Pretarsal fullness of the lower eyelid

 

The pretarsal fullness of the lower eyelid is another popular area of correction. Shaping is a key aspect of the filler procedure in this area. As long as the filler is injected superior to the inferior palpebral groove, there will not be problems. If the filler is injected beyond this area, it could create a droopy outline of the eyes and patients may complain of a sad looking face. Inject thinly in the beginning and gradually increase thickness to be the thickest at 2/3 of the length of the eye opening and fade away toward the outer corner. The injections should lie very close to the eyelash to avoid awkward lumps. The skin is very thin in this area as well and can cause the injected filler to be translucent. This is very difficult to avoid even for seasoned doctors.

 

A soft filler should be used for pretarsal augmentation as well. Some doctors prefer using a hard filler to create a definite shape but this could lower patient satisfaction. Patients will not be happy when they feel a hard lump under their eyes.

 

The pretarsal fullness of the lower eyelid increases twofold in volume when a patient smiles. Therefore, it is important to adjust the size to about 70% of the desired size during filler injection. However, one should reflect the patient’s wishes as much as possible as patients have very strong personal views about how big the under eye fullness should be.

 

The ideal thickness of the pretarsal fullness is, at most, half of the vertical length of the eye opening. However, patients do not realize the right thickness for their eye shape. I recommend that the pretarsal fullness be shaped according to the inferior palpebral groove. I also provide follow-up corrections after the initial treatment according to what the patient wants. In conclusion, to carry out successful pretarsal augmentation, one should be able to inject the filler close to the line of the eyelash in a smooth continuum. After injection, make precise and fine adjustments.

 

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The nose

 

It is very important to have a good knowledge of the aesthetic standards for rhinoplasty and in particular, the anatomy of the nose. The nose has a complicated structure and the nasal dorsum is very different from the rest of the nose in anatomy. As the blood vessels that pass the nose are connected to the eye, the nose is also susceptible to very serious complications such as vision loss. Many Korean patients are very ambitious when it comes to nasal augmentation. It is important for a surgeon to have a clear understanding of the aesthetics of the nose, the differences between men and women, and what the patient expects from the procedure.  

 

The dermal filler properties are particularly important for creating shapes. A hard filler is generally used in the nose due to the high pressure of the tissues and the necessity to maintain the shape. Retaining the shape is more important in the nose than matching the hardness of the surrounding tissues. 

 

-To be continued