Skin pinch for lower eyelid skin excess
This is a difficult problem to assess via photographs. An important portion of the examination is pinching the skin and assessing your lower eyelid tone. Based on what I can see from this photo, it is only my opinion that the laxity is too far down on the eyelid to be improved by a skin pinch.
Skin Pinch with Volume Replacement
Often times the skin is not "excessive" but the volume of the lower eyelid has diminished. Skin Pinch or excision subcutaneously (same as the skin pinch) combined with orbital volume replacement will address the deflated lower lid.
Based on your photographs, I do not believe that a skin pinch is enough. It looks like you have moderate redundant skin on your lower lids. I think you would benefit from a subcutaneous belpharoplasty to elevate all the skin off of the muscle and pull it up (similar to tightening the sheets on your bed). If you do not elevate all the skin and just do the pinch, I think there will not be a significant improvement and it may lead to excess tension pulling on the lower lid. Since you have recently had a transconjunctival blepharoplasty and laser resurfacing, my advice would be to wait at least three months to allow all of the tissue to heal. Eye lid surgery is very complicated and repeated surgery can lead to big problems. Do no rush into anything. Good luck.
A skin pinch is a blepharoplasty
Removal of skin below the eye, if unsupported, exerts force on the lower eyelid: downward force. However subtly, it can affect eye shape by rounding or by pulling down on the corners of the eye. In lax lower eyelids or if the pinch is more extensive, the deformity will be greater.
In our practice, we do not perform skin pinches without supporting the corner of the eye, usually with an ultrashort incision cheeklift (USIC). This also enables greater tightening than a skin pinch could without causing lower eyelid retraction.
Your fears are well taken.
It will depend on the laxity of the lower lid, Althoughyou had a canthoplasty.
On exam what is the distraction tst and the snap test show, these are tests to assess the laxity of the lid.
Pinch excision of the skin can improve you some (according to the picture).
You can protect against Ectropion by suture lateral lids or FROST STITCH
You have a HOLLOW EYE SYNDROME, and deflation of the upper and lower lid, volume replacement will improve you further
Too much fat removed with blepharoplasty.
I do see the lines of course. These often look thicker after CO2 laser. I wonder what you look like when you are not smiling.
In any case, the main problem is hollowing of your lower lids after blepharoplasty. Removing a little skin will not help. Skillfully done fat injections would make you look better.
A conservative pinch of skin in the lower eyelid blepharoplasty is an excellent technique for excess lower eyelid skin. It, if performed conservatively without tension, heals with nearly an imperceptible scar. The incision can be closed with Histocryl tissue glue or meticulous dissolvable sutures. Pinching of the lower eyelid skin will help with wrinkles but will not get rid of all of the lower lid wrinkles. It is very important not to change the shape of the lower lid.
Skin pinch may be appropriate
A skin pinch may be quite appropriate but it is difficult to say given the available information. I would say that some CO2 laser resurfacing was performed at the time of your concerns about excess skin and wrinkling and lower eyelids. These lasers are quite effective but not all patients will see complete resolution and tightening of the skin excess. It can take up to six months to see the final effects of the laser resurfacing.
I think it is likely, based on your photos, and that some type of skin excision will be required. If, however, your laser procedure was performed fairly recently than I would wait at least six months before making a decision. If excess skin persists then you can make a decision about whether potential scarring is more of concern than the skin excess. I have often been amazed by how the skin continues to change following laser resurfacing and I would encourage you to give adequate time for your wounds to mature.
Removal of skin is okay....
I've seen your questions previously. My take on this is 1. you originally had too much skin truly for CO2 resurfacing and should have had skin removed. 2. If a canthopexy is performed often muscle plication and skin removal is necessary. Only if the patient is very young with abnormal lower lids do I do a canthopexy along.
So yes have some skin removed. Now when I remove skin from the lower lids we're only talking about 2-4mm and muscle plication is added. This helps prevent ectropion. Less is better in this situation.
Consider a second opinion
A skin pinch might help your lower eyelids or it might not. Dr. Moelleken is absolutely right to be concerned about lower eyelid support, particularly given how much excess skin you appear to have in your lower eyelid.
The amount of skin you need removed is actually much more than is classically addressed with a skin pinch. That is not to say it can't be done. However, this will directly couple the lower eyelid to your falling cheek, placing the weight of the cheek on the lower eyelid. This has the potential to alter the lower eyelid position even if the canthal tissue is supported with a canthoplasty, a more aggressive procedure than the canthopexy you had with your original surgery.
I am also struck by how hollow your under eye area is. This also matched the hollow upper eyelid sulcus evident in the upper eyelid. You are obviously not entirely sold on your surgeon's proposal or you would not be asking this question on the Realself website.
I have responded to two other questions you have posed here, and again, I strongly encourage you to seek other surgical opinions regarding your options.