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

Question

No wrinkles when my face is expressionless. But, after my lower bleph (transconjectival fat pad removal) there is not as smooth transition from eye muscle and lower eye (tear trough?) to cheek making those eye muscles look like bags. Wrinkling under eye when smiling. Also, wrinkles when sming were not present when bags were there. It seems like there's extra skin. My surgeon said my eyelid quality is good and she wouldn't do a pinch with lower bleph bc wrinkles not visible head on/no smile.

John J. Martin, Jr., MD · Answer

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.

Tanveer Janjua, MD · Answer

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

Keshav Magge, MD · Answer

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,

James R. Gordon, MD, FACS, FAAO · Answer

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.

Ira Vidor, MD · Answer

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.

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

Answers (8)