Ptosis Correction in Singapore
Doctor-led assessment and surgery for true upper-eyelid ptosis, where the eyelid margin sits lower than expected because of levator or related eyelid-elevating dysfunction.
Ptosis is different from excess eyelid skin or brow descent. New, variable or neurologically associated ptosis requires medical evaluation before elective cosmetic correction.
This is one of the more technically demanding procedures in eyelid surgery, because the target is a specific millimetre-level height that must simultaneously look symmetrical and still allow the eye to close and stay protected. Revision rates are higher than for straightforward blepharoplasty, and that should be part of the conversation before rather than after.
Ptosis correction at a glance
| What it is | Surgery to raise a low upper-eyelid margin by addressing the levator system that elevates the lid |
|---|---|
| What it is not | Removal of excess eyelid skin, which is blepharoplasty and treats a different problem |
| Key measurement | Margin-reflex distance — the distance from the corneal light reflex to the upper lid margin |
| What determines technique | Levator function. Good function allows levator advancement; poor function may require frontalis suspension |
| Anaesthesia | Often local with the patient able to cooperate, since eyelid height can be checked during surgery |
| Recovery | Bruising and swelling over one to two weeks; final height assessed at around three months |
| Main risks | Under- or overcorrection, asymmetry, contour irregularity, dry eye and exposure, revision |
| Revision rate | Higher than for blepharoplasty. Adjustment is a recognised part of ptosis surgery, not a failure |
| Assess first | Sudden onset, fluctuation, double vision or pupil changes require medical evaluation before elective surgery |
| Where | Consultation and follow-up at 160 Robinson Road, #05-01 SBF Centre Medical Suites, Singapore 068914 |
What is true eyelid ptosis?
Ptosis refers to a low upper-eyelid margin. Evaluation includes eyelid height, levator function, eyelid crease, pupil coverage, asymmetry and whether the problem changes with fatigue or gaze.
The mechanism in adults is usually mechanical rather than neurological. The levator muscle attaches to the eyelid through a thin tendon-like sheet called the aponeurosis, and with age, long-term contact lens wear, previous eye surgery or repeated eyelid rubbing that attachment can stretch or partially detach. The muscle still works normally — it has simply lost some of its purchase on the lid. That distinction matters because it means the repair is usually about reattaching or advancing the aponeurosis rather than replacing muscle function.
Involutional / aponeurotic
Common in adults when the levator aponeurosis stretches or becomes less effectively attached.
Congenital
Present from childhood and associated with variable levator development and function.
Neurological / muscular
Conditions such as Horner syndrome, third-nerve palsy or myasthenia can cause ptosis and require medical assessment.
Mechanical
A mass, scarring or significant lid swelling can weigh the lid down, and the underlying cause needs addressing first.
Contact lens related
Long-term rigid lens wear is a recognised contributor to aponeurotic stretching and worth mentioning at consultation.
Post-surgical
Ptosis can follow previous eye surgery, including cataract surgery, and this history should be declared.
A high eyelid crease is a clue. When the aponeurosis detaches, the crease it creates often sits higher than normal and the eyelid above it appears unusually thin or hollow. Patients notice their eyelid looking “deeper set” on the affected side without realising why.
How ptosis is measured
Assessment may include margin-reflex distance, levator excursion, brow position, ocular motility and pupil findings. These help distinguish true ptosis from dermatochalasis or brow descent and guide the surgical technique.
Two measurements do most of the work. Margin-reflex distance records how far the upper lid sits from the light reflex at the centre of the pupil, quantifying the degree of droop. Levator function measures how far the lid travels from downgaze to upgaze with the brow held still, and this determines which operation is appropriate: good travel allows the existing muscle to be used, while poor travel means the lid must be suspended from the forehead instead.
Brow position is held during measurement for a reason. Patients with ptosis unconsciously lift the brow to compensate, and failing to control for that produces a falsely reassuring measurement. It is also why the true extent of ptosis sometimes looks worse at the assessment than the patient expected.
New or fluctuating ptosis is not automatically cosmetic. Sudden onset, double vision, pupil changes, severe headache, weakness or variability should prompt appropriate medical evaluation.
The specific patterns worth knowing: a droop with a small pupil on the same side suggests Horner syndrome; a droop with a large pupil and double vision is a potential emergency; a droop that worsens through the day or with sustained upgaze raises myasthenia gravis. These are uncommon in cosmetic practice, but they are the reason the history matters as much as the measurement.
Surgical options depend on levator function
Ptosis correction may involve advancement or tightening of the levator/aponeurosis, posterior-approach procedures in selected cases, or frontalis-suspension techniques when levator function is poor.
There is no single operation for every patient. The target eyelid height must also balance eyelid closure and corneal protection.
| Levator function | Typical approach | What it involves |
|---|---|---|
| Good | Anterior levator advancement | Through a crease incision, the stretched aponeurosis is reattached or advanced. Height can often be checked with the patient cooperating. |
| Good, mild ptosis | Posterior approach | Performed from the inner surface of the lid, avoiding an external incision, suited to smaller corrections. |
| Poor | Frontalis suspension | The lid is connected to the forehead muscle so brow elevation raises it. Used when the levator cannot do the work. |
| Variable or neurological | Treat the cause first | Surgery is deferred until the underlying condition is diagnosed and stable. |
Operating under local anaesthetic with the patient able to open and close the eyes is a genuine advantage in many levator advancement cases, because height and contour can be assessed intraoperatively rather than estimated. It does mean a slightly more demanding experience for the patient, which is worth knowing in advance.
Risks and recovery
Potential risks include bleeding, infection, asymmetry, undercorrection, overcorrection, contour irregularity, dry-eye symptoms, exposure keratopathy, difficulty closing the eye, double vision, scar concerns and need for revision.
Early asymmetry can occur because of swelling. Final eyelid height is assessed after healing rather than immediately after surgery.
Undercorrection is the commonest reason for revision and is generally the safer error, since a lid left slightly low protects the eye. Overcorrection is more troublesome: a lid raised too high may not close fully, exposing the cornea to drying and injury, and this is why the target height always balances appearance against protection rather than simply maximising lift.
Another effect worth anticipating: correcting one side can make the other look lower. There is a physiological linkage between the two lids, so the brain reduces its effort once the droopy side is fixed, and a previously unnoticed mild ptosis on the other side becomes apparent. This is not a surgical error and is discussed in advance where both lids are borderline.
| Period | What is typical | What matters most |
|---|---|---|
| First 48 hours | Swelling and bruising build. The lid may look too high or too low from oedema alone. | Cold compresses, head elevation, lubricating drops, no rubbing. |
| Week 1 | Bruising most visible. Sutures usually removed around this point. | Ointment at night if closure is incomplete. Report significant grittiness or pain. |
| Weeks 2–6 | Swelling settles and height becomes more representative. | Still too early for firm conclusions about symmetry. |
| Month 3 | Height and contour largely settled. This is the fair assessment point. | Photographic comparison. Revision discussion belongs here if needed. |
| Months 6–12 | Scar maturation complete, final result stable. | Long-term review of lid closure and ocular comfort. |
Frequently asked questions
Is ptosis the same as excess eyelid skin?
No. Ptosis is a low eyelid margin. Excess eyelid skin is dermatochalasis and may require blepharoplasty rather than ptosis repair.
Can ptosis affect vision?
Severe ptosis can obstruct the superior visual field, but not every ptosis case causes functional visual loss.
Can botulinum toxin cause ptosis?
Temporary eyelid or brow ptosis can occur after toxin diffusion in some cases. This is different from structural involutional ptosis and settles as the effect wears off.
Can both eyes be made perfectly equal?
Exact symmetry cannot be guaranteed. Pre-existing asymmetry and healing differences are common, and ptosis surgery has a higher revision rate than blepharoplasty for this reason.
What causes ptosis in adults?
Usually the levator aponeurosis stretching or partly detaching from the lid, so the muscle works normally but has lost purchase. Ageing, long-term contact lens wear, previous eye surgery and eyelid rubbing all contribute.
Why does my eyelid crease look higher on one side?
A high crease with a thin or hollow-looking lid above it is a classic sign of aponeurotic detachment, and patients often notice the eye looking more deep-set without knowing why.
What is levator function and why does it matter?
It measures how far the lid travels from downgaze to upgaze with the brow held still. Good travel allows the existing muscle to be used; poor travel means the lid must be suspended from the forehead instead.
Why is my brow held down during examination?
Because patients with ptosis unconsciously raise the brow to compensate. Controlling for that reveals the true extent, which sometimes looks worse than the patient expected.
Will I be awake during surgery?
Often, for levator advancement. Being able to open and close the eyes lets height and contour be checked during the procedure rather than estimated, which improves accuracy.
Why might my other eyelid drop after surgery?
There is a physiological linkage between the lids. Once the droopy side is corrected the brain reduces its effort, and a previously masked mild ptosis on the other side becomes apparent.
What happens if the eyelid is lifted too high?
The lid may not close fully, exposing the cornea to drying and injury. This is why the target height balances appearance against eye protection rather than maximising lift.
Which is worse, under- or overcorrection?
Undercorrection is commoner and generally safer, since a slightly low lid still protects the eye. Overcorrection risks exposure problems and is the more troublesome error.
How likely is revision?
More likely than after straightforward blepharoplasty. Adjustment is a recognised part of ptosis surgery given the millimetre-level precision required, not a sign something went wrong.
When is the result final?
Height and contour are largely settled at around three months, which is the fair point for assessment and for any revision discussion.
Can ptosis follow cataract surgery?
Yes, this is recognised. Any previous eye surgery should be declared, as it affects both the likely cause and the surgical planning.
Should I stop wearing contact lenses?
Long-term rigid lens wear is a recognised contributor to aponeurotic stretching. Lenses are also paused around surgery, with timing advised by your surgeon.
What if my droop varies through the day?
Fluctuation, particularly worsening with fatigue or sustained upgaze, raises the possibility of myasthenia gravis and needs medical assessment before elective surgery.
What if my pupil is different on the drooping side?
A smaller pupil suggests Horner syndrome and a larger pupil with double vision is potentially an emergency. Either requires medical evaluation rather than cosmetic planning.
Is ptosis surgery claimable under MediSave or insurance in Singapore?
Where ptosis causes documented visual-field obstruction the position may differ from purely cosmetic surgery, but criteria vary. Check directly with your insurer.
Where is Aquila Medical Center?
Aquila Medical Center is at 160 Robinson Road, #05-01 SBF Centre Medical Suites, Singapore 068914, in the CBD, a short walk from Tanjong Pagar, Shenton Way and Telok Ayer MRT stations.
Selected references
- Ptosis. StatPearls, NCBI Bookshelf.
- EyeWiki, American Academy of Ophthalmology. Blepharoptosis.
- EyeWiki, American Academy of Ophthalmology. Congenital ptosis.
- Blepharoplasty. StatPearls, NCBI Bookshelf.
- American Academy of Ophthalmology. Ptosis patient information.
This page is educational and does not replace an individual eyelid assessment. Surgical technique depends on levator function, cause and ocular surface health. Results vary, revision is sometimes required, and no surgical outcome can be guaranteed. Content reviewed by the medical team at Aquila Medical Center, Singapore. Last reviewed: 26 August 2026.
Doctor-led ptosis assessment
The key is to confirm that the eyelid margin itself is low, determine the cause and levator function, and only then select the appropriate surgical or medical pathway.
Aquila Medical Center is located at 160 Robinson Road, #05-01 SBF Centre Medical Suites, Singapore 068914, a short walk from Tanjong Pagar, Shenton Way and Telok Ayer MRT stations. Where the findings point to a medical cause, we will direct you there rather than to surgery.