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

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 surgery in the future should you choose to have it.

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 along the bony rim. I frequently see patients who have this same issue.  It can still occur when the incision is placed on the back side of the eyelid (trans-conjunctival), but it is less likely, although that is a moot point at this stage. 

Upward massage of the eyelid with your fingers should be performed frequently with the goal of free movement of the lower eyelid.  Often this will provide improvement. Make sure your eye continues to be lubricated well with artificial tear drops and/or ointments. I suggest you avoid battery-powered massagers as there have been case reports associating them with cataracts when used near the eyes. Over time, if an issue remains, you should seek consultation with an oculoplastic surgeon.   A spacer graft may be required as a last resort.  Best of luck!

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.