• #4-2. Lower Pretarsal Roll Correction Techniques



    First, it is important to understand and adjust the patient’s expectations. Second, pay attention to symmetry. Third, there should be no sagging after treatment. Fourth, the pretarsal roll should have smooth and natural consistency. Fifth, there should be no lumps.


    Prior to treatment, check with the patient whether he/she is planning to receive botulinum toxin injections in the eye area. Botulinum toxin used for removing wrinkles after pretarsal roll correction can cause the pretarsal fullness to droop downward.


    For anesthetics, infraorbital nerve block or topical anesthetic can be used prior to treatment.


    I prefer using cannulas for dermal filler injection. Divide the target area along the lower eyelash into three subparts, tunneling immediately under the lower lash, using linear retrograde injections. Using the correct amount of filler is the most important for the outcome of pretarsal correction. Inappropriate amount of injection can cause the filler to spill over the infraorbital crease.


    Figure 4. Place the filler spatula under the conjunctiva using the guide and massage the pretarsal roll to even out the injected filler. Apply ophthalmic ointment and massage gently with fingers.


    Figure 5. Apply adhesive bands after treatment to guide the shape of the lower pretarsal rolls.


    The target injection depth should be infraorbital fat layer. Lower pretarsal correction with filler can last up to three years in some cases. Massaging can help create a desirable shape. The skin of lower pretarsal area is very thin and susceptible to Tyndall’s phenomenon and bruising. Select the filler with easy administration and low risk of migration. I recommend hyaluronic acid fillers.


    Patients with droopy lower eyelids who seek lower pretarsal correction present a challenge. In such cases, PDO thread lift can be carried out before pretarsal correction to address the sagging. In the previous article, I discussed inserting the thread from the temple. Using this method of thread lift can lift the zygomatic ligament, which can improve the sagging lower lid. Using the recently introduced cannular type 31G PDO thread to strengthen the infraorbital crease under the lower pretarsal roll can enhance the elasticity of the skin through fibrosis in 3-4 weeks of treatment and improve pretarsal fullness. These techniques can cause bruising and patients need to be explained of this risk before treatment.  


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    Consideration should also be given to the fact that such methods for improving pretarsal fullness are popular only in South Korea, Japan, China and a few South East Asian countries and may not be accepted by patients from other countries with different aesthetic standards.


    Figures 1-5 show the guiding techniques that I use for lower pretarsal correction. Lower pretarsal correction can be challenging as patients have varying individual expectations. Sufficient communication is needed between the surgeon and patient during pre-treatment consultation. I advise avoiding aggressive techniques in this area.


    -To be continued

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