Periorbital Reconstruction in Facial Paralysis

Megan V. Morisada, Steven G. Hoshal, Travis T. Tollefson

Research output: Contribution to journalArticlepeer-review


The primary function of the eyelids is to maintain ocular health and protection. In facial paralysis, neurogenic dysfunction of the orbicularis oculi muscle complex leads to a spectrum of ocular and periocular issues including xerophthalmia, exposure keratopathy, and lower eyelid malposition contributing to epiphora and facial deformity. Conservative techniques can foster a safe environment for patients awaiting surgical intervention. Eyelid coupling using a combined lower eyelid tightening and modified tarsoconjunctival flap is our preferred technique for older patients with flaccid facial paralysis, usually performed with a platinum weight. Medial eyelid ectropion remains a difficult area for those with senile changes. For best lower eyelid outcomes, the midface must be lifted with reanimation, facial sling, or temporalis tendon transfer. Herein we describe several chosen techniques to improve patients’ ocular and cosmetic outcomes after facial paralysis.

Original languageEnglish (US)
JournalOperative Techniques in Otolaryngology - Head and Neck Surgery
StateAccepted/In press - 2021


  • Canthopexy
  • Canthoplasty
  • Eyelid Coupling
  • Facial Paralysis
  • Lagophthalmos
  • Paralytic Ectropion
  • Platinum Weight

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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