title: Volumizing viaducts of the midface: defining the Beut techniques.
abstract: BACKGROUND
  In nonsurgical facial rejuvenation, autologous fat and dermal fillers have become an effective method to achieve symmetry and balance of the midface. Nonsurgical techniques that target the dynamic anatomical relationships existing in the midface can improve rejuvenation outcomes in this commonly augmented region.
  
  
  OBJECTIVE
  The authors described techniques for fat compartment and potential space volumization of the midface via a standardized and reproducible technique. They placed emphasis on access to anatomical spaces and compartments within the midface.
  
  
  METHODS
  In 11 hemifacial cadavers, hyaluronic acid filler homogenized with red dye was injected via 3 midfacial ports that were anatomically designed to access the superficial fat compartments, deep fat compartments, or traverse the prezygomatic space. Specimens were dissected in a layered fashion to analyze relationships between the injected filler and midfacial anatomy. We have described 4 site-specific procedural techniques and created a video containing anatomical renderings of each targeted viaduct accompanied by technique demonstrations.
  
  
  RESULTS
  We found that Beut techniques 1 through 4 can be performed through 3 midfacial viaducts. Port placement 1.5 cm inferolateral to the alar base in the nasolabial crease created a medial midface viaduct, suitable for access to the deep medial cheek fat, medial superficial fat compartment, premaxillary space, and adjacent superior nasolabial cheek compartment. Port placement within the nasojugal groove provided a middle midface viaduct to access the middle superficial fat compartment and medial suborbicularis oculi fat (SOOF). Port placement 1.5 cm inferolateral to the lateral canthus created a lateral midface viaduct to approach the pre-periosteal fat, prezygomatic space, lateral SOOF, and infraorbital fat compartment.
  
  
  CONCLUSIONS
  Our findings indicate that anterior and lateral cheek projection, V-deformity correction, rhytid softening, and tear trough effacement can be achieved through the midfacial viaducts. Systematic assessment and site-specific nonsurgical rejuvenation of the midface may lead to increased safety, accuracy, and technique reproducibility in this commonly injected region.
authors.affiliation: Dr Surek is a Resident Physician in the Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas. Dr Beut is a plastic surgeon in private practice in Palma de Mallorca, Spain. Dr Stephens is Chairman of the Department of Anatomy, Kansas City University of Medicine and Biosciences, Kansas City, Missouri. Dr Lamb is a plastic surgeon in private practice in Independence, Missouri. Dr Jelks is Associate Professor, Department of Plastic and Reconstructive Surgery, New York University, New York, New York.
authors.forename: Christopher
authors.initials: C
authors.lastname: Surek
authors.affiliation: Dr Surek is a Resident Physician in the Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas. Dr Beut is a plastic surgeon in private practice in Palma de Mallorca, Spain. Dr Stephens is Chairman of the Department of Anatomy, Kansas City University of Medicine and Biosciences, Kansas City, Missouri. Dr Lamb is a plastic surgeon in private practice in Independence, Missouri. Dr Jelks is Associate Professor, Department of Plastic and Reconstructive Surgery, New York University, New York, New York.
authors.forename: Javier
authors.initials: J
authors.lastname: Beut
authors.affiliation: Dr Surek is a Resident Physician in the Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas. Dr Beut is a plastic surgeon in private practice in Palma de Mallorca, Spain. Dr Stephens is Chairman of the Department of Anatomy, Kansas City University of Medicine and Biosciences, Kansas City, Missouri. Dr Lamb is a plastic surgeon in private practice in Independence, Missouri. Dr Jelks is Associate Professor, Department of Plastic and Reconstructive Surgery, New York University, New York, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Stephens
authors.affiliation: Dr Surek is a Resident Physician in the Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas. Dr Beut is a plastic surgeon in private practice in Palma de Mallorca, Spain. Dr Stephens is Chairman of the Department of Anatomy, Kansas City University of Medicine and Biosciences, Kansas City, Missouri. Dr Lamb is a plastic surgeon in private practice in Independence, Missouri. Dr Jelks is Associate Professor, Department of Plastic and Reconstructive Surgery, New York University, New York, New York.
authors.forename: Jerome
authors.initials: J
authors.lastname: Lamb
authors.affiliation: Dr Surek is a Resident Physician in the Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas. Dr Beut is a plastic surgeon in private practice in Palma de Mallorca, Spain. Dr Stephens is Chairman of the Department of Anatomy, Kansas City University of Medicine and Biosciences, Kansas City, Missouri. Dr Lamb is a plastic surgeon in private practice in Independence, Missouri. Dr Jelks is Associate Professor, Department of Plastic and Reconstructive Surgery, New York University, New York, New York.
authors.forename: Glenn
authors.initials: G
authors.lastname: Jelks
mesh_terms: D000273:Adipose Tissue / Q000033:anatomy & histology*; D000328:Adult; D000368:Aged; D000375:Aging; D002102:Cadaver; D002610:Cheek / Q000033:anatomy & histology*; D005145:Face / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008297:Male; D012060:Rejuvenation; D015203:Reproducibility of Results