Simultaneous skin pinch lower blepharoplasty and full-field Er:YAG laser resurfacing: a novel combined approach for lower eyelid rejuvenation.

Evaluate safety and aesthetic outcomes of combining lower eyelid skin pinch blepharoplasty with full-field erbium:YAG resurfacing for lower eyelid rejuvenation. Retrospective case series of 25 consecutive patients undergoing simultaneous lower eyelid skin pinch excision and full-field erbium:YAG resurfacing as part of a standardized lower-eyelid rejuvenation protocol that also included tear trough/lid-cheek autologous microfat grafting with blunt orbital retaining ligament release; transconjunctival fat removal and canthopexy were performed as indicated. Two masked oculoplastic surgeons graded standardized photos using the Barton Tear Trough Scale (0-3). MRD2 was measured to assess lid position. Complications and clinically evident lower lid tightening were recorded. Barton scores were compared with Wilcoxon signed-rank testing and MRD2 with paired t-testing. Mean Barton scores improved from 2.88 ± 0.33 to 0.52 ± 0.51 (p < .0001), with improvement in all patients. All patients had Fitzpatrick skin types I - III. Mean MRD2 was unchanged (3.75 ± 0.79 mm vs 3.71 ± 0.53 mm; p = .65), indicating preserved lid position. Lower lid tightening was noted in 21/25 patients. No ectropion, lower lid retraction, new scleral show, or vision-threatening complications occurred. Transient chemosis occurred in 6 patients and prolonged erythema in 2, all resolving with conservative care. Combined lower eyelid skin pinch surgery and full-field erbium:YAG resurfacing, within a comprehensive lower-eyelid rejuvenation protocol, significantly improved tear trough appearance and wrinkles while preserving lid position, with mostly transient complications.