A comparative study in upper lid loading in facial paralysis

Background and Purpose: Facial paralysis has devastating consequences. Different surgical techniques have been proposed for the treatment of lagophtalmos, but lid loading is the preferred technique. Its simplicity, reversibility, and effectiveness are well established. In this study, we aim to discuss which implant shows better results (gold or platinum implants) and which approach (supratarsal or retrograde approach) can lead to lower complication rates. Material and Methods: We performed a retrospective study of patients with facial paralysis that had been treated with lid loading techniques using gold or platinum implants, either through a supratarsal or retrograde approach at our department. Demographic data, type of implant and approach were recorded. Complications and outcomes were analyzed. Results: In this study, 79 patients met the inclusion criteria. The use of a platinum implant and a retrograde approach demonstrated 0% migration and the lowest rates of implant removal. The retrograde approach showed lower migration rates (6.6%) than the supratarsal approach (8.3%). Also, platinum implants demonstrated better cosmetic results and most patients reported good and excellent results (52.64% and 26.31%, respectively). The retrograde approach was also superior in terms of cosmesis compared to the supratarsal approach. Conclusions: In our study, the lowest migration rates were found with the retrograde approach. Furthermore, we found that the combination of a platinum implant and a retrograde approach offered the best results, showing the lowest rates of implant removal and migration and better cosmesis.