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'Pinch Bleph' Within Cosmetic Dermatologists' Realm of Expertise


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ORLANDO – Cosmetic dermatologists can easily perform a skin pinch blepharoplasty to remove excess skin from a patient’s lower eyelid, according to N. Fred Eaglstein, D.O.

"This is a very simple technique, especially for derm surgeons used to doing large skin flaps and grafts," said Dr. Eaglstein at the annual meeting of the Florida Society of Dermatologic surgeons. "I do all these procedures in my office."

The "pinch bleph" can be performed alone or in conjunction with laser resurfacing to improve the appearance of dermatochalasis and thin, wrinkled, sun-damaged lower eyelid skin, Dr. Eaglstein said. Not all patients are candidates, however. Because the technique removes only excess skin, it is not indicated for patients with lower, orbital, fat-pad protrusion.

Following a baseline ophthalmology examination, instruct the patient to discontinue aspirin, NSAIDs, and any herbal products that could prolong bleeding. Exclude or get clearance for patients with significant medical problems such as thyroid disease, Dr. Eaglstein said.

To determine how much skin to remove, pinch the lower eyelid skin together using blunt forceps until the eyelid margins start to evert. Then, mark the area with a fine tip gentian violet marker. He said that he crushes the excess skin using a curved hemostat and excises the tissue with Westcott or sharp iris scissors. He recommends 6-0 nylon sutures or 6-0 fast absorbing gut sutures to close the wound. "I use 6-0 fast absorbing."

"Don’t take too much skin if you plan to do laser resurfacing. You don’t want to get too much tightening [if you also plan to do] erbium laser resurfacing," said Dr. Eaglstein, a private practice dermatologist in Orange Park, Fla.

Expected complications include ecchymosis and edema. Less commonly, patients can experience hematoma, infection, scleral show, or ectropion.

"The pinch blepharoplasty is a simple, safe, and effective surgical procedure for the derm surgeon interested in providing cosmetic rejuvenation of the lower eyelid," Dr. Eaglstein said.

For more information, Dr. Eaglstein recommended a report by Joesph Niamtu III, D.M.D. on his lower eyelid blepharoplasty technique and experience (Cosmetic Derm. 2008;21:652-7).

He also recommended a report on a series of 77 candidates for traditional lower blepharoplasty who underwent a pinch blepharoplasty (Plast. Reconstr. Surg. 2005;115:1405-12). The author reported no significant scleral show or ectropion adverse events.

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