Reply: Pretarsal Augmented Lower Blepharoplasty

Background: Narrow and chubby pretarsal fullness is a characteristic of attractiveness and youthfulness, and pretarsal augmentation has gained popularity in Asia. Conventional lower blepharoplasty has focused on correcting the aged appearance of the lower eyelids by repositioning fat and removing excess skin. However, this technique can create flat lower eyelids and provide an indication that cosmetic surgery was performed. Therefore, our pretarsal augmented lower blepharoplasty technique focuses on restoring pretarsal fullness and creating a three-dimensional lower eyelid-cheek complex. The authors present the results of this technique, which demonstrate that it simultaneously enhances lower eyelid support and restores pretarsal fullness. Methods: This retrospective chart review evaluated 659 consecutive patients who underwent pretarsal augmented lower blepharoplasty between 2011 and 2014. All procedures were performed by a single surgeon (H.L.C.). The outcomes and complications were assessed by evaluating the patients' preoperative and postoperative digital photographs and medical records. Results: There were no permanent major complications, such as retrobulbar hemorrhage, diplopia, or hypertrophic scarring. Chemosis occurred in 90 patients (13.7 percent), 10 patients (1.5 percent) underwent minor revision because of an undercorrected nasojugal groove or loosened orbicularis oculi muscle suspension suture, and three patients (0.46 percent) experienced mild ectropion that resolved spontaneously. Approximately 98 percent of the patients were satisfied. Our technique provided a natural and younger appearance with pretarsal fullness, rather than the flattened appearance that is associated with conventional blepharoplasty. Conclusions: Pretarsal augmented lower blepharoplasty uses simple methods to restore pretarsal fullness. This technique improves periorbital contouring, rejuvenates the pretarsal roll, and provides excellent aesthetic results.