Eyelid Weight Implant Technique

Final placement of the Eyelid Implant may be septal, mid-pretarsal or low-pretarsal. Two representative techniques from Dr. Richard Jobe 1 and Dr. Stuart Seiff 2 respectively are presented.

Septal Fixation

Local or general anesthesia may be used. A 1.5 cm to 2.0 cm incision is made horizontally in the deep portion of the upper lid sulcus. The incision should be centered at the juncture of the medial and central thirds of the lid. It should be carried just through the orbicularis muscle fibers to the plane beneath the orbicularis. By blunt dissection, the plane is opened to make room for the implant on the surface of the orbital septum and the tarsal plate. Usually, the Gold Tapered Eyelid Weight will rest more comfortably with its lower edge 4 to 5 mm above the lid margin.

The implant is placed with the rounded corners down. The implant is tied to the orbital septum with a single 6-0 non-absorbable suture to hold it in place until the tissues heal around it and through the suture holes. If the Gold Tapered Eyelid Weight does not sit comfortably parallel to the lid margin, then another suture should be placed. The implant is placed a short distance above the lid margin so that it will not be evident in the thinnest portion of the lid. A slight bulge may nevertheless be visible. The skin and orbicularis are closed by the method of the surgeon’s choice.

Septal Placement

Pretarsal Fixation

Local or general anesthesia may be used. The lid crease is marked. A 4-0 black silk suture is placed near the upper lid margin to allow for downward traction. A blade is used to incise at the lid crease through skin and orbicularis. Scissors dissection is performed inferiorly into the pretarsal

Pretarsal Placement

space. The levator aponeurosis is stripped from its attachments to tarsus in the area of planned implantation, thus baring the anterior tarsal surface and effecting a modest levator recession. Hemostasis is achieved. The previously selected Gold Tapered Eyelid Weight, which has been thoroughly cleaned and sterilized, is centered over the bare superior tarsal surface. The implant is placed with the rounded corners down. Sutures are placed through the holes in the implant directly to the tarsus using 5-0 polyglactin sutures on spatula needles. Antibiotic solution is irrigated into the wound.

Orbicularis is closed over the implant with interrupted 6-0 polyglactin sutures. The traction suture is removed and the skin is closed with a running 6-0 silk or nylon suture. Antibiotic ointment is placed over the wound and a double eye pad is applied.

Note: Proper surgical technique is the responsibility of the surgeon. Each surgeon must evaluate the procedure based on previous medical training and experience.

1 Jobe RP: A technique for lid loading in the management of lagophthalmos of facial palsy. Plastic and Reconstructive Surgery, 53: pp 29-32, 1974.

2 Seiff SR, Sullivan JH, Freeman LN, Ahn J: Pretarsal fixation of gold weights in facial
nerve palsy. Ophthalmic Plastic and Reconstructive Surgery 5(2): pp 104-109, 1989.

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