What’s in a Pinch: A Closer Look at Lower Eyelid Pinch Blepharoplasty

Introduction: The skin pinch technique is generally thought to excise a skin-only specimen, with minimal damage to the underlying orbicularis oculi muscle. The purpose of this study was to assess for the presence and quantity of muscle excised during routine lower eyelid pinch blepharoplasty. Methods and Materials: Horizontal tissue sectioning (Mohs technique) with histologic circumferential peripheral and deep margin assessment was employed to allow for evaluation of the entire deep margin of the pinch specimen. Hematoxylin and eosin slides were examined. The presence of and total surface area of skeletal muscle were calculated. Results: Ten pinch blepharoplasty specimens with a mean surface area of 70.6 ± 29.0 mm2 were evaluated. Overall, 90% (9/10) of specimens had at least 1 quadrant with muscle. On average, 3 ± 3% (range 0%-9%) of the total pinch specimen surface area contained muscle. There was a strong positive correlation between the size of skin excision and the percentage of surface area with muscle (Pearson correlation: 0.942; P < .001). Discussion: In the majority of cases, the amount of muscle excised during pinch blepharoplasty is negligible; however, larger skin excisions may be expected to result in disproportionately greater muscle resection. Conclusions: The lower eyelid pinch blepharoplasty technique is an effective method of excising redundant skin with minimal resection of orbicularis muscle.