Gold Weight Eyelid Implant Surgery

The procedure involves careful selection of the implant weight and its precise placement within the upper eyelid.

• Weight Selection: Before surgery, different weights (typically ranging from 1.2 g to 1.6 g in 0.2 g increments) are taped to the upper eyelid to determine the optimal weight for complete closure without causing ptosis (drooping). The selected weight provides closure by gravity when the patient looks down or blinks, while being light enough not to interfere significantly with normal eye opening.
• Implant Placement: A small incision is made in the upper eyelid crease (the natural skin fold). A precise pocket is created over the tarsal plate, and the weight is placed and sutured securely into position. The wound is closed with fine sutures. The incision is hidden within the eyelid crease and heals to a barely visible scar.
• Gold vs. Platinum Weights: Traditional gold weights are the most widely used. Platinum weights are an alternative that are denser (allowing a thinner, less visible implant) and may have better biocompatibility. The choice is made based on individual anatomy and preference.
• Reversibility: The implant can be removed or exchanged if facial nerve function recovers, if the weight causes ptosis, or if the patient develops an intolerance to the implant material.

Gold weight surgery is indicated for patients who cannot close their eye adequately due to facial nerve palsy. Suitable candidates include those with:

• Bell's palsy — the most common cause of acute facial nerve paralysis — when lagophthalmos is causing significant corneal exposure and conventional lubricants are insufficient.
• Facial nerve palsy following surgery for acoustic neuroma, parotid gland tumours, or other procedures near the facial nerve.
• Facial nerve palsy due to trauma, infection, or other neurological causes.
• Significant corneal exposure (exposure keratopathy) that is not adequately protected by eye drops, ointments, or taping alone.
• Cases where facial nerve recovery is expected — the implant can be removed once function returns.

A thorough ocular surface and corneal assessment is performed before surgery to determine the urgency and optimal timing of intervention.

Pre-surgery

Weight selection is performed in the clinic by taping trial weights to the eyelid. Corneal health is assessed by slit-lamp examination. A detailed discussion of expectations, reversibility, and concurrent treatments (e.g., lower eyelid tightening) takes place at consultation.

On the day of surgery

Surgery is performed under local anaesthesia and usually takes 30–45 minutes. The incision is placed in the natural upper eyelid crease. You go home the same day.

Post-operative period

Mild swelling and bruising of the upper eyelid are expected in the first few days. Antibiotic and lubricating eye drops are used after surgery. Sutures are removed at 7–10 days. The implant settles into position over 2–4 weeks as swelling resolves.

Available Options:

• Local Anaesthesia: The eyelid is numbed with injections. The procedure is performed with the patient awake, which allows the surgeon to assess eyelid closure intraoperatively. This is the standard choice.
• Local Anaesthesia with Sedation: Intravenous sedation for patients who prefer a more relaxed experience.
• General Anaesthesia: Occasionally used when combined with other facial procedures under general anaesthesia.

First 24–48 Hours

Swelling and bruising of the upper eyelid are expected. Cold compresses applied gently to the area reduce discomfort. Continue lubricating drops as prescribed to protect the cornea during the early healing period.

First Week

Sutures are removed at 7–10 days. Swelling diminishes rapidly. Most patients notice improved eyelid closure within the first few days, though final results are seen at 4–6 weeks as all swelling resolves.

Long-Term

The implant is permanent unless removed. In patients where facial nerve function recovers, the implant can be removed electively. Regular follow-up with the oculoplastic surgeon allows monitoring of corneal health and implant position.

• Passive eyelid closure: The weight enables the eyelid to close by gravity during blinking and sleep, protecting the corneal surface.
• Corneal protection: Prevents or resolves exposure keratopathy, reducing the risk of corneal ulceration and permanent vision damage.
• Reduction in need for lubricants: With effective eyelid closure, patients typically require fewer eye drops and ointments than before surgery.
• Reversibility: The implant can be removed if facial nerve function recovers or if any complication arises.
• Cosmetic improvement: A slight contour of the implant may be visible through the eyelid skin, particularly in patients with thinner skin, but it generally does not noticeably alter the overall appearance of the eyelid. .

• Mild ptosis (drooping of the upper eyelid) is a common and expected effect following gold weight implantation. In some cases, the eyelid may droop more than desired if the implanted weight is heavier than necessary. If this occurs, the condition can usually be corrected by replacing the implant with a lighter weight. .
• Implant visibility or palpability through the eyelid skin, more common in patients with thin eyelid skin.
• Implant migration, requiring repositioning or removal.
• Extrusion of the implant through the eyelid skin — uncommon but possible in rare cases.
• Infection — uncommon with appropriate antibiotic prophylaxis.
• Incomplete eyelid closure despite the implant, requiring supplementary lubricants or a heavier weight.