• #4-1. Lower Pretarsal Roll Correction Techniques



    Lower pretarsal roll correction techniques


    In this article, we will take a look at the techniques used in lower pretarsal correction. Lower pretarsal fullness is particularly noticeable in younger people and is heavily influenced by muscle movement.


    It is important to first analyze the structure and movement of the lower pretarsal rolls of an individual patient. Lower pretarsal rolls tend to be more noticeable during muscle movement. Generally, they are not visible in a poker face but become very noticeable in a smile. For optimal outcomes, the surgeon should aim for the lower pretarsal rolls to appear fuller when the patient smiles.  


    Figure 1. Using a guide, assess and model the patient’s lower pretarsal rolls.


    Figure 2. Puncture a cannula entry point with a 26G needle after making necessary measurements of the patient’s eye area.


    Patient selection


    In lower pretarsal correction, patient selection is a very important determinant of the treatment outcome. Utmost caution is needed in patients with previous lower blepharoplasty and age-related sagging and loss of elasticity. Also, carefully consider the eligibility of patients with previous medial or lateral canthoplasty. Ideal candidates for pretarsal correction have young, elastic skin, with already desirable amount of lower pretarsal fullness.


    Most patients want very large and noticeable lower pretarsal rolls. However, it is important to clearly communicate to the patient that the best outcome maintains the original shape of their pretarsal rolls, instead of drastic improvement. Drastically enlarged pretarsal rolls can unnaturally pull down the lower eyelid, especially in patients with large eyes or protruding eyes.  


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    One needs to pay particular attention to the following aspects during lower pretarsal correction for attaining optimal outcomes.


    -To be continued

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