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

It is still too early to see the final result of a fractional CO2 treatment, I would wait a few more months. At that point you can consider re-treatment with fractional CO2 or CO2 laser. CO2 will give you the most tightening, but has a longer recovery period.

A pinch of skin is safe to do if you actually have excess skin.  However the pinch does not change the texture of the remaining skin.  For that you need the laser treatments.  Many people need 2-3 fractionated CO2 treatments to see significant improvement in the texture.  And if you are fair skinned, you might want to consider a full CO2 laser which gives the best tightening.  If you are volume deficient some filler will also help to stretch out the skin and make it look smoother.    

The problem with a 'pinch' blepharoplasty is that it can change eye shape.  An almond shaped eye can be pulled down in the center, causing a rounded appearance, or in the corners, causing a sad appearance.The lower eyelid is a very weak structure, and subtracting from it by the pinch method exerts a downward force, causing the skin to sit lower on the globe or eyeball.  This even occurs in the best of hands with this technique, albeit subtly. We usually rely on an ultrashort incision cheek lift to reduce crepey lower eyelid skin, elevate the eye cheek junction, deal with the lower eye fat bulging, but preserve almond eye shape.

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

Thanks for posting your question. A fractional CO2 laser is a good treatment for the fine lines of the lower eyelid and crows feet area.  The treatment needs time for the collagen to build and reduce wrinkles.  6 months for final results. In my opinion your options include:1) repeating the fractional laser 2) Botox if the wrinkles are dynamic3) skin only lower blepharoplast aka skin pinch. Please consult with an experienced board certified surgeon to diacuss your options in person.  

I cannot comment without at least looking a photo. In general, you are young to have enough safe loose skin in lower eyelid area for removal. Best to see an oculoplastic specialist for evaluation.

A lower lid skin pinch can be a great option for the right patient. You would benefit from an in person consultation with a board certified surgeon with expertise in periorbital rejuvenation.

You state that your problem is wrinkling, not excessive eyelid skin or orbital fat. Removing skin will do nothing to smooth the skin left behind. During a "pinch" lower eyelid blepharoplasty a tiny strip of skin is removed. The skin that's left behind is the same wrinkled skin, only slightly less of it. A Fractional CO2 laser achieves only modest improvements and should not be confused with a traditional CO2 laser treatment which will obtain dramatic improvement in wrinkling as well as noticeable skin tightening. The fractional CO2 laser was developed to offer faster and easier recovery but also offers much less of a result.  If wrinkles are the primary concern the traditional CO2 laser is still the gold standard skin texture treatment.  Follow the link to see some examples of what CO2 laser can accomplish.

It's hard to comment without a photo but performing a lower eyelid surgery with orbicularis muscle hitch and skin tightening is usually the best way to go.  Even if it doesn't seem like it, performing a fat transposition at the same time gives a big improvement for most patients and prevents hollowing down the line