Under-eye rejuvenation may involve both reduction of the fat pads and the tightening of the skin laxity. The fullness under the eyes is caused by the 3 lower eyelid fat pads pushing forward. The second is the skin itself, which can become loose, thin, and crepey over time. Some patients present mainly with one or the other, but some patients, such as the patient highlighted here, need to have both addressed.
This patient had an upper blepharoplasty including inner upper eyelid fat reduction, a lower bag reduction, and a skin pinch below the lower lash line to tighten the lower eyelid skin.
What is a skin pinch blepharoplasty?
A skin pinch is a conservative way to remove excess lower eyelid skin. A thin strip of skin is gently pinched with a fine instrument just below the lash line, measured carefully, and removed. Only skin is removed. The muscle beneath it is left completely undisturbed.
The amount taken is small. In published surgical series, the removed strip typically measures between 4 and 7 millimeters depending on the degree of laxity under the eyes. That is enough to smooth skin that folds or bunches, without changing the shape or position of the eyelid.
Why removing fat alone can fall short
Many lower eyelid procedures focus on the fat pads, either removing or repositioning them through an incision hidden inside the eyelid. That approach treats the bulge well, and for the right patient it is all that is needed. I have written about that scarless approach before.
But when the surface skin has lost its elasticity, correcting the contour underneath does not fix the texture on top. The skin can still fold, wrinkle, or rest in fine creases. In some patients, this can be addressed with ablative laser skin resurfacing, in others a skin pinch may be best.
This patient’s procedure
His examination showed excess upper eyelid skin above and both fullness and loose skin below. The plan was an upper blepharoplasty, a lower blepharoplasty to address the fat pads, and a skin pinch to finish the lower lids.
Everything was done in our Fullerton office under local anesthesia, with no hospital and no general anesthesia. The upper eyelids were marked with him seated upright in their natural position with gravity. The pinch incision sits just below the lower lashes and heals as a fine line that hides in the natural shadow of the lash line. As with every patient, I called him that evening to check in. He had minimal discomfort by the evening of surgery.
Image: before and after, front view
What is recovery like?
Recovery is similar to a standard eyelid procedure. There are no eye covers blocking vision, and most patients can drive and do desk work the day after surgery. Sutures come out at about one week, and most visible bruising and swelling resolves over the first two weeks. The fine incision line beneath the lashes fades steadily over the following weeks.
Frequently asked questions
Is a skin pinch the same thing as a lower blepharoplasty?
A skin pinch is one part of what a lower blepharoplasty can include. Blepharoplasty means eyelid surgery, and the pinch is the step that addresses loose surface skin. It can also be performed on its own for patients whose only concern is skin laxity.
Will there be a visible scar?
The incision sits immediately below the lower lashes. Once healed, it rests in the natural shadow of the lash line and is very difficult to see.
Who is a good candidate for a skin pinch?
Patients with loose, crepey, or finely wrinkled lower eyelid skin, with or without under-eye bags. The pinch is for true excess skin, which is something I assess during the consult.
Can a skin pinch be combined with other treatments?
Yes. It is commonly combined with lower eyelid fat removal or repositioning, with an upper blepharoplasty, as it was for this patient, and in selected patients with laser skin resurfacing to further improve skin texture.
Does a skin pinch change the shape of the eye?
No, when it is performed conservatively. Only true excess skin is removed, and the deeper support of the eyelid is never disturbed, which is what protects the natural shape and position of the lid.
If your lower lids have both bags and loose skin
The right plan depends on which layers are actually causing what you see. At a consultation, we will look at the fat, the skin, and the support of the lid separately, and I will tell you plainly which steps your eyes do and do not need.
Call 714-449-1940 or book an appointment online. Fresh Eyelids is located in Fullerton and serves patients across Orange County, including Anaheim, Brea, Yorba Linda, Irvine, and Newport Beach. You can view more patient results in our gallery.
