"Pinch" lower blepharoplasty for saggy wrinkled under eye skin unmitigated by peels, retinol, and fractional CO2 laser?

A skin pinch can be an excellent option.  The key is really finding the right approach for you.  In your late thirties, it is critical to preserve structure and function.  Often skin pinches are really performed as skin/muscle pinch.  That is bad because is damages the underlying muscle that keeps the lid margin against the eye surface.  Ask questions and look for a surgeon who makes sense to you.

When treating the lower eyelids it may be important to consider the limitations of surgery. If you do have surgery your surgeon will need to address support of the lateral canthus (the outside corner of the eye). An an alternative to skin reduction surgery is the use of tissue fillers.I hope this helps.Alexander Anzarut