Like all aging processes, changes around the eyes are gradual with an onset and progression over many years. Aging changes often begin in the 30s with a little puffiness or bags on the lower eyelids and the beginning of some fine wrinkles in the crow’s feet. As it progresses into the 40s, excess skin is eventually evident in the upper and lower eyelids as well. Early eyelid aging is usually bothersome in the lower eyelids to most patients as they see the once smooth and pristine skin change. As more and more patients are interested in ‘early onset’ aging surgery so that more major surgery may not be needed later, concerns about the lower eyelids are usually voiced long before the upper eyelids.
In the younger patient who does not have a severe aging issue on the lower eyelids, a traditional more formal lower blepharoplasty (eyelid) procedure is usually not needed. A little removal of fat, tightening up a little bit of skin, and erasing some of the early wrinkles is often all that is need. This can be accomplished by a limited lower blepharoplasty or a ‘pinch and peel’ technique.
In the pinch and peel lower blepharoplasty, an extended skin-muscle flap is not raised as in the traditional lower blepharoplasty. A special instrument is used to pinch up a little excess skin underneath the eye lashes and then it is trimmed. Some lower eyelid fat can be removed from inside the lower eyelid at the same time. Finally the lower eyelid skin is peeled with a chemical solution, usually 25% or 35% TCA (trichloroacetic acid), which is perfectly safe as the skin which is being peeled has not been undermined. This combination of three ‘little’ procedures, when put together at the same time, produces a very noticeable change but without a lot of recovery. There usually is no bruising and minimal swelling. The ‘recovery’ from this procedure is more related to the pinkness from the chemical peel.
The pinch and peel lower blepharoplasty is a procedure perfectly suited to the younger patient with limited aging issues of the lower eyelid. This procedure, combined with Botox treatments in the crow’s feet area, creates a nice rejuvenative effect with very minimal recovery. I have performed this procedure in the office under local anesthesia although it is more ideal if the patient is in the operating room under some form of anesthesia. The pinch and peel lower blepharoplasty truely fits my plastic surgery motto of….match the size of the oepration to the size of the problem.
Dr. Barry Eppley