Innovations

Hyaluronic Acid Gel Gold-Weight for Paralytic Lagophthalmos

Functional & Clinical Benefits

The Hyaluronic Acid Gel Gold-Weight technique, developed by Dr. Ronald Mancini, is a novel surgical approach used to treat paralytic lagophthalmos, a condition in which patients cannot fully close their eyelids due to facial nerve paralysis.

Traditional treatments often involve surgically implanting a small gold weight into the upper eyelid to help gravity close the eye. Dr. Mancini's innovation uses hyaluronic acid gel as a functional alternative, allowing physicians to temporarily restore eyelid closure while preserving eyelid anatomy and function.

This minimally invasive approach can help protect the cornea, improve eye comfort, and reduce complications associated with permanent eyelid implants.

The technique was first described in:
Mancini R, Taban M, Lowinger A, et al. Use of hyaluronic Acid gel in the management of paralytic lagophthalmos: the hyaluronic Acid gel "gold weight". Ophthalmic Plast Reconstr Surg. 2009;25(1):23-26. doi:10.1097/IOP.0b013e318192568d

Illustration related to the gold-weight technique

Functional & Clinical Benefits

  • Provides temporary eyelid closure restoration without permanent implants
  • Helps protect the cornea and reduce exposure keratopathy
  • Offers a reversible, minimally invasive treatment option
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Who May Benefit from This Procedure?

Patients experiencing facial nerve paralysis, Bell's palsy, or eyelid weaknessthat prevents complete eye closure may benefit from this innovative approach. The technique is particularly useful for patients who need temporary eyelid support while nerve function recovers or while planning long-term surgical reconstruction.

Dr. Mancini in surgery

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Clinical expansion

An overview of a temporary hyaluronic acid gel approach for selected paralytic lagophthalmos.

Written by Ronald Mancini, MD, FACSReviewed by Ronald Mancini, MD, FACSReviewed 2026-08-03Physician reviewed

Facial nerve weakness can prevent complete eyelid closure, leaving the cornea exposed and causing dryness, irritation, or risk to vision.

Who may read this information: Patients with facial paralysis and lagophthalmos who need evaluation of eyelid closure, corneal protection, and the cause of facial weakness.

How the technique is considered: A hyaluronic acid gel gold-weight concept uses injected gel as a functional weight to assist eyelid closure in selected patients. It is considered as an alternative to a permanent implant when the clinical situation supports a temporary or adjustable option.

Protecting the cornea

The first priority in lagophthalmos is protecting the ocular surface. Lubrication, taping, moisture protection, and treatment of the facial nerve cause may all be part of care.

A weight-based eyelid treatment is considered only after evaluating closure and corneal exposure.

A temporary gel approach

Hyaluronic acid gel may provide a temporary, adjustable way to add weight in selected cases. The expected duration and possibility of further care should be discussed in advance.

Potential benefits and limitations

  • May support eyelid closure in selected cases
  • Uses a temporary material rather than a permanent implant
  • Keeps corneal protection central to treatment planning

Limitations: The technique is not appropriate for every patient and does not treat the underlying facial nerve problem. Gel behavior, resorption, asymmetry, inflammation, and the need for additional treatment must be discussed.

Recovery: Swelling, bruising, tenderness, or temporary asymmetry may occur. Patients need clear instructions about lubrication, eye protection, and symptoms that require prompt evaluation.

Consultation: Consultation includes facial nerve history, eyelid closure, corneal status, prior eyelid treatment, and the expected course of nerve recovery.

Supporting publication

Mancini R, Taban M, Lowinger A, et al. Use of hyaluronic acid gel in the management of paralytic lagophthalmos: the hyaluronic acid gel gold weight. Ophthalmic Plast Reconstr Surg. 2009;25(1):23-26.

Related clinical information

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Questions patients ask

Frequently asked questions

Is a hyaluronic acid gel weight permanent?

No. Hyaluronic acid gel is temporary and its duration varies. Ongoing eye protection and follow-up remain important.