Share this article on:

Cultural Differences in Pretarsal Fullness Acceptance

Putterman, Allen M. M.D.

Plastic and Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 1018e–1019e
doi: 10.1097/PRS.0000000000003195

Department of Ophthalmology, University of Illinois College of Medicine in Chicago, 111 North Wabash, Suite 1722, Chicago, Ill. 60602,

Back to Top | Article Outline


I read with interest the article by Jeon et al.1 on pre tarsal augmented lower blepharoplasty. The authors indicated that pretarsal fullness is an attractive aspect of the lower eyelid and, in their article, they present a procedure to create this.

I attach a lateral lower eyelid orbicularis flap to the lateral orbital wall when I perform a midface lift and a lower eyelid plication blepharoplasty.2,3 At times, this creates a tightening of the pretarsal orbicularis and a subsequent fullness of the pretarsal area. Most of my Caucasian patients find this to be unacceptable, and I then have to treat this with either excision of the thickened orbicularis or botulinum toxin type A injections into it. I point this out, as I suspect there may be a cultural difference in what is considered attractive with the authors’ procedure.

Back to Top | Article Outline


The author is supported by an unrestricted grant from Research to Prevent Blindness, New York, N.Y. (EY001792).

Back to Top | Article Outline


The author has no financial interest to declare in relation to the content of this communication.

Allen M. Putterman, M.D.

Department of Ophthalmology

University of Illinois College of Medicine in Chicago

111 North Wabash, Suite 1722

Chicago, Ill. 60602

Back to Top | Article Outline


1. Jeon YR, Rah DK, Lew DH, Roh TS, Kim YS, Choi HLPretarsal augmented lower blepharoplasty. Plast Reconstr Surg. 2016;138:74–82
2. Putterman AFagien SCheek/mid-facelift. In: Putterman’s Cosmetic Oculoplastic Surgery. 2008:4th ed. Philadelphia: Saunders/Elsevier; 187–204.
3. Putterman AMPutterman AMLateral canthal plication. In: Cosmetic Oculoplastic Surgery. 1999:3rd ed. Philadelphia: Saunders; 221–228.
Back to Top | Article Outline


Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.

Letters submitted should pose a specific question that clarifies a point that either was not made in the article or was unclear, and therefore a response from the corresponding author of the article is requested.

Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS’ enkwell, at

We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

The Journal requests that individuals submit no more than five (5) letters to Plastic and Reconstructive Surgery in a calendar year.

©2017American Society of Plastic Surgeons