Skin Pinch Unwanted Side Effects or Risks?

Question

What are the chances of scarring after having a skin pinch? What are the risks? After having lower transconjunctival lower Blepharoplasty done with laser CO2 Resurfacing. I have extra skin and am going to do a skin pinch to get rid of it. Yet, I am concerned with scaring and risks. Are the chances high? Any advice?

Brent Moelleken, MD · Answer

The scarring from a skin pinch procedure is usually minimal.  In most patients it is fact undetectable.
However, the alteration in eye shape may not be.
When skin is removed from the lower eyelid, it causes a downward force on the lower eyelid.  The lower eyelid is a very weak structure, and can pull down.  The result, over several months time, can be a typical blepharoplasty look, with a rounding of the eye, of a pulling down of the lower eyelid especially on the corners.
We do not therefore perform the skin pinch on the lower eyelid without doing an ultrashort incision cheeklift (USIC), which pulls up on the cheek, allowing conservative removal of skin from the lower eyelid without the high risk of eyelid shape alteration.

Larry S. Nichter, MD, MS, FACS · Answer

Skin Pinch Blepharoplasty refers to removing skin only and staying superficial in performing this procedure so that underlying structures like your muscle or fat pads are untouched. This superficial approach minimizes the chance for complication such as scar retraction (Ectropion). As long as not too much skin is removed, and the procedure is performed by an expert that is board certified, it is a safe procedure and most often the scar is undetectable.

Andrew Miller, MD · Answer

A skin pinch, in the hands of a well trained, qualified, and experienced surgeon should have minimal to no risk. With a proper incision placement, the scar should fade away nicely, and since only excess skin is removed with no violation of the muscle, drooping of the eyelid should not be a problem. These complications can happen if the surgeon is not extremely familiar with this procedure, so be careful.

Frank P. Fechner, MD · Answer

Many blepharoplasty surgeons combine skin pinch and trans-conjunctival fat removal in one procedure. If the lid support is assessed accurately and the skin removal done with conservatism, this procedure can be effective. Scaring should be minimal and not an issue.
Keep in mind, that a couple of skin wrinkles under the eye are OK, a droopy eyelid with ectropion is not. Therefore, your surgeon will not want to compromize lower lid support.

Richard D. Gentile, MD · Answer

The skin pinch is a common approach used by plastic surgeons to eliminate redundant eyelid skin. It can be done at the same time as transconjunctival blepharoplasty or later as a "touch up" procedure. The results obtained in reference to the visibility of the incision line are usually good and rarely do patients complain about the scar or feel it is overly conspicuous.

S. Randolph Waldman, MD · Answer

In experienced hands the incision should be insonspicous. However I have seen incisions placed too low or even too high and I have seen too much skin removed. With this in mind make sure your surgeon is experienced and ask to see some pictures. Then if you are still uneasy ask to speak to a previous patient.

Christopher L. Hess, MD · Answer

Removal of skin from the lower lid is a very delicate procedure and one that requires thought and understanding of the forces on the lower lid.  I agree with Dr. Moelleken and will remove skin from the lower lid but only in conjunction with a cheek or lid supporting procedure. 
Usually only 2-4 mm of skin can be removed safely.  In addition I will do a cheek elevation or a tarsal support with muscle plication.  Scarring is very minimal to virtually invisible if done correctly.
Pick your surgeon wisely.

Brooke R. Seckel, MD, FACS (retired) · Answer

Skin pinch blepharoplasty sould produce minimal scarring right below the eye lashes.
If too much skin is removed, ectropion is a risk.
If your lower eyelid support is weak, meaning that the lower eyelid is loose and has a tendency to droop, the risk of ectropion or lid droop is increased.
Your doctor should do a "lid snap back test" to make certain that your lower eyelid has adequate support.
This is particularly important since you have had both a previous blepharoplasty and CO2 laser resurfacing.

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