Indications and Technique for Skin Pinch Skin Excision in the Lower Eyelids
Charles H. Thorne
Sammy Sinno
DEFINITION
Skin pinch skin excision is a technique in which excess lower eyelid skin is simply grasped and excised without performing any subcutaneous dissection.
Dermatochalasis is the condition of excess and loose eyelid skin. It is important to distinguish this condition from blepharochalasis.
Blepharochalasis is a syndrome of recurrent eyelid edema that causes thinning and fine wrinkling of eyelid skin.
ANATOMY
The skin of the eyelid is the thinnest of the body at less than 1 mm and has a high concentration of sebaceous glands.
PATIENT HISTORY AND PHYSICAL FINDINGS
All patient undergoing eyelid surgery should have a detailed ophthalmologic history. History of previous periorbital surgery, visual disturbances, and relevant medications are noted.
Patients who are candidates for skin pinch lower eyelid blepharoplasty have redundant and lax skin and often complain of a “tired” look. The stimulated effect of surgery can be reproduced preoperatively by providing gentle lateral traction on the lower eyelids.
Patients who undergo this procedure may undergo additional procedures to correct other periorbital deformities, ie, transconjunctival lower eyelid fat removal for “puffy eyelids.”
IMAGING
No imaging is needed for this procedure.
SURGICAL MANAGEMENT
The procedure is relatively simple and straightforward if carefully planned.
Preoperative Planning
Skin pinch lower blepharoplasty can be performed under general anesthesia or local anesthesia. If local infiltration is used, the surgeon must be aware that skin excision may be less precise because the field has been distorted.
Positioning
The patient is positioned supine. Corneal protectors can be used but are associated with increased risk of corneal abrasion.
Approach
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