Facial Paralysis Treatment Options

Golden Eyelid Weight

Permanent facial paralysis may cause the eye not to close, resulting in dryness, stinging and injections in the eye. Since the eyelid remains open as a result of not closing, its protection is a priority. Failure to close the eye may occur as a result of the eye muscle not working due to facial paralysis, causing the upper eyelid to remain open (lagophthalmus), lower eyelid drooping (ectropion), or a combination of both. When facial paralysis causes the eyelid not to close, upper eyelid weight loss, lower eyelid surgery, or both may be required. It is one of the facial paralysis surgery options.

Gold Weight on Eyelid

In such a case, a weight of approximately 1 gram is placed under local anesthesia to facilitate eye closure, allowing the eye to blink and closing the eye. Rehearsing with different weights before the surgery is important for the success of the surgery. In my clinical practice, I decide the amount of weight to be chosen (0.8 gram, 1 gram, 1.2 gram, etc.) by rehearsing with different weights during the pre-operative examination. I think this is what affects the patient's comfort the most. Below you can see the proofing weights I use and examples of gold and platinum weights in different sizes from my own practice. It is a relatively easy procedure that takes less than 1 hour, can be performed even with local anesthesia, has a high success rate.


Why is it important to treat eyelid non-closing?

One of the consequences of permanent facial paralysis that requires prompt intervention is the inability to close the eye. Eliminating blinking and keeping the eye open puts the eye at risk of damage for two important reasons:

1. Each blink ensures that the eyeball is cleaned and moistened with tears.

2. Failure to close the eye makes the eye vulnerable to trauma, especially while sleeping. This can lead to problems such as dry eyes, stinging eyes and eye infections.

In some facial paralysis patients, the eye regains movement over time, but in patients who cannot fully regain eye function, it is important to ensure that the eye can "close". At this point, surgical placement of a gold weight on the upper eyelid is a frequently preferred method to facilitate the "closing" of the eye and to prevent problems that may arise. The use of gold weight helps manage this condition by reducing the patient's dry eyes and reducing the use of eye drops.


How is the surgery performed?

Eyelid weight placement, a procedure that can be performed under local anesthesia and takes less than an hour, is an outpatient procedure that does not require hospitalization. Before this procedure, where weights are available in different sizes (between 0.8 grams and 1.4 grams), the most appropriate eye weight, determined according to the patient's needs, is determined through trial during preoperative interviews. Using the existing fold lines of the upper eyelid skin, a pocket is created under the skin and muscle and the gold weight is fixed into this pocket with stitches. Then, the opened pocket is closed with cosmetic stitches to create an aesthetic scar.

Placing weights on the upper eyelid generally enables blinking and adequate eye closure in most patients. However, some patients may need additional procedures due to conditions such as the position of the lower eyelid and drooping due to facial paralysis. Lower eyelid reconstruction may be required in some patients to achieve optimal results.


Who are good candidates for eyelid weight placement?

Patients who do not have natural and adequate eye closure and have blinking problems; As a result of these conditions, individuals who are at risk of eye dryness, stinging eyes and secondary infection may be among the suitable candidates for eyelid weight placement.


Is placing a gold weight on the eyelid always sufficient?

Unfortunately, sometimes it may be necessary to perform lower eyelid ptosis (ectropion) surgery in addition to upper eyelid weight placement.


How does the healing process proceed after a gold implant is placed on the eyelid?

The procedure is performed on an outpatient basis, takes less than an hour in total, and the patient can be discharged on the same day. Immediately after the procedure, the patient may have the ability to close his or her eyes, and function improves within weeks. Some swelling and bruising may occur, but will subside over time and usually last no longer than a week.


Can it be noticed when a gold weight is placed on my eye?

A slight swelling may be observed in the area where the weight is placed on the eye. The goal during the procedure is to be placed in harmony with the curve of the upper eyelid and to be as unnoticeable as possible.


Why are eyelid weights made of gold?

Eyelid weights are generally made of gold because gold is preferred because it is MRI compatible. Additionally, it is an ideal material due to its low risk of skin irritation and allergies.


What are the dangers of inadequate eye closure?

Inadequate eye closure hinders important functions such as moistening the eyeball with each blink and preventing it from drying out. Not being able to close the eye completely may reduce the ability to protect the eye from incoming foreign objects and impacts. This may cause problems such as dry eyes, stinging eyes and may require the use of tear drops.


What are the undesirable side effects associated with this surgery?

Undesirable effects due to this surgery are as follows: Problems such as bleeding and infection may occur in the early period. In the long term, situations such as rejection of the gold weight by the body, risk of infection, formation of a capsule around it due to micromotions and its becoming apparent may occur.

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