Definition:

Pinch lower blepharoplasty is a skin-only lower-eyelid procedure in which a narrow strip of redundant skin immediately beneath the lash line is excised by “pinching” the skin to determine a safe amount for removal. There is no skin undermining and the orbicularis oculi muscle and middle lamella are preserved, reducing the risk of lid malposition. It can be combined with transconjunctival fat adjustment and/or resurfacing when needed.

Indications:

Best suited for patients with:

• Mild–moderate lower-lid skin laxity/“crepey” rhytids with good lid tone.
• Minimal or well-controlled fat prolapse, or cases where fat is treated transconjunctivally and the skin excess is addressed with a pinch.
• Fine rhytids where adjunctive laser/peel may be planned.
• Patients desiring a conservative, quick procedure under local anaesthetic with a low risk of ectropion/scleral show compared with skin-muscle flaps.

Contraindications : (relative/absolute)

• Poor lower-lid tone or lax canthus (weak snap-back/distraction test) unless supported with canthopexy/canthoplasty.
• Significant negative vector anatomy with prominent globes and/or marked laxity requiring more extensive support.
• Severe dry-eye disease, lower-lid retraction, cicatricial changes, or previous complicated lower-lid surgery.
• Uncontrolled smokers, anticoagulation that cannot be paused, active thyroid eye disease, infection, or unrealistic expectations.

Advantages:

• Skin-only excision—preserves orbicularis and middle lamella → lower risk of scleral show/ectropion.
• Predictable, conservative skin reduction ; easy to stage/repeat if needed.
• Compatible with adjuncts: transconjunctival fat contouring, canthopexy, and resurfacing.
• Efficient and well-tolerated under local anaesthetic in clinic settings.

Limitations:

• Does not correct significant fat herniation, deep tear-trough/ORL tethering, or malar descent by itself—these may need transconjunctival fat excision/reposition, ORL release, fat grafting, and/or canthopexy.

Limited role in marked laxity or poor canthal support where skin-muscle flaps or canthal procedures are preferred.