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To report a 5-year series with longer term outcomes of individually sutured platinum segment chains for upper eyelid loading in a single referral centre.

Single-centre, prospective audit. Segments of 0.4g and 0.2g were assembled to create a desired weight and placed in supratarsal location after levator aponeurosis recession.
Primary outcome measures were lagophthalmos, upper eyelid margin to reflex distance (MRD1), complications and, when relevant, static and dynamic validated scoring for facial palsy patients. Secondary outcome measures were visual acuity, ptosis, need for further surgery and cosmesis.

Between July 2013-2018, a total of 195 upper eyelids underwent loading. Of them 122 eyelids (63%) of 117 patients received platinum segment chains (mean weight 1.2±0.2 g ranging 0.8–1.6 g) for lagophthalmos and were included in the study.
All grades of lagophthalmos were reduced significantly (P<0.0001).
Cosmesis was graded as having no prominence in 83 % of eyelids; the eyelids were graded as having normal contour in 73 % of cases.
Overall, 23.0% (28 eyelids) underwent weight-related revision surgery: removal of entire segment chain (5.7%, 7 eyelids) and a single segment (4.1%, 5 eyelids), addition of a single segment (3.3%, 4 eyelids), repositioning (3.3%, 4 eyelids) and ptosis correction (9.8%, 12 eyelids).
Three segment chains became exposed and consequentially were removed.

Platinum segments are FDA approved and provide benefits of platinum chains with the additional advantages of allowing postoperative adjustability, being thinner, inducing less visible prominence and with less likelihood of allergy than gold. They are an ideal first-line loading implant for lagophthalmos.