title: Cosmetic comparison of gold weight and platinum chain insertion in primary upper eyelid loading for lagophthalmos.
abstract: OBJECTIVE
  Platinum chains are thinner than gold weights (GWs) and may confer a better eyelid curvature profile with reduced visibility. Outcomes compared eyelid measurements, cosmesis, and complications.
  
  
  METHODS
  Forty-two primary GW and 17 primary platinum chain insertions were identified and subsequently matched for laterality, pathology, and weight of implant. Twenty-two patients were randomly allocated into 2 groups for comparison; those receiving a GW (n = 11) or platinum chain (n = 11) to formulate a retrospective case-controlled study. Primary upper eyelid loading surgery with both implants involved a standard technique of a high tarsal placement with levator recession. Blinded assessment of preoperative and 6-month postoperative photographs calculated eyelid parameters: upper marginal reflex distance and lagophthalmos. Standardized photographs were used to define cosmesis in terms of abnormal eyelid contour and prominence.
  
  
  RESULTS
  Gold weights demonstrated an improvement in eyelid parameters. Nine eyelids had prominent implants: mild (2), moderate (3), and severe (4). Eyelid contour was affected in 7 patients, 5 with droop, and 2 with flattened contour. Platinum chain improved eyelid measurements. Mild eyelid prominence was noted in 2 cases, but eyelid contour remained normal in all patients. No complications were noted with either the GW or the platinum chain implants.
  
  
  CONCLUSIONS
  Both devices are successful in treating complications of lagophthalmos. Platinum chains appear less prominent and maintain normal eyelid contour. Although more expensive, platinum chains appear to be as safe and effective as GWs yet provide better cosmesis.
authors.affiliation: Corneo Plastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, United Kingdom.
authors.forename: John C
authors.initials: JC
authors.lastname: Bladen
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Norris
authors.forename: Raman
authors.initials: R
authors.lastname: Malhotra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty / Q000379:methods; D016022:Case-Control Studies; D003358:Cosmetics; D004311:Double-Blind Method; D005141:Eyelid Diseases / Q000503:physiopathology / Q000601:surgery*; D005143:Eyelids / Q000502:physiology*; D005260:Female; D006046:Gold; D006801:Humans; D008297:Male; D008875:Middle Aged; D010984:Platinum; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D003358:Cosmetics; D010984:Platinum; D006046:Gold