J Cosmet Dermatol. 2020;00:1–7. wileyonlinelibrary.com/journal/jocd | 1 © 2020 Wiley Periodicals LLC Received: 2 February 2019 | Revised: 18 September 2019 | Accepted: 6 March 2020 DOI: 10.1111/jocd.13394 ORIGINAL CONTRIBUTION Evaluation of combination therapy with peeling added to minimal invasive blepharoplasty in lower eyelid rejuvenation Ali Asilian MD 1,2 | Zabihollah Shahmoradi MD 1,2 | Mahboobeh Talakoub MD 1,2 | Fatemeh Mokhtari MD 1,2 | Amir Hossein Siadat MD 1,2 | Fatemeh Mohaghegh MD 1,2 | Neda Adibi MD 2 | Samaneh Mozafarpoor MD 2 | Samira Kazemipour MD 1,2 | Farzaneh Danesh MD 1,2 | Hossein Hafezi MD 1,2 1 Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran 2 Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Correspondence Mahboobeh Talakoub, Department of Dermatology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. Email: mahboobeh.talakoob@gmail.com Funding information The current study was sponsored by Isfahan University of Medical Sciences. Abstract Introduction: Aging is an inevitable process in life that can pose unsatisfactory changes in appearance. Recently, rejuvenation surgeries have opened an exciting new window toward people who are vulnerable according to their facial appearance. Periocular plastic microsurgeries are among the most common aesthetic surgeries with various outcomes. The current study was aimed to compare outcomes of blepha- roplasty with and without peeling regarding lower eyelid rejuvenation. Methods: This is a randomized clinical trial study conducted on 30-patients referred for inferior lid rejuvenation in 2017-18. Patients were randomly divided into two 15-member subgroups of microinvasive blepharoplasty with and without peeling. Peeling for the group underwent blepharopeeling was performed all over the infe- rior periocular region using Phenol 89%. Then, skin and underlying muscle were in- cised superficially, and underlying fat tissue was excised. The other group underwent blepharoplasty without peeling. Patients were followed daily for 2 months to assess complications, patients' and physicians' satisfaction. Results: Two assessed groups were not statistically different regarding age and gen- der distribution (P-value = .417 and .666, respectively). Considering patients' opin- ion, symmetry, scar formation, skin laxity, swelling, and total satisfaction score were not different between two groups (P-value > .05) while physicians presented simi- lar outcomes except for better scar formation status of peeling add-on therapy (P- value = .042). Rate of adverse effects was significantly higher among those under blepharoplasty plus peeling treatment (P-value < .05). Conclusion: Outcomes of blepharoplasty alone versus blepharoplasty plus peeling were not significantly different regarding both patients' and physicians' assessments in general while fewer complications due to blepharoplasty without peeling were presented. KEYWORDS blepharopeeling, blepharoplasty, periocular rejuvenation, rejuvenation