Lower Eyelid Sagging After Zygomatic Reconstructive Surgery? (photo)

5 weeks ago I underwent reconstructive surgery for repairing my zygoma (cheek) and blow-out orbital floor fracture. My surgeon used a transconjunctival approach. He mentioned my lower eyelid would sag lower afterwords (from incision), and recommended massaging, gently lifting the lid repeatedly a few times a day for a few minutes. If massaging is unsuccessful at bringing my lower eyelid back into place, what are my options? How long should I wait? What is the recovery time?

Doctor Answers 9

5 Weeks after Facial Fracture Repair and Eyelid Malposition

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    Eyelid malposition at 5 weeks needs to be managed with massage and nighttime taping with lubrication to manage dryness if necessary.  It may be reasonable to wait 6 months or so if improvement is noted with conservative measure.

Lower Eyelid Sag After Zygomatic Fracture Repair

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Lower eyelid sag or ectropion after cheekbone fracture repair, or any midface surgery through the lower eyelid, is not rare. It is still early after your surgery so some improvement in lower lid position can still be expected. Lower eyelid and cheek massage is a reasonable thing to do for now. If not significantly improved by 3 months after surgery, then an ectropion repair should be considered. If some inmprovement has occurred, then give it another 3 months to see how much further improvement will happen.

Lower eyelid retraction after fracture surgery

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The likely problem is muscle/nerve weakness from either the fracture or surgery, for which you have to wait at least 6 months before deciding on any further intervention. However, it is possible the lower eyelid is pulled down secondary to contracture/scar, for which more immediate intervention may be beneficial.  See an oculoplastic surgeon for evaluation.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Lower eyelid problem after facial fracture reconstruction

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From the photo,  there are still some swelling around the surgical area. Your surgeon's recommendation is very useful. 5 weeks is very early in your recovery period. Unless your sagging lower eyelid is worsening or causing functional issues, I would recommend wait at least 1 year before revision. At this point it's too early to tell if you even need revision. Keep up with your massage therapy and keep communicating with your operating surgeon regarding your progress.

Best Wishes,

Stewart Wang, MD FACS, Wang Plastic Surgery



Stewart Wang, MD, FACS
Los Angeles Plastic Surgeon
4.6 out of 5 stars 28 reviews

Healing time for orbital floor repair

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I would suggest waiting at least 6 months for healing to occur. Perhaps a year would be better.

Sheldon S. Kabaker, MD FACS
San Francisco Facial Plastic Surgeon

Sagging Eyelid After Repair of Orbital Fracture

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There are a number of factors affecting the appearance of your eyelid at this point. Not only are your lids swolleng but also there is swelling of the soft tissue and muscles around the globe which contributes to the overall asymmetry noted in your picture.  Five weeks is early, but if by six to 8 weeks this does not improve, then it may be worthwile to visit your surgeon, who can inspect the wound and can inject a small amount of a steroid into the incision if it appears to demonstrate a very aggressive wound healing response. In my experience this along with message can resolve a good number of lid malpositioning assuing there are no additional factors at play.

Arthur N. Falk, MD
Albany Facial Plastic Surgeon

Lower eyelid issue aftere zygoma fracture

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I treat zygoma fractures all the time. The ransconjucntival approach is one way to expose the fracture. Usually as the swelling subsides the lower eyelid retraction improves. Follow closely with your surgeon.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Lower Eyelid Sagging After Zygomatic Reconstructive Surgery?

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You are still very early in recovery phase. Allow at least 4 months of recovery time. Things should improve by than. 

Eyelid sagging after orbit fracture repair

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Eyelid sagging after orbit fracture repair is not unusual. The massage your surgeon has recommend is very helpful for this. Your lid has had two injuries, the surgery being the second one. It will take months for the area to fully heal. Conservative treatment (massage) usually works. If conservative treatment fails, there are other surgical procedures that can help.

Joseph Mele, MD
Walnut Creek Plastic Surgeon
4.5 out of 5 stars 17 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.