After an orbital fracture surgery, my lower eyelid retracted. Should I have a skin graft or alloderm spacer to fix? (photos)

The ophthalmology surgeon (2nd dr.) who failed to correct the retraction believes I should attempt another surgery involving an alloderm spacer which SHOULD fix my retraction. I since visited a plastic surgeon for a 2nd opinion who said I should instead be having a lower eyelid skin graft and lateral canthopexy because the eyelid lacks the skin needed. Should I go through with the alloderm spacer or attempt the skin graft? What could I expect from each surgery? What would most likely help me?

Doctor Answers 3

I am sorry but neither of the approaches advocated by these surgeons are likely to accomplish the goal.

First, do not let the plastic surgeon place a skin graft.  He or she is not wrong.  A skin graft will lengthen the eyelid.  However, the grafted skin will never look right.  Cosmetics are very important here.  You will feel just as self conscious about your appearance as you do now maybe even more so.  Will the skin graft allow the lid to be raised?  Yes, it is just ugly.  So much so that procedures have been developed to avoid the use of a skin graft.  The problem with using alloderm is that it disappears after a few months.  We will sometimes use it as a temporary space.  However, you look like you may need a longer term solution.  In that situation, I favor the use of hard palate graft.

One point that both of these surgeons are missing is the relative lack of bone projection at the top of the cheek.  I think the best approach for the type of situation you are in is with the use of a hand carved rim implant with hard palate graft.  You can read about this type of repair on my website.

A canthal surgery (canthoplasty or canthopexy) lack the power to accomplish anything here and by itself is not an appropriate approach to this type of issue.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

It all depends.

It depends on when you had the operation to fix the orbital fracture.  Normally, I would advise to wait a year prior to doing anything to allow the scars to heal fully.  If you still have the problem, then a canthopexy (tightening of the lower eyelid) is what you may need without skin grafting or alloderm.  I would advise you to get another opinion from a board certified plastic surgeon.  Good luck!

Tae Ho Kim, MD
New York Plastic Surgeon
4.5 out of 5 stars 12 reviews

Correction of retracted lower lid after in orbital fracture depends on the problem.

Without physical examination I cannot give a separate opinion. In your particular situation you might need a spacer, you might need skin graft, you might need both.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 36 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.