Changes in Lower Eyelid Appearance Following Zygomaticomaxillary Complex Fractures

ABSTRACT Objective To describe the loss of lower eyelid bags and resulting lower eyelid asymmetry in patients with surgical and conservative treatment of zygomaticomaxillary complex (ZMC) fractures. Methods Patients with unilateral ZMC fractures were identified from medical records and invited to follow‐up examinations. Fractures were classified based on the fracture pattern of the infraorbital rim. Lower eyelid bags and other cosmetic stigmata were evaluated on photographs taken at follow‐up. Results The study sample consisted of 104 patients, with a median age of 56 years and follow‐up of 72 months after trauma. Surgical treatment was given to 77 patients (74%). Lower eyelid asymmetry due to loss of bags was seen in 42 patients (40.4%), out of which 16 patients were not treated with lower eyelid incisions. Lower eyelid asymmetry was significantly associated with lower eyelid incisions ( p = 0.008) but not with fracture severity or satisfaction with facial appearance. Conclusions Lower eyelid incisions are the most important cause of lower eyelid bag loss in patients with ZMC fractures. Loss of eyelid bags can also appear in patients without incisions, indicating trauma and soft tissue healing as contributing mechanisms. Level of Evidence 3.