augmentation, blepharoplasty, eyebag removal, droopy eyelid (ptosis) correction, facelift and fat grafting

    Our Philosophy

    Dr Ng Siew Weng is active in the field of research, as reflected by the numbers of research papers he published, and the several invitations he received to present at medical conferences in North America, Europe and Asia including Singapore. During his attachment at the Hand Surgery Department in SGH, he received a prestgious Economic Development Board Proof of Concept Grant to investigate the treatment of trigger finger and subsequently invented a novel treatment device which is patented.

    Dr Ng has also researched into stem cells and demonstrated that stem cells derived from autologous adipose tissue improved the rate of wound healing. Dr Ng’s research interest in fat stem cells has led him to use it in clinical practice in order to achieve the best cosmetic results.

    He uses fat grafting regularly in his surgery to achieve natural cosmetic enhancement such as fat gratfing to breast and fat grafting to face. He had organised a Fat Grafting Workshop at SGH so that local surgeons have the opportunities to learn fat grafting techniques from him and a top Korean surgeon.

    During his attachment at the Hand Surgery Department in SGH, he received rigorous microsurgery training which is invaluable for honing his techniques in facial and breast reconstruction .

    Our Clinic is a fully equipped, Ministry of Health accredited Ambulatory Surgical Centre as well as state-of-the-art health care facilities. We aim to provide a safe and comfortable environment so that our patients can have their best possible experience when receiving cosmetic treatment in Singapore.

    Our main clinic is located at Farrer Park Medical Centre, Connexion – a three-in-one medical tourism friendly complex that comprises of Farrer Park Medical Centre, Farrer Park Hospital and One Farrer Hotel and Spa. A first of its kind in Asia, patients have the option of recovering in the comfort of a 5-star hotel or hospital after treatment. Our team would be glad to arrange concierge service and hotel stay is required. To serve our patients better, we have a branch in Gleneagles Medical Centre.

    Dr Ng believes in providing sufficient information and management options for the patient to make an informed decision. The patient needs to clearly understand : (1) The nature of their current condition, (2) The whole range of management options : from non-invasive to operative solutions, and (3) The pros and cons of each option.

    Most patients find this approach helpful. Dr Ng often reiterates that his role is to provide guidance, highlight to the patient if the choice of treatment is incorrect, but the final decision still lies with the patient.

    He normally provide a summary list of procedures that is suited for the patient. It is difficult to balance between providing detailed information and being mistaken for overselling.

    Dr Ng had been active in the training of doctors and residents while he was Visiting Consultant at the Singapore General Hosipital (SGH). He was also an Adjunct Assistant Professor at the Duke-NUS Graduate Medical School. He hopes that training and knowledge sharing would produce the best surgeons in Singapore.

    Despite Dr Ng’s hectic schedules, he had volunteered in humanitarian trips to perform free treatments to correct cleft lip and/or palate, post-traumatic or burns deformities in Laos, Indonesia, China and Uzbekistan.

    BOOK AN APPOINTMENT

      What can I expect from consultation to recovery?

      Step 1

      Consultation (KIV notify insurance agency)

      Step 2

      Visual field test by eye specialist

      Step 3

      Pre-operative screening

      Eg : Blood test

      Step 4

      Treatment day - correction of blepharoptosis

      Step 5

      Remove sutures @ 1 week after operation

      Step 6

      Monthly reviews

      • The levator aponeurosis is shortened by pleating and suturing in levator plication procedure. A portion of the excess aponeurosis is removed and the free edges are overlapped and sutured together in the levator advancement procedure.

      What can I expect from consultation to recovery?

      Step 1

      Consultation
      (KIV notify insurance agency)

      Step 2

      Visual field test by eye specialist

      Step 3

      Pre-operative screening

      Eg : Blood test

      Step 4

      Surgery day - correction of blepharoptosis

      Step 5

      Remove sutures
      @ 1 week after operation

      Step 6

      Monthly reviews

      Frequently Asked Questions

      • Combination of local anaesthesia with light intravenous sedation administration :
        • Maximal patient comfort
        • Patient able to participate in checking symmetry of eye-opening during the surgery.
      • General anaesthesia :
        • At special request of the patient.
        • Result might be affected because of inability to check for symmetrical eye-opening.
      • Mild discomfort to be expected includes:
        • Swelling usually resolves by 1 week.
          • In rare instances swelling may take several weeks to resolve.
          • Avoid exertion and rest 30 degree head up to hasten resolution of swelling.
        • Bruising usually resolves by 2 weeks.
        • Tearing
        • Lagophthalmos
          • Incomplete eyelid closure – usually transient
          • May need lubricant eye drop or eye gel to prevent corneal desiccation (drying).
          • Eye pad may be required during sleep.
        • Post-operative medication:
          • Antibiotic ointment to be applied regularly 3-5 times a day
          • Antibiotic eye drop 3 times day
          • Oral antibiotics
          • Analgesics (pain relief) and anti-swelling medications
        • Removal of suture at 1 week.
        • Resumption of light exercise for 3-4 weeks.
        • Refrain from wearing contact lens up to 4 weeks post-surgery.
      • Bleeding/ Haematoma (blood clot accumulation)
        • Avoid exertion post-operative.
      • Infection
        • Very rare
        • Avoided by clean (sterile) technique during the surgery.
      • Asymmetrical eye-opening is fairly common in the early post-operative period
      • This is a common occurrence and it is usually transient. The eye will take a short while to adjust to its new eyelid opening position.
      • Many patients have pre-existing asymmetrical height of the globe of eye, size of eye-opening, the amount of extra skin and fat in the eyelids, and the distance between the brow and upper lid.
      • Due to all these factors, asymmetry can still result despite best efforts during surgery.
      • Although blepharoptosis may be unilateral (exist in one eye) it is common to suggest correction in both eyes because ptosis correction in one eye can affect the eye opening of the opposite un-operated eye. During consultation, Dr Ng would explain why this is affected by the complex nature of equal innervation of both eyes (Hering’s law).
      • Blepharoptosis correction is considered medical and financial assistance by medical insurance is possible provided a set of strict criteria are met. These criteria include special test e.g. visual field testing by eye specialist.
      • The amount of reimbursement by the insurance company is determined on a case-by-case basis by their assessment team.

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