Tutorial: how to inject cheeks with dermal filler

Aesthetic clinicians often find that the cheeks are a difficult or tricky area to inject. With so many differing angles of projection in this area of the mid-face, it can leave you unsure whether to inject the dermal filler more laterally or more medially to achieve your goals. This decision depends entirely on the goal – the outcome you are aiming to achieve for your patient – whether that is to address volume loss or harmonise and balance facial asymmetry, for example.

In this blog, Dr Tim Pearce will explain the different angles of projection and where you should place dermal filler to achieve your patients’ desired results.

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Exploring injection points for cheek dermal filler

Lateral cheek injection point

Let’s look first at an injection point on the upper surface of the lateral zygoma. The needle is placed at a 90° angle to the bone but appears to be slightly pointing upwards when in position.

This lateral injection is onto the periosteum. You can palpate the area with your needle – using little taps on the lateral surface of the lateral zygoma for a defining injection – and feel the curve of the underlying bone, which becomes particularly noticeable if you slide off inferiorly, notes Dr Tim.

Our main anatomical focus is the angle of the zygoma. This is the greatest curvature on the bone but is usually not the greatest curvature on the face because as we get older the curve shifts down and medially resulting in a cheek with the greatest curvature lower down. The remedy for this, as demonstrated by Dr Tim in the accompanying video, is to add volume in the central and lateral injection points to counterbalance the excess volume medially.

Central/apex cheek injection point

The central or apex injection point is key to this process, explains Dr Tim, where you can slide the needle down onto the periosteum after feeling the shape of the bone.

He recommends before you inject or even place your needle into the skin that you feel the anterior and lateral surface of the area and then, with your fingers, work your way up until you feel the apex. This allows you to choose an appropriate entry point that will ensure your needle lands directly on the apex, which you should then feel when in position. Bolus placement of dermal filler at this point will achieve a beautifying injection.

Lateral lid-cheek junction

Our discussion now moves to the next injection point, the most superior, at the lateral lid-cheek junction. This is a powerful injection point for restoration, but carries a risk of over-treatment, warns Dr Tim. He advises using a thinner dermal filler product that has an intermediate-grade thickness.

Furthermore, he explains that he has changed his injection angle slightly at this point in recent years, preferring now to enter with the bevel facing down, to touch the periosteum, and then inject, followed by gentle moulding. This approach is aimed at reducing risk because it is unfortunately very easy for the product to come up to the surface resulting in a small bump or irregularity if the bevel is facing upwards.

Anterior cheek injection point

We can now look at the anterior cheek injection point. This requires a 90° angle of injection to ensure you are entering the anterior face, maintains Dr Tim. As soon as you enter from a different angle, you risk touching different parts of the periosteum and not achieving anterior cheek projection.

The needle should go straight down at the 90° angle and touch the periosteum with delivery of a small bolus of dermal filler, after aspirating, which should cause anterior cheek projection.

Another useful note for this injection point is that sometimes when you can see the zygomatic ligament, and tissue is depleted above the zygomatic ligament, it can result in a cheek shadow that can be completely remedied with injection at this point. He urges you to be certain of the shadow presentation and differentiate the cause from malar oedema.

The final injection point for discussion is the most inferior on the cheek. This should not be approached with such a direct angle because it would place you in the direct path of the transverse facial artery, in some people. Dr Tim explains that he uses a much shallower angle, staying in the hypodermis and using small depth checks and aspiration to avoid complication risks. A bolus of dermal filler can then be placed, moulding the product up afterwards, resulting in a rounded cheek but maintaining a high point that defines the cheek after injections at the apex and lateral points.

For more advice from Dr Tim, read up on injecting the zygoma: safety advice and injection points.

If you struggle with understanding needle depth, we recommend this blog from Dr Tim to help you tell where your needle is when injecting dermal filler. He also covers the hot debate on whether you should treat cheeks or nasolabial folds with dermal filler.

You can also find Dr Tim Pearce on Instagram if you have any tips to share, case studies to discuss, or questions for him.

If you want to learn more in-depth treatment plans to treat smile lines and upskill your knowledge of anatomy, make sure you get on the waiting list for Dr Tim Pearce’s Pro Injector membership.

Aesthetics Mastery Show

How To Inject The Cheeks – Injection Points Tutorial

Dr Tim says:

“The cheeks can be difficult to inject. This is because there are so many angles of projection in this area, do you inject filler more lateral or medial? It all depends on the outcome you are trying to achieve for your patient, whether it’s to address volume loss? Or harmonise and balance facial asymmetry, for example.

“In this episode I explain the different angles of projection and where to place filler to achieve your patients desired outcome.”

Watch the full Aesthetics Mastery Show here.

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Injectable eLearning Courses

If you want to increase your knowledge about safe and effective injectable treatments, Dr Tim Pearce offers a series of fabulous courses, including:

• Dermal Fillers Foundation Course
• BOTOX® Foundation Course
• 8d Lip Design

Courses include CPD and certificates on completion and are highly rated by our delegates.

In addition, browse our FREE downloadable resources.

Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

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