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Suggest Remedy To Camouflage The Exophtalmia Of Eye Post Injury
Question: Hello,my name is XXXXXXX Long story short i had an accident 7 months ago,and had orbital floor and zygomatic fractures all over the left side of my face.
Did a reconstructive surgery 20 days after.
Now,almost 7 months after the surgery i am really depressed about my looks.
Surgery left me a bulgy eye(exophthalmos) and a droopy lower eyelid that makes my eye look a lot bigger than the right one(see pics please).
Plus my upper lip (where the incision be made) has shrinked a lot,leaving a curve that make my lip look thinner and uneven,showing a bit more tooth than the eight side.(see pics please).Because of that,i got speech issues,eating food and drinking water issues.Plus my facial expressions have changed as i feel the left side of my face numb,tight,like the grafts are pulling and holding my upper lip up.
I am so depressed and desperate i think i look like a monster and i don`t know what to do.
I think that a (lower eyelid tightening surgery) could help camouflage the exophtalmia of my eye..What do you think?
But i don`t know what to do with my lips.My primary surgeon said that release of the contractures where the incision made,may help but may not and may create even more scar tissue.Please help me doctor.
Thank you in advance
Did a reconstructive surgery 20 days after.
Now,almost 7 months after the surgery i am really depressed about my looks.
Surgery left me a bulgy eye(exophthalmos) and a droopy lower eyelid that makes my eye look a lot bigger than the right one(see pics please).
Plus my upper lip (where the incision be made) has shrinked a lot,leaving a curve that make my lip look thinner and uneven,showing a bit more tooth than the eight side.(see pics please).Because of that,i got speech issues,eating food and drinking water issues.Plus my facial expressions have changed as i feel the left side of my face numb,tight,like the grafts are pulling and holding my upper lip up.
I am so depressed and desperate i think i look like a monster and i don`t know what to do.
I think that a (lower eyelid tightening surgery) could help camouflage the exophtalmia of my eye..What do you think?
But i don`t know what to do with my lips.My primary surgeon said that release of the contractures where the incision made,may help but may not and may create even more scar tissue.Please help me doctor.
Thank you in advance
Brief Answer:
Provide more information
Detailed Answer:
Hello and welcome to healthcaremagic
I ma Dr. Kakkar. I have gone through your query and I empathize with you
Yes, I do notice a little drooping of felt lower lid. Though I cannot really appreciate much that you told about the upper lip asymmetry
I would be able to judge the asymmetry better if you can upload a few more photographs: preferably one with a broad smile, as if you are trying to show teeth, and one with your eye closed with the lids just apposing(it should not be forceful).
I would like to gather more information whether is there any difficulty in closing the eyes or difficulty blinking, tearing from left eye or dry eye?
Do you have a problem with drooling of saliva from the left side?
When you chew food, does it stick onto the left side and is there any issue with trickling of water from that side?
Regards
Provide more information
Detailed Answer:
Hello and welcome to healthcaremagic
I ma Dr. Kakkar. I have gone through your query and I empathize with you
Yes, I do notice a little drooping of felt lower lid. Though I cannot really appreciate much that you told about the upper lip asymmetry
I would be able to judge the asymmetry better if you can upload a few more photographs: preferably one with a broad smile, as if you are trying to show teeth, and one with your eye closed with the lids just apposing(it should not be forceful).
I would like to gather more information whether is there any difficulty in closing the eyes or difficulty blinking, tearing from left eye or dry eye?
Do you have a problem with drooling of saliva from the left side?
When you chew food, does it stick onto the left side and is there any issue with trickling of water from that side?
Regards
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Greetings Mr Kakkar,thank you for your interest i really appreciate it.
I did upload more pictures for you to have a better look on my situation.
1)Yes blinking on the operated eye is a bit weird,like it`s lagging,like it blinks slower than the other eye by 0.3 seconds or something(feels like theres too much skin from the eyebrow sitting on the eye and make it heavy),sorry for my broken english but i don`t know how to explain it..
And yes,i am tearing specially when i go out and it`s windy,dryness is a fact and one more thing,when i close my eyes to sleep i feel that my eylids do not come in touch 100%,they do like 90%,if you know what i mean.
2)As for my mouth(see pictures),in pic003,is how my moth looks like when i am talking(my tooth show a lot more on the left side,and pic004 i think that makes clear the thing with the shrinkness.
But i know myself so many years and i know how i used to look like and i feel that it`s not only shrinkness but the muscle there is generally damaged,cauuse it feels tight when i am trying to eat,talk or do facial expressions and most of the times it doesn`t follow the moves of the right muslcle,for example when i talk sometimes my lips in the operation side,do not come in touch so i misspronounce words or i don`t pronounce them properly.
Most of the times i got drooling,i speak and i feel that saliva is leaking out,and yes,when i take big bites of food,it stucks onto the left side(sometimes i need to use my finger to help it,pathetic i know)
By the way picture 006 is how my mouth used to be before the surgey(i just put my finger to help the skin go to the right place.Without my finger it looks like pic003.
My life has changed since my sirgery,i am so depressed because looks is not the only issue,i got neurological issues as well from the accident,but i am here to discuss about the looks,so please help me doctor.
Thank you in advance
(i can upload more pics if you request)
I did upload more pictures for you to have a better look on my situation.
1)Yes blinking on the operated eye is a bit weird,like it`s lagging,like it blinks slower than the other eye by 0.3 seconds or something(feels like theres too much skin from the eyebrow sitting on the eye and make it heavy),sorry for my broken english but i don`t know how to explain it..
And yes,i am tearing specially when i go out and it`s windy,dryness is a fact and one more thing,when i close my eyes to sleep i feel that my eylids do not come in touch 100%,they do like 90%,if you know what i mean.
2)As for my mouth(see pictures),in pic003,is how my moth looks like when i am talking(my tooth show a lot more on the left side,and pic004 i think that makes clear the thing with the shrinkness.
But i know myself so many years and i know how i used to look like and i feel that it`s not only shrinkness but the muscle there is generally damaged,cauuse it feels tight when i am trying to eat,talk or do facial expressions and most of the times it doesn`t follow the moves of the right muslcle,for example when i talk sometimes my lips in the operation side,do not come in touch so i misspronounce words or i don`t pronounce them properly.
Most of the times i got drooling,i speak and i feel that saliva is leaking out,and yes,when i take big bites of food,it stucks onto the left side(sometimes i need to use my finger to help it,pathetic i know)
By the way picture 006 is how my mouth used to be before the surgey(i just put my finger to help the skin go to the right place.Without my finger it looks like pic003.
My life has changed since my sirgery,i am so depressed because looks is not the only issue,i got neurological issues as well from the accident,but i am here to discuss about the looks,so please help me doctor.
Thank you in advance
(i can upload more pics if you request)
Brief Answer:
Possibility of nerve palsy
Detailed Answer:
Hi.
Judging from the description and reviewing the latest photographs, I could gather following important points:
-Inability to completely close your left eye during sleep along with excessive tearing from left eye.
-Muscle weakness on the left side (not able to approximate lips, drooling from left side, food getting stuck on the left side) and I guess if you try to blow a puff of air it would leak from the left side?Right?
-The shrunken appearance is probably due to slight muscle atrophy on the left side
I would have preferred a photograph with a broader smile as if showing your entire set of teeth to a dentist (that would show me if there is any real asymmetry)
I think you have a facial nerve palsy(weakness) on the left side, probably as a result of injury or surgery, though it is not complete paralysis. You would certainly benefit from facial exercises that would gradually strengthen the muscles.
Regards
Possibility of nerve palsy
Detailed Answer:
Hi.
Judging from the description and reviewing the latest photographs, I could gather following important points:
-Inability to completely close your left eye during sleep along with excessive tearing from left eye.
-Muscle weakness on the left side (not able to approximate lips, drooling from left side, food getting stuck on the left side) and I guess if you try to blow a puff of air it would leak from the left side?Right?
-The shrunken appearance is probably due to slight muscle atrophy on the left side
I would have preferred a photograph with a broader smile as if showing your entire set of teeth to a dentist (that would show me if there is any real asymmetry)
I think you have a facial nerve palsy(weakness) on the left side, probably as a result of injury or surgery, though it is not complete paralysis. You would certainly benefit from facial exercises that would gradually strengthen the muscles.
Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you again Doctor.
I uploaded the photo you need as well.One with teeth showing(that looks pretty normal to me) and one with no teeth(smile there looks crooked and uneven,i don`t know why this is happening when i don`t show my teeth).
As for the blowing air,you`re right there too!
So you mean with facial exercises is going to improve?Because i it`s been 7 months already and every day is a facial exercise(you know,talking,eating and things) and i can see no really sagnificant improve.
Plus some more pics of facial expressions(eyebrows etc) for you for a better evaluation ..(pic005 you see what i mean,even with the specific facial expression,teeth show more left side)
You still think it`s a facial nerve paralysis?(by the way don`t be surprised if some times the right side of my face looks even weaker than the operated one( i had Bells Palsy there almost 2 years ago).
Thank you in advance again,
you seem to be a great Doc
I uploaded the photo you need as well.One with teeth showing(that looks pretty normal to me) and one with no teeth(smile there looks crooked and uneven,i don`t know why this is happening when i don`t show my teeth).
As for the blowing air,you`re right there too!
So you mean with facial exercises is going to improve?Because i it`s been 7 months already and every day is a facial exercise(you know,talking,eating and things) and i can see no really sagnificant improve.
Plus some more pics of facial expressions(eyebrows etc) for you for a better evaluation ..(pic005 you see what i mean,even with the specific facial expression,teeth show more left side)
You still think it`s a facial nerve paralysis?(by the way don`t be surprised if some times the right side of my face looks even weaker than the operated one( i had Bells Palsy there almost 2 years ago).
Thank you in advance again,
you seem to be a great Doc
Brief Answer:
Seems like a facial nerve palsy
Detailed Answer:
Hi.
Yes, going by your complaints, it does seem to me as a case of facial nerve palsy or weakness (not facial nerve paralysis which is actually complete loss of function as in bell's palsy). I could not see any scar tissue which could be pulling on or restraining facial movements and also how would you explain the lip atrophy or shrinkage?
Facial exercises for facial nerve palsy are not routine facial movements. They are also known as facial retraining exercises. You can find a few videos on youtube, also can do a search on internet for facial retraining exercises.
I have a link for you: http://www.ncbi.nlm.nih.gov/pubmed/0000
I wonder what is the opinion of your operating surgeon about your complaints? Or any other doctor you have visited in person? I think the most important thing is to first arrive at an underlying cause. To me it seems like facial nerve palsy (weakness).
Regards
Seems like a facial nerve palsy
Detailed Answer:
Hi.
Yes, going by your complaints, it does seem to me as a case of facial nerve palsy or weakness (not facial nerve paralysis which is actually complete loss of function as in bell's palsy). I could not see any scar tissue which could be pulling on or restraining facial movements and also how would you explain the lip atrophy or shrinkage?
Facial exercises for facial nerve palsy are not routine facial movements. They are also known as facial retraining exercises. You can find a few videos on youtube, also can do a search on internet for facial retraining exercises.
I have a link for you: http://www.ncbi.nlm.nih.gov/pubmed/0000
I wonder what is the opinion of your operating surgeon about your complaints? Or any other doctor you have visited in person? I think the most important thing is to first arrive at an underlying cause. To me it seems like facial nerve palsy (weakness).
Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
Doctor my whole face is a big scar tissue...Only thing is that the incissions are made on the inside
Heres a link to understand what kind of operation i had,so maybe you can realize the reasons of shrinkness etc:
https://www2.aofoundation.org/wps/portal/surgery/?showPage=redfix&bone=CMF&segment=Midface&classification=92-Zygoma,+Zygomatic+complex+fracture&treatment=&method=Open+treatment+with+orbital+reconstruction&implantstype=3-point+fixation&redfix_url=0000
i have one HUGE incision inside of my lips,covering half of my mouth(all the left area)so they can access to put the metal plates
And yes ive seen my doctor too many times,he`s telling me that the only thing hes left to do is release of the contractures on that area,that may help,but may not and create even more scar tissue.
Basically i think he butchered me,cause i saw so many situations like mine online,but their face isn`t that a mess like mine :(
i wish i could send you a video somehow to see that i can do all of the kind of facial expressions and muscle is moving ok,BUT somehow it looks like its moving towards to the operated side like something it`s pulling it that way,dont know how to explain it :(
Heres a link to understand what kind of operation i had,so maybe you can realize the reasons of shrinkness etc:
https://www2.aofoundation.org/wps/portal/surgery/?showPage=redfix&bone=CMF&segment=Midface&classification=92-Zygoma,+Zygomatic+complex+fracture&treatment=&method=Open+treatment+with+orbital+reconstruction&implantstype=3-point+fixation&redfix_url=0000
i have one HUGE incision inside of my lips,covering half of my mouth(all the left area)so they can access to put the metal plates
And yes ive seen my doctor too many times,he`s telling me that the only thing hes left to do is release of the contractures on that area,that may help,but may not and create even more scar tissue.
Basically i think he butchered me,cause i saw so many situations like mine online,but their face isn`t that a mess like mine :(
i wish i could send you a video somehow to see that i can do all of the kind of facial expressions and muscle is moving ok,BUT somehow it looks like its moving towards to the operated side like something it`s pulling it that way,dont know how to explain it :(
Brief Answer:
Don't rush into surgery just as yet
Detailed Answer:
Hi.
I am sorry for some delay in my reply and I apologise for it.
The option that you have is either to go for a surgical correction which is a bit risky or try physiotherapy.
I think you would benefit from facial retraining exercises. You should not rush into surgery right away.
I would also suggest you to consult either a Neurologist or a Head and Neck specialist, may be on healthcaremagic or in person, and specifically ask whether do you have a facial palsy or is the asymmetry the result of surgery.
Let me what you find out from them.
Regards
Don't rush into surgery just as yet
Detailed Answer:
Hi.
I am sorry for some delay in my reply and I apologise for it.
The option that you have is either to go for a surgical correction which is a bit risky or try physiotherapy.
I think you would benefit from facial retraining exercises. You should not rush into surgery right away.
I would also suggest you to consult either a Neurologist or a Head and Neck specialist, may be on healthcaremagic or in person, and specifically ask whether do you have a facial palsy or is the asymmetry the result of surgery.
Let me what you find out from them.
Regards
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Ok thank you Dr.Kakkar for everything
i visited a neurologist in person already and all tests came out clear,it`s not neurological
I was thinking about a neck specialist though,cause many times that i move my head,my neck is doing spasms on the operated side and feels tight.
You think it can be related?
i visited a neurologist in person already and all tests came out clear,it`s not neurological
I was thinking about a neck specialist though,cause many times that i move my head,my neck is doing spasms on the operated side and feels tight.
You think it can be related?
Brief Answer:
Physiotherapy might be useful for you
Detailed Answer:
Hi.
I don't think so. Neck spasms seems to be entirely different from what you initially asked for. Neuromuscular in origin for sure. It could be related to bad posture. You can take an OTC analgesic and a muscle relaxant.
Regarding your initial complaint, I must say that give it some more time (6-8 months or so), don't rush into surgery as yet and I do recommend facial retraining exercises/physiotherapy for you. I still feel it is related to facial nerve palsy and facial muscle weakness, it might take between 12-18 months for a noticeable recovery. Till then I wont suggest any surgery.
I wonder, since it has been already 7 months. Do you notice the facial changes getting a little better or have they worsened or stayed as it is?
Regards
Physiotherapy might be useful for you
Detailed Answer:
Hi.
I don't think so. Neck spasms seems to be entirely different from what you initially asked for. Neuromuscular in origin for sure. It could be related to bad posture. You can take an OTC analgesic and a muscle relaxant.
Regarding your initial complaint, I must say that give it some more time (6-8 months or so), don't rush into surgery as yet and I do recommend facial retraining exercises/physiotherapy for you. I still feel it is related to facial nerve palsy and facial muscle weakness, it might take between 12-18 months for a noticeable recovery. Till then I wont suggest any surgery.
I wonder, since it has been already 7 months. Do you notice the facial changes getting a little better or have they worsened or stayed as it is?
Regards
Above answer was peer-reviewed by :
Dr. Shanthi.E
For sure things are less tight and more flexible comparing the first 2 months.
But after the 5th month i dont see much improvement
Plus ive been told that most of the healing happens the first 6 months and i shouldnt expect much after then
I don't know..
One more question.My bones healed more outwards after the metal plates.Doesnt show in a first look,but if you touch my face youre going to feel it for sure,even if you are not a doctor,like my parents and my friends did.
Feels like i got bumps,certainly more outwards than the normal side of my face,maybe by 1cm or something
Do you you think this is enough to cause an asymmetry in the mouth or even muscle position change??
But after the 5th month i dont see much improvement
Plus ive been told that most of the healing happens the first 6 months and i shouldnt expect much after then
I don't know..
One more question.My bones healed more outwards after the metal plates.Doesnt show in a first look,but if you touch my face youre going to feel it for sure,even if you are not a doctor,like my parents and my friends did.
Feels like i got bumps,certainly more outwards than the normal side of my face,maybe by 1cm or something
Do you you think this is enough to cause an asymmetry in the mouth or even muscle position change??
Brief Answer:
This might be causing that feeling of tightness
Detailed Answer:
Hi.
Logically if the same amount of skin and soft tissue is covering a wider circumference of bone on the side of injury than on the normal side then it might also be the reason for pulling your lower eyelid downwards and left side of lip upwards and this might also be responsible for the tightness that you often mention in our discussion.
Regards
This might be causing that feeling of tightness
Detailed Answer:
Hi.
Logically if the same amount of skin and soft tissue is covering a wider circumference of bone on the side of injury than on the normal side then it might also be the reason for pulling your lower eyelid downwards and left side of lip upwards and this might also be responsible for the tightness that you often mention in our discussion.
Regards
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thats what i said to my surgeon and she said that theres no way such a little amount of bone change cause that skin asymmetry and that my lower eyelid is a result of the incision they made there to fix my orbital floor and that the nerves there are dead thats why it`s droopy...
But still if you`re right doctor,do you think my skin is going to produce more skin or get more flexible by the years ot this is imposible? and what is possible that i can do to fix that asymmetry,like lower eyelid tightening surgery and fillers for my lips?
Whats your opinion?
Is it going to look better by time if i dont go for any further surgeries?
What you suggest?
This is my final question to this topic
Thank you very much for everything
But still if you`re right doctor,do you think my skin is going to produce more skin or get more flexible by the years ot this is imposible? and what is possible that i can do to fix that asymmetry,like lower eyelid tightening surgery and fillers for my lips?
Whats your opinion?
Is it going to look better by time if i dont go for any further surgeries?
What you suggest?
This is my final question to this topic
Thank you very much for everything
Brief Answer:
Allow more time before surgery
Detailed Answer:
Hi
Ok, so the droopiness of lower eyelid is due to nerve injury, that's what I was speculating in my earlier replies.
Regarding the feeling of tightness of skin, I must say that skin has good amount of elasticity and it certainly can accommodate the extra bit and the tightness wound certainly be bettter over a period of time, gradually.
Regarding surgery for lower eyelid I am a bit skeptical at this time. I think you should allow a little more time for nerve regeneration and assist with facial retraining exercises.
Facial retraining exercises would be beneficial.
Regarding fillers for lips, you can definitely go for that because they are anyways temporary
Regards
Allow more time before surgery
Detailed Answer:
Hi
Ok, so the droopiness of lower eyelid is due to nerve injury, that's what I was speculating in my earlier replies.
Regarding the feeling of tightness of skin, I must say that skin has good amount of elasticity and it certainly can accommodate the extra bit and the tightness wound certainly be bettter over a period of time, gradually.
Regarding surgery for lower eyelid I am a bit skeptical at this time. I think you should allow a little more time for nerve regeneration and assist with facial retraining exercises.
Facial retraining exercises would be beneficial.
Regarding fillers for lips, you can definitely go for that because they are anyways temporary
Regards
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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