Micropunch Blepharopeeling of the Upper Eyelids: A Combination Approach for Periorbital Rejuvenation – A Pilot Study J. BARTON STERLING, MD, FAAD
BACKGROUND Upper eyelid skin excess is commonly treated using a surgical excision that is then sutured, resulting in a linear scar. Deep chemical peeling of the upper eyelids using the Baker Gordon formula has been described as a nonsurgical alternative to tighten upper eyelid skin with the advantage of lessening periorbital rhytides, although prolonged healing and hypopigmentation are risks. The goal of this study was to show the benefits of a less-invasive approach to periorbital rejuvenation that combines 89% phenol peeling with small, nonlinear excisions that heal by secondary intention. METHODS Eight patients were chosen (mean age 59.6). All patients had thin to medium-thick skin, diffuse periorbital rhytides, and mild to moderate upper eyelid skin excess. Their eyelids were peeled using 89% phenol. Immediately after peeling, a scissor was used to make multiple small nonlinear excisions of upper eyelid skin that healed by secondary intention. RESULTS
Patients were satisfied with the results, and no complications or scarring occurred.
CONCLUSIONS Eighty-nine percent phenol peeling combined with multiple small upper eyelid skin excisions effectively tightens upper eyelid skin excess and lessens periorbital rhytides. The procedure has the advantage of not creating a linear scar and decreases the risk of prolonged healing and hypopigmentation, which is more likely with deeper peels. The authors have indicated no significant interest with commercial supporters.
“M
icropunch blepharopeeling” is a procedure to treat periocular rhytides and reduce upper eyelid skin excess without the linear scar associated with traditional surgical blepharoplasty. The procedure involves peeling the eyelids with 89% phenol and then immediately excising small nonconnecting pieces of upper eyelid skin using scissors. The excisions heal by secondary intention. Unlike the previously described and useful technique called “blepharopeeling”,1 micropunch blepharopeeling does not rely on the deepest chemical peel solution (the Baker-Gordon phenol-croton oil peel) to tighten excess upper eyelid skin. The deepest peels may modestly reduce upper eyelid skin excess but carry the
risks of prolonged erythema and skin hypopigmentation. Micropunch blepharopeeling follows the trend of less-invasive cosmetic procedures and can be performed comfortably and rapidly in-office. Similar to “skin only” blepharoplasty, which involves excising a strip of upper eyelid skin without removing muscle and fat, micropunch blepharopeeling conforms to the current emphasis of volume preservation as the youthful esthetic ideal.
Method Over an 8-month period, eight patients (6 women, 2 men; mean age 59.6, range 50–69) were selected
Private Practice, Spring Lake, New Jersey © 2014 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc. ISSN: 1076-0512 Dermatol Surg 2014;40:436–440 DOI: 10.1111/dsu.12449 436
BARTON STERLING
from a solo private practice. All but one patient had Fitzpatrick type I to III skin. All had thin to mediumthick skin, diffuse periorbital rhytides, and mild to moderate upper eyelid skin excess. All patients had their history taken, and informed consent was obtained. No previous topical treatment was used. No laboratory tests or electrocardiograms were performed. The majority of patients received intramuscular ketorolac and oral alprazolam. Some had only oral acetaminophen. No anticoagulants were stopped. Before the procedure, patients washed their faces with chlorhexidine cleanser and then thoroughly rinsed to remove any residue from the skin. If the patients had thicker skin or more-severe wrinkles or solar damage, the skin was further degreased with acetone or isopropyl alcohol, which enhances peel penetration. Patients were placed in the supine position, and the upper eyelids were injected in the most superficial manner possible to avoid hematoma with
BACKGROUND Upper eyelid skin excess is commonly treated using a surgical excision that is then sutured, resulting in a linear scar. Deep chemical peeling of the upper eyelids using the Baker Gordon formula has been described as a nonsurgical alternative to tighten upper eyelid skin with the advantage of lessening periorbital rhytides, although prolonged healing and hypopigmentation are risks. The goal of this study was to show the benefits of a less-invasive approach to periorbital rejuvenation that combines 89% phenol peeling with small, nonlinear excisions that heal by secondary intention. METHODS Eight patients were chosen (mean age 59.6). All patients had thin to medium-thick skin, diffuse periorbital rhytides, and mild to moderate upper eyelid skin excess. Their eyelids were peeled using 89% phenol. Immediately after peeling, a scissor was used to make multiple small nonlinear excisions of upper eyelid skin that healed by secondary intention. RESULTS
Patients were satisfied with the results, and no complications or scarring occurred.
CONCLUSIONS Eighty-nine percent phenol peeling combined with multiple small upper eyelid skin excisions effectively tightens upper eyelid skin excess and lessens periorbital rhytides. The procedure has the advantage of not creating a linear scar and decreases the risk of prolonged healing and hypopigmentation, which is more likely with deeper peels. The authors have indicated no significant interest with commercial supporters.
“M
icropunch blepharopeeling” is a procedure to treat periocular rhytides and reduce upper eyelid skin excess without the linear scar associated with traditional surgical blepharoplasty. The procedure involves peeling the eyelids with 89% phenol and then immediately excising small nonconnecting pieces of upper eyelid skin using scissors. The excisions heal by secondary intention. Unlike the previously described and useful technique called “blepharopeeling”,1 micropunch blepharopeeling does not rely on the deepest chemical peel solution (the Baker-Gordon phenol-croton oil peel) to tighten excess upper eyelid skin. The deepest peels may modestly reduce upper eyelid skin excess but carry the
risks of prolonged erythema and skin hypopigmentation. Micropunch blepharopeeling follows the trend of less-invasive cosmetic procedures and can be performed comfortably and rapidly in-office. Similar to “skin only” blepharoplasty, which involves excising a strip of upper eyelid skin without removing muscle and fat, micropunch blepharopeeling conforms to the current emphasis of volume preservation as the youthful esthetic ideal.
Method Over an 8-month period, eight patients (6 women, 2 men; mean age 59.6, range 50–69) were selected
Private Practice, Spring Lake, New Jersey © 2014 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc. ISSN: 1076-0512 Dermatol Surg 2014;40:436–440 DOI: 10.1111/dsu.12449 436
BARTON STERLING
from a solo private practice. All but one patient had Fitzpatrick type I to III skin. All had thin to mediumthick skin, diffuse periorbital rhytides, and mild to moderate upper eyelid skin excess. All patients had their history taken, and informed consent was obtained. No previous topical treatment was used. No laboratory tests or electrocardiograms were performed. The majority of patients received intramuscular ketorolac and oral alprazolam. Some had only oral acetaminophen. No anticoagulants were stopped. Before the procedure, patients washed their faces with chlorhexidine cleanser and then thoroughly rinsed to remove any residue from the skin. If the patients had thicker skin or more-severe wrinkles or solar damage, the skin was further degreased with acetone or isopropyl alcohol, which enhances peel penetration. Patients were placed in the supine position, and the upper eyelids were injected in the most superficial manner possible to avoid hematoma with
