Cultural Differences in Pretarsal Fullness Acceptance

Sir: I read with interest the article by Jeon et al.1 on pre tarsal augmented lower blepharoplasty. The authors indicated that pretarsal fullness is an attractive aspect of the lower eyelid and, in their article, they present a procedure to create this. I attach a lateral lower eyelid orbicularis flap to the lateral orbital wall when I perform a midface lift and a lower eyelid plication blepharoplasty.2,3 At times, this creates a tightening of the pretarsal orbicularis and a subsequent fullness of the pretarsal area. Most of my Caucasian patients find this to be unacceptable, and I then have to treat this with either excision of the thickened orbicularis or botulinum toxin type A injections into it. I point this out, as I suspect there may be a cultural difference in what is considered attractive with the authors’ procedure. ACKNOWLEDGMENT The author is supported by an unrestricted grant from Research to Prevent Blindness, New York, N.Y. (EY001792). DISCLOSURE The author has no financial interest to declare in relation to the content of this communication. Allen M. Putterman, M.D.Department of OphthalmologyUniversity of Illinois College of Medicine in Chicago111 North Wabash, Suite 1722Chicago, Ill. 60602[email protected]