Lower eyelid trouble after occipital fracture surgery, will eyelid fix itself? (photo)

9 weeks ago I had ZMC and Occipital Fracture Repair. After the surgery I noticed that my left lower eyelid would not raise when I smiled. At my six week follow up appointment my surgeon told me I do not have ciccatricial (scar based) ectropion of the lower eyelid. Now that I am at 9 weeks and have seen little improvement I am wondering if it is now due to nerve or muscle damage of the lower eyelid. I have been doing eyelid exercises, massages, and stretches routinely. What could be the cause?

Doctor Answers 4

Eyelid malposition after orbital fracture

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  • Thank you for the photos- I assume you had a ZMC and orbital floor fracture repair
  • The changes of the eye position and eyelid position will continue for several months after such a repair
  • Pay attention to potentially having double vision when you look up
  • Be patient with the process of healing, but discuss your concerns with your surgeon in a few months. 
  • Time, not revision surgery should be the first approach

Sacramento Facial Plastic Surgeon

Lower eyelid weakness after fracture surgery

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It might relate to the trauma or the ZMC fracture surgery. It could be mechanical problem or nerve/muscle weakness problem. You need a proper in person evaluation. See an oculoplastic surgeon.

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

May be related to the trauma or the repair of the trauma.

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There is much information we do not know.  If the surgeon repaired the zygomatic fracture through an infracillary lower eyelid incision, adhesions can form that might account for the issue even though you don't have an ectropion.  Both lower eyelids show significant inferior scleral show so that increases the likelihood of healing with an issue like this.  I do not consider this to be a complication of this approach.  You had reconstructive surgery not cosmetic surgery.  Part of the issue may be residual depression of the orbital rim due to the fracture.  There are ways of improving this situation if it does not improve on its own.  Generally for this type of circumstance, I recommend letting the area heal for 6 to 12 months before having additional reconstructive surgery to address this issue. It is not too early for second opinions but mostly now you need more time to heal.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Early problems after orbital reconstruction

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thank you for the question.  The cause could be the injury or the surgery or both.  9 weeks, though it feels like quite a long time, is relatively early and your healing phase.  I would expect some of the motion to come back if not most of it but you will have to wait at least 6 months.  Follow your surgeons recommendations and don't be tempted into some sort of revision procedure.

One early option you may have to accelerate your healing process would be PRP or platelet rich plasma.  This is not covered by insurance but does help with scar tissue.  When I say scar tissue there is definitely scar tissue and your wound that is totally expected.  There is no surgery without scar tissue so we'll simply have to give it more time.

Chase Lay, MD
Double board-certified facial plastic surgeon

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 80 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.