Would a skin pinch be performed if wrinkles appear under eye after transconjectival lower bleph when smiling only?

A skin pinch is done when there is extra skin.  This excess may not be noticed when at rest, but only when smiling.  But if there is excess it can be removed, or laser done to tighten the skin.  When fat is removed, the lines may become more obvious since there is now less volume in the lower lid.   May need to consider fillers.   

It is very tricky to take too much skin from the lower eyelid trying to remove all the wrinkles.  It can lead to ectropion and is not the best option.  The best option at this time would be Thermismooth treatments to the eyelid area in the baggy appearance and the wrinkles.RegardsDr. J

Thank you for your question.  The risk of removing skin when there is not excess is causing what is called an ectropion, or pulling down of the eyelid.  This can cause eye irritation and a poor cosmetic result.  Without an evaluation in person, it would be difficult to assess if there was excess skin.  Best to speak with a board certified plastic surgeon about your concerns.  All the best,

Thank you for sharing your question. Without an in-person evaluation, it is not possible to judge your situation. It sounds like you may not have extra skin to remove, but in office evaluation is best. Good luck.

Hi. Smiling can make excess lower eyelid skin more obvious. This is because smiling elevates your cheek, which in turn recruits more skin towards you lids. In addition, contraction of the muscles around your eyes can cause the appearance of wrinkles as well. It may or may not be possible to remove lower eyelid skin with a pinch blepharoplasty. If you skin is loose when you are expressionless, then a smallpinch blepharoplasty may be possible. On the other hand, if you skin is tight, then removing skin can cause ectropion of lid retraction. If the excess skin is due to volume loss, then fillers may help. An in person exam is essential to determining your best options. Best regards, Ira Vidor, M.D.

If you have some excess lower lid skin, this can be treated by a simple skin pinch. Best of luck if this is the case.

Removing too much skin of the lower eyelid is worse than having too much skin because it can lead to a pulled down or droopy eyelid which is cosmetically and functionally unacceptable. The wrinkles that you describe can be treated with a small pinch of skin if there is, in fact, too much skin. The skin tone may respond to laser resurfacing in some cases. Small amounts of Botox injections into the muscle may help to delineate whether it is merely a muscle issue or excess skin. John Standefer MD

Eyelid closure is dependent on having excess tissue  Removal of too much tissue can cause dry eye symptoms with scleral show or ectropion.When you smile the smile muscles (zygomaticus left cheek skin upward causing the bunching of tissue near the lower eyelid.  This is completely normal.  A pinch blepharoplasty of the margin of the lower eyelid would be appropriate only if there were excess skin at the margin when a person is at rest.  A small amount of botulinum toxin (Botox) may be helpful here for short-term benefit.