Purpose: To describe a novel modification of upper eyelid gold weight implantation using a vascularized preaponeurotic fat pedicle for improved implant concealment, and to report outcomes from a 4-patient case series. Methods: Four patients with paralytic lagophthalmos underwent tarsal gold weight implantation with concealment using an inferiorly advanced pedicled preaponeurotic fat flap. Implant visibility, eyelid contour, closure, and complications were assessed. Results: All 4 patients achieved improved eyelid closure (complete in 3, near-complete in 1). The vascularized fat flap provided robust implant coverage in all cases. One patient had mild early edema, resolving by 1 month. No implant visibility, extrusion, or contour deformity was noted at final follow-up (8–24 months). Conclusions: This technique offers a simple and reproducible method to enhance cosmetic results of gold weight implantation. The vascularized fat flap provides durable, living coverage with excellent concealment and maintains optimal lid mechanics without donor site morbidity.
Udhay et al. (Fri,) studied this question.