Will My Sagging Lower Eyelid After A Cheekbone Fracture Repair Need Surgery To Fix It?

Q: Dr. Eppley, One month ago I underwent surgery on my left cheekbone which was fractured fixed after being punched in the face. The surgery was done through a lower eyelid incision. My surgeon warned me that there was a chance that my lower eyelid would sag lower afterwords and, if it did, he recommended massaging of the lower eyelid and cheek a few times a day for a few minutes. If time and massaging is unsuccessful at bringing my lower eyelid back into place, what can be done? How long should I wait before having additional surgery to fix the lower eyelid sag?

A: Lower eyelid sag, also known as ectropion, is a known potential complication from any surgery that passes through the lower eyelid. Scarring of the layers of the lower eyelid or loss of lateral canthal tendon support can result in lower eyelid malposition. In some cases it is temporary until the swelling from surgery goes away and the lower eyelid skin relaxes. But if it is persistent  or significant still at 3 months after surgery with no significant change, then a lower eyelid revision procedure will be needed. There are a variety of options to get the lid back up to a more normal horizontal position, the most common being release and lateral canthal tightening. This works satisfactorily when the ectropion and scarring is not severe. In more difficult cases, the release and lateral canthal tightening needs to be combined with a dermal graft in the middle lamellar tissues to add tissue that is scarred and provide good support for lateral canthal attachment.

Dr. Barry Eppley