Commentary on: volumizing viaducts of the midface: defining the Beut techniques.

Abstract

The authors of the manuscript “Volumizing Viaducts of the Midface: Defining the Beut Techniques” reveal their mastery of fat compartments and anatomical spaces by providing a comprehensive approach to midface rejuvenation.1 The discussion will focus on the ports, techniques, and concepts inherent in the authors’ approach to facial augmentation. The authors’ technique is a noteworthy departure from earlier attempts at midface rejuvenation that relied on en bloc repositioning of soft tissue. Rather than visualizing the midface as “malar fat,” the authors view the midface as a set of independent compartments and spaces, each of which contributes to overall morphology. Their use of ports or viaducts is a direct extension of this concept. Three ports enable access to the compartments and spaces that may require augmentation. This approach to facial rejuvenation by augmentation specifically addresses shape, support, and structure prior to augmentation of folds and creases. The authors suggest this approach improves the final dynamic result. In addition, augmentation of key regions as a preliminary step may decrease the volume required to improve some creases. The example of deep cheek fat augmentation and the nasolabial crease supports an approach directed primarily at support and secondarily at creases and wrinkles. This approach may also help to limit one of the most common unsolved problems in facial augmentation: prolonged refractory edema. If one dissects either the nasolabial crease or the vermillion white roll carefully under high power magnification, large lymphatic vessels will be noted to travel parallel within these structures. This is in keeping with the concept that creases do not occur sporadically nor in an arbitrary manner, but rather form over subsurface structures, including lymphatic vessels. Malar edema after injection of the nasojugal crease is …