Surgical Technique - FAQ
Whatís involved in the procedure?
Final placement of the Eyelid Implant may be septal, mid-pretarsal or low-pretarsal. Recognizing that surgical technique is a matter of individual surgeon preference, MedDev presents two representative techniques from Drs. Richard Jobe1 and Stuart Seiff2 respectively.
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 Eyelid Implant 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 Eyelid Implant 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 surgeonís choice.
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 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 Eyelid Implant, 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.
Pretarsal Placement Septal Placement
Advantages of The Surgical Procedure
1. Clinically proven with a low rate of complications (a 92% reported surgical success rate3)
2. Straightforward procedure; relatively easy to learn
3. Reversible procedure if normal eyelid function is regained
4. Outpatient procedure, can be performed under local anesthesia
5. Permits rapid patient recovery, an immediately functional eyelid and improves distribution of tear film to the cornea
6. Procedure produces aesthetically pleasing outcome, high level of patient satisfaction
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.
What type of suture is typically used?
Typically, a 5-0 polyglactin absorbable or 6-0 silk or nylon, non-absorbable is used. Sometimes a 4-0 black silk is used.
Is the implant sutured to the tarsus?
Yes, implant placement is typically sutured to the anterior surface of the tarsus. Yet several surgeons place the implant on the edge of the orbicularis inferiorly so that the implant is better hidden in the lid crease and is less conspicuous. The functional postoperative results are the same in either placement. A septal placement may be indicated in cosmetic considerations.
Are the implants sutured with the rounded corners (side with the most suture holes) up or down?
In both of the surgical techniques for pre-tarsal and septal fixation the implant is placed with the rounded corners down.