Many people with flaccid facial paralysis have difficulty fully closing their eye on the affected side. This condition is known as lagophthalmos. Lagophthalmos puts people at risk for eye dryness, irritation, infection, and corneal abrasion.
To help people with lagophthalmos achieve full eye closure, doctors may place a very thin platinum weight in the upper eyelid. This procedure can be combined with lower eyelid tightening to help achieve full eyelid closure and the desired aesthetic. This is a relatively straightforward procedure and can often be performed in the clinic setting.
UPMC is at the forefront of restoring facial function in individuals with facial nerve disorders.
Upper eyelid weights are thin platinum weights that can be implanted in the upper eyelid to help a person with facial paralysis achieve better eye closure.
Injury to the facial nerve causes flaccid facial paralysis, resulting in a loss of muscle tone and movement of the facial muscles. This can cause the face, eyelid, and mouth on the affected side to droop when at rest.
Sometimes, facial nerve injury can make it hard for someone to close their eye completely, especially when they’re sleeping. This condition is known as lagophthalmos.
Besides causing discomfort, lagophthalmos can also put people at risk for serious eye problems, including:
The procedure to place an upper eyelid weight can be performed in the procedure clinic or in the operating room, when coordinated with other procedures.
Unlike traditional gold weights that were used in the past, the new platinum weights are thinner, less visible, and have a significantly lower risk of extrusion (pushing through). Because platinum is denser than gold, smaller platinum weights can do the same job as gold with less bulk.
The platinum implant features a smooth surface curved to fit the anatomy of the eye with rounded corners and tapered edges. It can barely be seen when the eye is closed and disappears into the eyelid fold when the eye is open.
If eyelid function subsequently improves, the weight can be easily removed in the clinic.
Some people with flaccid facial paralysis experience sagging of their lower eyelid. This condition is referred to as paralytic ectropion.
Paralytic ectropion can affect a person’s ability to fully close their eye and be aesthetically unappealing. Lower eyelid tightening is a minor procedure that removes excess lower eyelid skin and helps reverse ectropion. This procedure may be performed in the procedure clinic or in the operating room, depending on personal preference.
Upper eyelid weighting and lower eyelid tightening are procedures used to treat flaccid facial paralysis, a condition resulting from injury to the facial nerve. Flaccid facial paralysis can cause facial unevenness and impair a person's ability to convey emotions through facial expressions.
The psychosocial impact of facial paralysis is very real.
Up to 60% of those with facial paralysis meet the clinical criteria for depression and/or anxiety disorder.
Several studies have found that observers perceive people with facial paralysis as more distressed, less trustworthy, and less intelligent. And when casual observers interact with individuals with facial paralysis, they frequently misinterpret facial expressions. This can lead to a negative experience for both parties.
Yes, this procedure is covered by insurance for the indication of facial paralysis.
Like any surgery, upper eyelid weight surgery and lower eyelid tightening surgery have risks.
The most common side effects include:
Less common complications include:
About 10% of people may need a second procedure later on to adjust the eyelid or to replace or remove the weight.
Very rare risks include:
On the day of your appointment, you will have a chance to meet with a team member to ask any questions and sign the necessary paperwork.
Although there is very little discomfort associated with the procedure, you may experience a small amount of bruising or swelling of the eyelid.
Yes, platinum eyelid weights are compatible with MRI.
You will be provided with an implant card with information about the implant. Before any MRI, you should notify the technician about the presence of the eyelid weight and provide the implant card. Adjustments to the MRI settings may be required.
Almost all people who undergo this procedure achieve improved eye closure, less dryness, and less irritation.
By UPMC Editorial Staff. Last reviewed on 2026-03-01.
