Orbit. blowout- 2 surgeries later & looks worse (Photo)

Question

2019 car accident caused multiple fractures to my face and skull, one being left orbital floor blowout fracture. First surgery was in Nov 2022, which the surgeon placed a silicone implant where the hole was. Second surgery was a canthoplasty in an attempt to make eyes more even. Unfortunately, both procedures seemed to make eyes more UNEVEN. My eyes (especially left) are so heavy now. I’m very insecure about it and just want my left to look like the right again. What can I do, if anything?

Lucian Ion, FRCS · Answer

Thank you for your question and for sharing your photographs. It would be worth checking your passport photos from before your injury to see the position of your left eye. Your left cheekbone is a little bit lower, which can be due to the injury or natural asymmetries of the face. However, your left pupil is slightly higher than the right which disrupts the local relationships.

It is possible that the silicone implant used to correct the enophthalmos on the left side has displaced the globe slightly too much, in the effort to achieve symmetry between the pupillary position , making it very difficult to produce symmetry in the relationship between the pupil and the palpebral aperture. 
You might need either a slightly smaller implant in the orbit or for the implant to be positioned slightly differently to assist with the position of the globe. It is technically challenging to produce such accurate results but using front view images of your face from before the injury can guide toward the features of your natural asymmetries that made the whole balance of the facial appearance more coherent.

This principle goes a little away from the concept of symmetry across the midline to respect the symmetry of local relationships on each side. If you cover the right eye in the current photo, and in a photo before the injury it will help to understand what changes that are needed for the features of the left eye, independent of right/left symmetry.

Eric M. Joseph, MD · Answer

Orbital blowout fractures may need repair to prevent the orbital contents from falling into the maxillary sinus, or to repair issues of muscular entrapment. Your left upper eyelid may appear a bit droopier than your right, however, better photos would be necessary for a complete evaluation. Please consider meeting with an expert oculoplastic surgeon or facial plastic surgeon for another opinion about your eyelid appearance. Thank you for your question. Sincerely, Dr Joseph

Mats Hagstrom, MD (license on probation) · Answer

Your situation is way too complex to even begin assessing without a proper consultation. That should most likely take well over an hour or even two hours.
To make an assessment would require a reviewing all of your medical records all of your CAT scans and previous operative reports.
Before considering any more surgery, the key is to find the right provider.
That is not going to be easy or straightforward.
You need to have someone who has extensive experience in cranial facial surgery, facial trauma, and oculoplastic surgery.
It may need to be a team approach.
Unless you can put the right providers in place, you should probably consider not having more surgery.
Depending on how motivated you are, you may or may not want to pursue another procedure.
Wanting to look better it’s OK but recognizing what it may entail can change the reality.
I’m guessing you’ll probably need to consult with 10 or 20 plastic surgeons before finding the right provider and even that may be insufficient.
Most likely you should start at an academic Medical Center where they do this kind of work and where they have a local trauma center available and can bring together a team of experts.It may be simpler than that, but I would stay on the side of caution, considering your history.
Sometimes simply recognizing that we’re alive and have vision is a pretty good place.
Best,
Matt Hagstrom MD

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