Facial paralysis or weakness may be from multiple etiologies, including Bell’s palsy, parotid cancer or other head and neck cancers, skull base tumors, acoustic neuroma surgery, or certain infections (herpes zoster) and inflammatory disease. While various portions of the face may be affected, the most important is the upper division of the facial nerve, which is responsible for eye closure. The normal blink response effectively distributes tears, keeping the eye lubricated and functioning well. When someone has facial paralysis, this ability to close the eye may be compromised, and tears are no longer effectively distributed over the globe. In this case, patients may get inflammation and scarring of the cornea known as exposure keratitis, which can lead to vision loss and blindness. In order to help the eye close naturally, otolaryngologists are able to place a very small, thin weight made of gold or platinum in the upper eyelid (the weights are typically less than half a penny). At Mount Sinai, we are able to perform this procedure either without an external incision (as shown in this video using a transconjunctival approach) or through a conventional approach through the skin of the eyelid. Because the weight is very low profile, it is not noticeable after surgery. In addition to eyelid weights, Mount Sinai facial plastic surgeons are able to perform various facial reanimation procedures to give patients their facial expressions and smile back. Such procedures may include gracilis free flaps, nerve transfers, cross-face nerve grafts, masseteric-facial nerve grafts, hypoglossal-facial nerve grafts, temporalis tendon transfer, tensor fascia lata slings, and ectropion repair.