Secondary reconstruction of posttraumatic facial deformities has been consistently described as one of the most challenging procedures performed. Ideal primary reconstruction cannot always be achieved, and often it is complicated by severe comminution or inadequate surgical management. It also can arise because of a lack of definitive surgical repair or excessive delay of initial treatment. Complications leading to secondary deformities can occur even when craniofacial injuries are treated by experienced surgeons. Following proper surgical principles, meticulous perioperative planning, and anticipation of potential functional and aesthetic sequelae limit many of those complications. Herein, we discuss secondary procedures in traumatic midface injuries.

Zygomaticomaxillary (ZMC) fractures are the second most common facial fractures after nasal bone fractures. The zygoma, with its location and multiple points of articulations, lends itself to both facial structure and esthetics. Secondary ZMC deformities are complications of inadequate primary correction, delayed repair, or lack of repair. Secondary revisions of ZMC aim to correct ZMC displacement and projection and to address orbital discrepancies. Extensive correction involving significant orbital and malar defects requires zygomatic repositioning osteotomies and would greatly benefit from the utilization of virtual surgical planning, intraoperative navigation, and imaging. Minor corrections in malar projection can be corrected by onlay grafting and soft tissue augmentation and resuspension. Isolated or minor orbital corrections can be managed by autogenous or alloplastic material to restore lost orbital volume and anatomy.