Hyaluronic Acid Dermal Filler for Inducing Mechanical Ptosis in Facial Nerve Palsy: A Novel Approach to Treat Exposure Keratopathy.

Background: This study aimed to assess a dermal filler's safety, efficacy, and outcome for inducing temporary mechanical ptosis of the upper eyelid in patients with facial nerve palsy with exposure keratopathy.

Methods: A prospective interventional study was conducted on 13 patients with facial nerve palsy with various levels of lagophthalmos and exposure keratopathy. A total of 0.3 ml of dermal filler (Juvéderm Ultra Plus XC, Allergan, USA) was injected subdermally over the pretarsus area of the upper lid to induce mechanical ptosis. Post-dermal filler implantation patients were followed up for a reduction in the amount of lagophthalmos and adverse effects.

Results: Out of 13 patients exposed to keratopathy due to facial nerve palsy, two were females, and eleven were males, with a mean age of 54+/-6.5 years and House Brackmann severity grades IV and V. The preinjection average lagophthalmos was 5.5 mm, and it decreased to an average of 0.8 mm postinjection at 1 week of follow-up, which was maintained at 12 weeks and 24 weeks of follow-up. No adverse side effects were observed during the 24-week follow-up.Discussion: This study highlights the effectiveness and safety of hyaluronic acid-based dermal fillers in treating lagophthalmos and exposure keratopathy caused by facial nerve palsy. A single 0.3 ml injection in the pretarsal region successfully induced mechanical ptosis, significantly reducing lagophthalmos and protecting the cornea, with results sustained for 24 weeks and no adverse effects. Offering a minimally invasive, cost-effective alternative to traditional surgical methods, dermal fillers show promise, particularly in early-stage management. Despite a small sample size and limited follow-up, these findings pave the way for future research to refine dosing and assess long-term efficacy.

Conclusions: Absorbable dermal filler implants are an easy and effective method for inducing mechanical ptosis and protecting the cornea in patients with exposure keratopathy due to facial nerve palsy.