Reply: Pretarsal Augmented Lower Blepharoplasty

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First of all, it is our delight to respond to Dr. Putterman’s letter. We do agree with the point Dr. Putterman has made, that there may be a cultural difference in perspective of attractiveness.
Today in many Asian countries, a narrow and plump pretarsal roll is considered a characteristic of attractiveness and youthfulness. Thus, it is not surprising to see that accentuation of pretarsal fullness by makeup technique or filler injection has gained popularity among young Asian women.1 It should be noted that pretarsal augmentation seems to be more effective in creating contour for shallow-set eyes, which is a typical Asian facial feature. Asians tend to have shallow-set eyes compared with a typical Caucasian face, resulting in a flatter facial appearance. As Dr. Putterman has mentioned, Caucasian patients might find additional contouring by pretarsal augmentation unnecessary, and we have to agree that this technique might have fewer advantages for deep-set eyes.
Nevertheless, it is hard to say that interest in pretarsal fullness is exclusive for Asian patients, because there indeed are Caucasian patients who favor a fuller pretarsal roll. In such cases, pretarsal augmented lower blepharoplasty has been implemented to achieve the desired effect. Thus, it is advisable to enquire about a patient’s preference for pretarsal fullness during preoperative consultation, regardless of his or her race. The authors would like to express sincere appreciation for the interest Dr. Putterman has shown for our work.

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