Simultaneous Skin Pinch Blepharoplasty, Full-Field Er:YAG Resurfacing Shows Favorable Outcomes for Lower Eyelid Rejuvenation

A combined approach incorporating lower eyelid skin pinch blepharoplasty and full-field erbium:YAG laser resurfacing demonstrated favorable aesthetic outcomes with a low complication rate in a retrospective case series published online ahead of print in the Journal of Cosmetic and Laser Therapy.

The study evaluated 25 consecutive patients who underwent simultaneous lower eyelid skin pinch excision and full-field Er:YAG resurfacing as part of a standardized lower eyelid rejuvenation protocol. Additional procedures included autologous microfat grafting to the tear trough and lid-cheek junction with blunt orbital retaining ligament release. Transconjunctival fat removal and canthopexy were performed when indicated.

Combined Surgical and Laser Approach Improves Tear Trough Appearance

Two masked oculoplastic surgeons assessed standardized photographs using the Barton Tear Trough Scale. Mean Barton scores improved from 2.88 ± 0.33 preoperatively to 0.52 ± 0.51 postoperatively (P < .0001). All patients demonstrated improvement. The study population consisted of patients with Fitzpatrick skin types I-III.

Investigators also evaluated lower eyelid position using margin reflex distance 2 (MRD2). Mean MRD2 measurements remained stable, changing from 3.75 ± 0.79 mm preoperatively to 3.71 ± 0.53 mm postoperatively (P = .65), suggesting preservation of lid position.

Lower lid tightening was observed in 21 of 25 patients. No cases of ectropion, lower lid retraction, new scleral show, or vision-threatening complications were reported. Transient chemosis occurred in six patients, while prolonged erythema was reported in two patients; all cases resolved with conservative management.

“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,” the authors wrote.

Source

Simultaneous skin pinch lower blepharoplasty and full-field Er:YAG laser resurfacing: a novel combined approach for lower eyelid rejuvenation. J Cosmet Laser Ther. Published online May 10, 2026. doi:10.1080/14764172.2026.2672347.