The severity of the complications of the paralyzed eyelid dictates the need for timely surgical intervention. This is to report the management of 41 patients over a period of 6 years. Patients and Methods: The charts of 41consecutive patients who underwent eyelid procedures were reviewed for July 1995 to June 2001. Patients were grouped into 3 groups as follows: 1) Those who had split hypoglossal and cross facial procedures alone (9 cases); 2) Those who had split hypoglossal, gold weight and lower lid support (10 cases); 3) Those who had traumatic facial nerve repair (15 cases); 4) Those who had lid loading procedure and lower lid support (7 cases). The cross facial nerve grafts were repaired in a single stage in three patients and in two stages in six patients. In group 2 the lower lid support was provided with sling or hard palate graft. In group 3, all facial nerves were repaired with nerve grafts. Three patients had facial nerve grafted to the upper facial nerve branches and split hypoglossal grafted to lower face. In the other 12 patients only the facial was grafted. Results: Of the 42 patients, there were 21 females and 20 males, with a mean age of 41 years and a range of 2 –68 years. The mean duration of facial palsy was 21 months with a range of 6 months to 5.5 five years. The mean follow up time was 4.2 years, with range 5 months to 6 years. In group 1, 6 patients (66%) had excellent improvement with no requirement for tears or ointment. No secondary procedures have been required. In group 2, 5 patients (50%) had excellent results with no requirement for tears or ointment. One patient (10%) has had repositioning of the gold weight. In group 3, 9 patients (75%) had excellent results requiring no tears or ointment. In group 4, 4 patients (57%) had excellent results with no requirement for tears or ointment. The others have had implant adjustment. Two of these were metallic spring and the other was a gold weight. In summary 58 % of patient had excellent results. Only 23%, 4 of 17 patients with metallic implants required revision. Conclusion: When the denervation time is less than 24 months neurotization of the sphincter must be provided as this improves the function,aesthetics of the eyelids and reduce the need for medical treatment.