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Upper Eyelid Postseptal Weight Placement for Treatment of Paralytic Lagophthalmos

Rozen, Shai M.D.

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Plastic and Reconstructive Surgery: January 2014 - Volume 133 - Issue 1 - p 70e-71e
doi: 10.1097/01.prs.0000438064.31043.b7
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I would like to thank Drs. Davies, Hink, and Durairaj for their gracious comment. I read with great interest the article by Tower and Dailey.1 Indeed, this is technically a similar technique and we are certainly happy to acknowledge this article, which we did not previously encounter. After reading this article, I would like to point out a few subtle differences. The first is the choice of weight. Having a facial palsy practice teaches you that in cases of incomplete palsy, there is often a time-dependent dynamic in terms of ability to close the eye—often improving although not normalizing. Therefore, we perform surgery with the patient under intravenous sedation, enabling us to insert the smallest possible weight that will provide protection when changing from previously placed weights. Second, the article details some additional considerations in secondary surgery, including position change from the pretarsal position to the postseptal position, including concomitant repair of entropion commonly encountered. Third, as the authors noted, we also emphasized using the postseptal fat as an additional layer of coverage when available and orbicularis muscle closure, and I am sure this was performed by Dr. Tower and Dailey in their original operation but not mentioned. Fourth, we suggested a general rule of increasing the measured weight in the office by 0.2 g because of its more posterior position, based on our experience, again enabling use of the smallest effective weight for closure yet minimizing the chance for ptosis. With this said, once more, I would like to thank Drs. Davies, Hink, and Durairaj for their comment, and humbly admit that no progress in surgery can be achieved without the experiences of our predecessors.


The author has no financial interest to declare in relation to the content of this communication.

Shai Rozen, M.D.

Department of Plastic Surgery

University of Texas Southwestern Medical Center

1801 Inwood Road

Dallas, Texas 75390-9132

[email protected]


1. Tower RN, Dailey RA. Gold weight implantation: A better way? Ophthal Plast Reconstr Surg. 2004;20:202–206


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