The lower eyelids are the first facial feature to show signs of facial aging and blepharoplasty, the plastic surgery operation used to rejuvenate the eyelids is one of the most common plastic surgery operations performed today. Many patients seeking blepharoplasty have puffy lower eyelids, dark circles under the eyes, wrinkles, and loose skin. Advanced eyelid aging changes such as these require a more complex blepharoplasty that includes fat removal or repositioning, arcus marginalis release, skin tightening or removal and canthopexy, a procedure that tightens the lower eyelid. However, many patients only have excess or lax lower eyelid skin, which is most noticeable beneath the lateral or outer corner of the eye, and do not have the puffiness and laxity of more severely aged lower eyelids. For these individuals a minimally invasive blepharoplasty technique called the pinch blepharoplasty" can provide very satisfactory results with minimal postoperative recovery time. Typically the pinch blepharoplasty can be done with local anesthesia, avoiding the need for general anesthesia. The pinch blepharoplasty involves making a small incision in a normal skin line or crow's foot" just beside the corner of the eye where the upper and lower eyelid meet. The incision is then extended beneath the eyelashes for about a centimeter or inch. This incision may be made with a scalpel although I use the CO2 Ultrapulse Encore laser, which eliminates bleeding and bruising, and results in much quicker recovery. Through this tiny incision the excess eyelid skin and muscle is loosened, and the loose tissue pulled upward and to the side towards the ear. The excess skin and muscle is then excised with the laser with minimal or no bleeding. Next, the lower eyelid muscle is tightened with an orbiculopexy. A small suture is placed in the outside corner of the lower eyelid muscle and then sutured to the tissues of the outer upper corner of the eyelid. This maneuver tightens the entire lower eyelid giving the lower eyelid a tight youthful appearance. The skin of the lower eyelid is then closed with 3 to 4 tiny sutures, which are removed in 5-6 days. The pinch blepharoplasty is a simple, minimally invasive blepharoplasty technique with effective results and minimal down time when properly performed on the appropriate patient. It is appropriate for younger patients with early signs of eyelid aging that include loose bunchy lower eyelid skin, which is, most noticeable at the outer corner of the eyelid. It is not however, an adequate blepharoplasty technique for patients who have more advanced lower eyelid aging changes such as puffy eyes, eyelid bags, dark circles under the eyes, loose lower eyelid, and moderate sagging or loose lower eyelid skin. Brooke R. Seckel, M.D., FACS
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