The pinch blepharoplasty revisited

The prevention of scleral show is truly one of plastic surgery's Holy Grails. This postoperative problem may be considered subtle, but it represents the most common cause of the "operated" look that we all strive to avoid. Of course, the postoperative fear of a true ectropion is all too common. These concerns, borne out in patient results following the traditional skin-muscle technique, are what drove the author to consider the "pinch" blepharoplasty.

All patients who were candidates for a lower blepharoplasty, primary or secondary, underwent the pinch blepharoplasty. Patients excluded were only those who underwent a carbon dioxide laser resurfacing of the lower eyelid, as no skin excision was planned.

Of the 77 blepharoplasties performed, there were no postoperative findings of lower eyelid malposition: no taping was necessary, no significant scleral show was evident, and no ectropion was produced. There was also noticeably less bruising and swelling postoperatively with this technique. Moreover, it was apparent that the crepe-like skin at the lower eyelid was often fully effaced or improved significantly.

The pinch blepharoplasty has proved to be a superior approach to lower eyelid rejuvenation. This series suggests that with this technique significantly more crepe-like skin can be removed with reliably less chance of scleral show.