https://orcid.org/0000-0002-3563-6610
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Joel E Pessa, Commentary on: Deep Cheek Fat Volumes and Midfacial Aging, Aesthetic Surgery Journal, Volume 40, Issue 5, May 2020, Pages 476–478, https://doi.org/10.1093/asj/sjz283
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This brief discussion of the paper “Deep Cheek Fat Volumes and Midfacial Aging” focuses on one of the main problems with the use of retrospective computed tomography (CT) scan analysis for aesthetic surgery studies.1 We encountered this very same problem 10 to 15 years ago. My criticism does nothing to take away from the authors’ precise and meticulous work, and their facile use of statistical regression analysis to analyze complex data. Indeed, I hope these comments spur them to perform further prospective studies with the following caveats.
The authors addressed the question of potential deep fat loss secondary to aging by reviewing previously acquired (retrospective) CT scans. Longitudinal data of a cohort aged from 21.7 to 91.1 years were analyzed to determine the volume of deep cheek fat (calculated by approximating the volume from the surface area of slices × distance between landmarks) and compared by statistical regression analysis.
The authors found deep fat increased with age, a finding most pronounced in the caudal (inferior) cheek. In a longitudinal subgroup the authors calculated a mean increase of 0.23 cc fat volume/10 years. The authors conclude that “aging was associated with an increase in deep cheek fat, possibly reflecting pseudoherniation of buccal fat.” 1 I would suggest a more accurate statement is “aging is associated with an increase in deep fat when the face is analyzed in the upright or supine position.”
