Expert Doctor

Skin Pinch Blepharoplasty

Clyde Ishii, MD

Honolulu, HI

Skin Pinch Blepharoplasty

Skin pinch blepharoplasty is a modification of the traditional lower. When a doctor does eyelid surgery on the lower eyelid, they are addressing two issues. The so called “bags” under the eyes may be caused by protruding fat as well as excess skin.



Many younger patients with “bags” have extra fat but little or no extra skin. The surgeon will either reduce or redistribute the amount of fat in the area but the surgeon will not do anything with the skin.



As people get older, there is usually some problem with fat protrusion as well as excess skin. The older type of lower blepharoplasty involved raising a skin flap or skin muscle flap off the lower eyelid, deal with the fat, and then remove the excess skin. With the skin pinch the surgeon does not have to raise a skin flap or skin muscle flap. The doctor can simply excise the skin through a pinch technique.



Skin pinch blepharoplasty helps to minimize complications of lower eyelid surgery such as lid malposition. Sometimes patients who have lower eyelid surgery end up with the lower eyelid pulled down. This is known as lower eyelid malposition. It is seen less often with skin pinch blepharoplasty because less surgery is being done to the inner layers of the lower eyelid. The procedure involves specific management of the excess skin on the lower eyelid to minimize complications like malposition.



Skin pinch blepharoplasty allows surgeons to address the excess skin without disrupting the deeper layers. Going deep into the eyelid causes more swelling and scar formation.



For many patients undergoing lower blepharoplasty adjunctive procedures to support he lower eyelid are not needed.  However, there are patients with “bags” who also have lower lid laxity due to loss of elasticity.  These patients are at greater risk to develop lid malposition.  Such patients require a skin pinch blepharoplasty as well as some type of lid tightening procedure to prevent the lid from sagging.



The skin pinch blepharoplasty minimizes complications as long as one does not remove too much skin.

Pinching the skin together with a forceps is kind of like a dry run. If the lid is pulled down by the pinch, this is a sign that too much is being taken. Less pinching is necessary in order to make the lid look good. Once it looks good, the surgeon can excise it and close it.



In general, the skin pinch blepharoplasty is associated with a shorter recovery time because the deeper layers of the eyelid are not involved. 

Recovery from the traditional skin flap or skin-muscle flap technique takes about three or four weeks while patients undergoing the skin pinch technique can look decent in 10 to 14 days because it is less traumatic.



It is important to note that the skin pinch technique is a way of managing the excess skin on the lower lid. If a patient has excess fat protruding, that is a completely separate issue and the skin pinch by itself will not address this problem. In most instances the protruding fat can be reduced or redistributed through a transconjunctival approach.


Written by Cosmetic Town Editorial Team - MA

Based on an exclusive interview with Clyde Ishii, MD, FACS, LLC, in Honolulu, HI