text: Lauren Crawley was given a new platinum implant . Facial palsy, or weakness of the facial muscles, can stop the patient's eyelids closing properly. Lauren Crawley, 54, a housewife from Kings Langley, Hertfordshire, was given a new platinum implant that makes it easier to blink again, as she tells THEA JOURDAN. THE PATIENT . A few years ago I started losing my sense of balance and developed tinnitus - my GP referred me for scans which showed I had a large but benign brain tumour behind my left ear. Surgery was the only option. Thankfully the operation, in July 2012, was a success. But my facial nerve, which was wrapped around the tumour, was damaged. I'd been warned that facial palsy could be a side-effect, but it was still a shock seeing my face in the mirror - the left side was droopy. Apparently, it's the same thing that can happen after a stroke. I felt very self-conscious, but the problems weren't just aesthetic. I'd lost the hearing in my left ear as well as my sense of taste, and my mouth became dry. Eating and speaking were difficult - and, worst of all, my left eye was permanently open and I couldn't even blink with it. To close it, I had to push the upper lid down with my hand. The eye itself was dry and painful. To sleep, I had to seal it closed with tape. I'd been told that about half those with the condition do improve, so I was hopeful. I tried lots of things to improve the muscle tone, including facial massages, taught by a physiotherapist. I also had electric impulse therapy to shock the muscles back to life. But nothing worked. It was very stressful - I stopped socialising as much, in case people stared. After a year, it was clear the nerve would never work again so I was referred to Raman Malhotra, a plastic surgeon at the facial palsy clinic at the Queen Victoria Hospital. He explained he could put a special platinum chain into my eyelid which would weigh it down and help it close by itself - I'd be able to open the eye easily because the muscle controlling this wasn't affected. Apparently, surgeons used to use gold, but platinum is better because it doesn't irritate the eye's inside lining. It is also more dense than gold, so you need only a thin chain, which meant people would barely see the implant through my eyelid. I had the operation under sedation and local anaesthetic in February last year. Surgery for a benign brain tumour behind her left ear damaged a facial nerve wrapped around it . My eye was wide open as they injected anaesthetic into my eyelid and the skin around my eye, then made lots of tiny stitches into my eyelid to hold the chain in place. It was strange watching it all but didn't hurt. I went home that day, and the difference was immediately obvious. The eye gently shut, and stayed shut, of its own accord. I could go to sleep without needing tape. I can't feel the implant, no one can see it, and I can blink normally. The procedure has made me look more normal - people don't stare as much. It's really boosted my confidence. THE SURGEON . Raman Malhotra is a consultant oculoplastic surgeon at Queen Victoria Hospital in East Grinstead. Around 100,000 people in Britain have facial palsy. It can be caused by a stroke, if the stroke affects the area of the brain that sends signals to the facial nerve. It can also be a result of traumatic injury, damage after surgery, or simply because of a virus damaging the facial nerve - this happens in Bell's palsy, which affects more than 28,000 people a year. Facial palsy affects not just appearance, but lots of functions, too. The facial nerve - which rises from the bottom of the brain on both sides, then sends branches across the face - controls the tongue's taste buds, for instance, and the salivary glands, so patients may suffer from dry mouth. Most also have difficulty blinking, because the nerve controls the muscle that makes the eye blink shut. However, it does not control the levator muscle, which holds it open. While many patients will recover, with symptoms easing within eight weeks, Lauren's facial nerve was too damaged to regain function. When she first saw me, her left eye was wide and staring because the lower lid was also pulled down and sideways. This can cause all sorts of problems, from dryness to injury. Five years ago, I would have recommended a gold implant - in the shape of a very thin bar - fitted under the eyelid to allow her to close the lid. The extra weight makes the eyelid heavier, so it closes automatically when the levator muscle relaxes. This procedure is used widely across the NHS. But I now believe platinum is much better. It's 10 per cent more dense than gold, so you can make the implant thinner without losing weight. Platinum is also inert - gold will cause reactions, such as irritation and inflammation, in about 5 per cent of people. The left side of her face was droopy - until now . I helped design a special system of individual links of platinum which we can join together with nylon to create a chain of the desired length and weight. For Lauren, I used three links weighing 0.4g each. This is much easier than stitching in a single bar of metal and then finding that it is too heavy or light. This way, we can easily add or remove a link. In 2013, we carried out a study at Queen Victoria Hospital, using platinum chain implants on 18 patients. Only two needed adjustments and 80 per cent said that they hardly noticed the implant, compared with just 20 per cent of patients who had a gold implant (the study will be published in the British Journal of Ophthalmology). First, we anaesthetised the skin around Lauren's eye. Then, on a workbench, I linked the correct number of platinum links to form the weight I required (I'd previously done a trial run, sticking temporary weights to the outside of her eyelids to check the weight). I made an incision across the outside of her eyelid, where it makes a natural crease, making sure not to cut through to the eyeball. I placed the links inside this incision, above the eyeball, stitching the chain in place from the outside in, before closing the incision. These nylon stitches stay in place for several years before being reabsorbed by the body. By then, the links will be embedded in surrounding tissue. When the chain was in place, and the eye was open, it sat above the eyeball so it did not come into direct contact with that delicate part of the eye. Even when the eye is shut, the implant doesn't touch the cornea. When Lauren wanted to blink, her brain switched off the levator muscle, which keeps the eyelid wide open. The corresponding muscle, the orbicularis occuli muscle, which should pull the eyelid down, does not work in Lauren's case because it is controlled by the facial nerve. The percentage of stroke patients who are affected by facial weakness . However, the new chain meant that the eyelid was sufficiently heavy to fall, thanks to gravity. Although it wasn't a perfect solution - at first, Lauren's eye closed more slowly than a fully functioning eyelid - at least she could blink again. Over time, the blinking gets better as muscle tone improves. Risks include infection and bleeding, but these are rare. I hope the implant will last Lauren a lifetime and that platinum implants will become the treatment of choice. ANY DRAWBACKS? 'Gold upper eyelid implants have been used for decades for facial palsy,' says Saj Ataullah, a consultant oculoplastic surgeon at Manchester Royal Eye Hospital. 'Platinum is more expensive, but seems to be better since it is inert and does not cause reactions. And as the implants are less bulky, it's also superior cosmetically. 'This chain segment innovation seems to work well. Any procedure can result in post-operative problems, but these appear to be rare. 'Longer-term follow-up is needed before we can conclude that chain-link implants are truly superior to other platinum weights, such as bars. But they are promising so far.' The operation costs around £3,000 privately. The NHS does not automatically fund it .
target: Lauren Crawley had surgery for a benign brain tumour behind her left ear .
  While the op was a success, it damaged a facial nerve .
  The left side of her face consequently appeared droopy .
  But a new platinum implant has 'made her look more normal'