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Lower Eyelid Trouble After ZMC Fracture Repair, Will It Fix Itself? (photo)

At 4 weeks after surgery my lower eyelid position has not changed much. When comparing left and right, the right one feels firm and only slightly moves when I smile or squint, appearing like the area around the scar is stuck there. Feels like I need the skin to get soft and the area around the scar to get unstuck! Is it common for the eyelid to appear hard and stuck like that? Is it lack of muscle tone? Should I be massaging it? Will time soften the scar and provide more flex? Thank you! Alex.

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13 Doctor Answers | Asked by alex1980

Doctor Answers (13)
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Ectropion of the lower eyelid

You have ciccatricial (scar based) ectropion of the lower eyelid, which is likely due to scarring from your ZMC fracture repair. Since it has only been 1 month since your surgery, I recommend that you try massaging and eyelid taping over the next 6 months, as well as using lubricating drops. Your surgeon will show you exactly how this is done by demonstrating and applying tape. Even if this does not completely resolve the issue, you will be a better candidate for corrective eyelid plastic... more

Eyelid retraction after subciliary incision

It is unfortunate and frustrating when the surgery to correct one problem leaves you with a new issue. The incision used to correct your facial fracture was disguised in your lower eyelid skin crease. This approach traverses the lower eyelid blinking muscle and the septum. This can cause weakness of the muscle either due to direct injury or due to injury to the nerves that supply the muscle on its underside. Scar formation may also cause tethering of the eyelid... more

Eyelid ectropion

As others have noted you have lower eyelid ectropion where the eyelid gets pulled downward by scarring. This is a known complication of facial fracture repair. The good news is that many will improve with massage, eyelid taping, and time. Keep your eye lubricated and talk with your plastic surgeon. Cheers, Dr Kerr

Mahlon Kerr, MD

17 reviews

Austin Plastic Surgeon

Lower eyelid malposition after orbital fracture surgery

Your lower eyelid is not moving well due to scarring and muscle/nerve weakness. Some of that may improve over the next 6 months, at which time, if still problematic, you can consider lower eyelid surgery to improve its position, by an oculoplastic surgeon. In the meantime, keep your eyes lubricted.

Abnormal Eyelid Position of Repair of Broken cheek

You have a classic ectropion ("ek tro pee yon"). Ectropion can have many causes (old age, trauma, scar , muscle weakness). Your ectropion is most likely secondary to scar from the surgical access to fix the orbital rim and/or repair the orbital floor of your ZMC fracture. Typically with massage and time this will resolve. Sometimes steroids injected in the scar will soften it. The typical time to allow resolution is a minimal of 3 months. If it... more

Lower Eyelid Trouble After ZMC Fracture Repair, Will It Fix Itself?

The tightness and lack of normal motion of the right lower lid after a repair of the cheek bone area is common due to the extensive needed separation of the muscles from the bone. The tissues get quite stiff and take time to soften and release. I think massage is crucial in your case, you can even use one of those small battery powered point massagers to help soften the tissue.

ZMC and lower eyelid issue

ZMC fractures are done through multiple incisions. Commonly a subtarsal incision is performed to maintain the orbicularis muscle function. Often when I do ZMC fractures i suspend the soft tissue along the lateral temporal region and then support the lower eyelid with steri-strips to the lateral temporal region as well. you have some tethering opost-op which may be scar tissue or muscle weakness. Massage may help now. You should follow closely with your surgeon.... more

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Lower Eyelid Trouble After ZMC Fracture Repair, Will It Fix Itself?

Photos posted are very good, thanks. At 4 weeks way way to early to discuss this issue. What has your surgeon of record told you? Massage is a good idea but clear it with your surgeon.

Sequelae after ZMC fracture repair

There are 2 possible things occuring in your lower lid. The soft tissue of the cheek needs to be resuspended by the periosteum. It is pulling the eyelid down. You have the beginning of cicatricial ectropion due to violation of the inferior orbital septum. Both of these are known and extremely common problems after repairing a ZMC fracture. There are NOT many ways to repair a ZMC fracture. There are actually only a few. Your motor nerve is NOT damaged and injection with... more

Facial bone fracture sequelae

Your posted photos are mostly consistent with scar tissue between the skin and deeper layers and possibly reattachment of soft tissues lower on the bones. In order to expose and fix the fracture the soft tissues on top of the bone have to be freed up. In some cases they reattach lower on the bone. Your best bet now is massage possibly with suture, finger or hook upward traction on the lower eyelid and if the issue does not resolve after a few months of this conservative treatment you will... more

Scarring will soften with time and massage

There are many different approaches to fixing a ZMC fracture, which can be quick complex and challenging. We deal with results like yours not uncommonly. Besides massage and time, there are some interventions that might mitigate the scarring and accelerate softening of the scar. These include injections of Kenalog [steroid] and/or 5Fu [a type of anticancer medication that has antiscar activity] Discuss these options with your surgeon, or obtain a second opinion. Best of luck more

A.J. Amadi, MD

14 reviews

Seattle Oculoplastic Surgeon

seattleface.com

I agree with Dr. Aldea that minimizing the skin incisions is best.

Alex It is ideal to approach ZMC fractures through a variety of incisions that help hide the work. However, it is also common to see an infracillary incision like you have. Surgeons continue to employ this type of direct incision to gain immediate access to the fracture site. Repairing these fracture can be challenging. In my opinion, this incision runs the risk of damaging the motor nerve that supply the lower eyelid. Also it is possible for the eyelid to... more

Kenneth D. Steinsapir, MD

8 reviews

Los Angeles Oculoplastic Surgeon

Lower Lid Stiffness after Orbital Floor (Zycomaticomaxillofacial) Fracture

The fracture you describe begins along the side wall of the eye socket traverses the floor of the orbit going through the front rim resulting in an unstable segment which at times entraps the muscle which allows us to look down when we go down stairs and often causing numbness of the cheek on the same side. Such a fracture requires repositioning of the bone back in its normal location and stabilizing it there with 2 or more sets of small titanium plates and screws. The surgical... more