Q: Dr. Eppley, I’m interested in CO2 laser resurfacing and skin under my eyes and also to remove dark spots on my cheeks. Or maybe I need a pinch blepharoplasty instead. I had a lower blepharoplasty three years ago which left my eyes more wrinkled. I was told this procedure would remove the fat and then cut and tighten underneath. Only the fat was removed. I’ve load an up close picture which also shows the spots and a smiling picture you can see how much extra skin is under my left side, which makes me not want to smile as it shows worse when I do.
A: By your description your original lower blepharoplasty sounds like a transconjunctival one in which no skin was removed but only fat from the inside of the lower eyelid. By deflating lower eyelid ‘bags’ (fat), skin wrinkles are often worsened as the skin retracts. This is why many transconjunctival lower blepharoplasties often include a simultaneous skin resurfacing procedure (laser or chemical peel) to avoid this aesthetic problem with fat ‘deflation’. At this point, you need a pinch lower blepharoplasty, as you have surmised, to get rid of the roll of skin and muscle that is just under your lashline. With smiling not all of the extra skin can be completely removed but a significant improvement can be obtained.
Dr. Barry Eppley