Further experience with the pinch technique for repair of eyelid deformities.

The pinch technique has been found to be useful in repairing cosmetic eyelid deformities. However, the local anesthetic containing hyaluronidase must be injected only in small amounts and only into the subcutaneous space. Scar tissue and skin that is firmly adherent to underlying muscle do not yield a satisfactory ridge, and therefore, the pinch technique should not be used. Ectropion can be predicted by the observation of eversion of the lid margin when even only minimal skin is pinched, and impending ectropion can be discovered by our "lean forward and look up" maneuver. An ectropion repair can then be combined with the blepharoplasty surgical operation. The pinch technique has also been found useful when upper and lower blepharoplasties are joined laterally to elevate the lateral canthus and eliminate "crow's feet." One component of a repair of trichiasis also involves the use of the pinch technique.