We evaluated retrospectively 101 patients to assess clinically the results of fixation methods on isolated unilateral zygoma fractures (mean follow-up 3.2 years). All patients were examined by an investigator who was blinded to the initial fixation method. Ninety-two patients were treated with wire or plate fixation alone. The major clinical parameters assessed were globe position abnormalities (enophthalmus and dystopia), malar projection, and cheek sensation. Rigid plate fixation achieved statistically better long-term malar symmetry (p = 0.002) and approached statistical significance in the achievement of more normal globe position (p = 0.06) compared with wire fixation alone. Cheek sensation showed a nonsignificant trend (p = 0.13) toward improvement with plate fixation. Other parameters that were evaluated were anatomic location of fixation points, number of fixation points, surgical approach and exposure, and breakdown of fixation dates by specialty. None of these factors showed any significant influence on outcome. The present study confirms what we have known to be true from our clinical experience--that rigid internal fixation is superior in minimizing or preventing long-term sequelae of facial fractures.