Vogue Arabia, February 2019. Photo: Jason Kim
Dermal fillers have been around for the last 16 years, and chances are, you know at least a handful of people who have had it injected into their cheek area — whether you realize it or not. Using filler along the cheekbone is about as versatile as a cosmetic procedure as can get, making it especially popular among first-time patients seeking filler across ages, races, and skin textures, because both the goals of patients and potential results that can be achieved are much more far-ranging than many think.
“Nearly everyone, really,” is a candidate for getting filler in the cheek area, says New York City-based board-certified plastic surgeon Dara Liotta, M.D., who explains that the procedure is also “good for general facial enhancement.”
Obviously, cheek filler can be used to, you know, make your cheeks look fuller. But that “general face enhancement” can include many other things, too, including smoothing away fine marionette lines, camouflaging an asymmetry, or strengthening a cheek contour. Read on to learn more about cheek filler, as well as what you can expect from the cosmetic procedure, including preparation to aftercare to cost.
What is cheek filler?
Cheek fillers are injections into the cheekbone area that can restore lost volume or more sharply define facial bone structure. According to Nowell Solish, M.D., a Toronto-based board-certified plastic surgeon who specializes in dermal facial fillers, doctors most often use a hyaluronic acid-based filler in this prominent area because they are reversible and “easily adjustable” if too much or too little is used. Biostimulators are another category of dermal fillers that can be used on the cheekbone to improve projection. While not as common as hyaluronic acid fillers — they are irreversible and require multiple sessions to see results — their results last longer than their HA-based counterparts.
Dr. Liotta notes that injecting filler into different parts of the cheek can have different benefits. “When I place a little bit of filler at the higher cheekbone area, it can make it look like the light is hitting your cheek perfectly, like how contour makeup would look,” she says. But for those who might be losing volume or noticing deeper lines near their nose and mouth, a provider may inject at the larger part of your cheek.
Which type of filler is best for the cheek area?
Each dermal filler brand makes different lines of gooey, gel fillers that vary in thickness, meaning that different goals and subsections within the broad cheek area call for different types of filler, explains Dr. Solish. As previously mentioned, he uses hyaluronic acid fillers exclusively because of their reversibility, but alternates between specific products depending on how much volume, lift, or projection the patient needs and their skin texture.
“RHA 4 is an amazing [filler product] for people who have really thin skin and for when I want to add volume,” he says of the thicker formulation, while Restylane or Juvéderm Voluma are his go-to for lifting. Often, he’ll use a combination: “After I get the volume right, then I’ll take a little bit of the lifting one and put that in a few spots that I want to give a little more of a pop.”
Dr. Liotta favors Juvéderm Voluma, which she calls “the gold standard for cheek enhancement,” believing it to be the “thickest, most reproducible, long-lasting, and natural-looking filler” for the cheek. “When we’re using filler against the bone that we’re asking to act like bone, we want it to be most like the bone so it is digested,” she explains, and Voluma’s viscous, hyaluronic acid-based formula, fits the bill.
What goals can cheek filler address?
“With cheeks, there are different facial planes,” explains Heidi Goodarzi, M.D., a board-certified plastic surgeon in Newport Beach, California. “Cheeks are a broad area, so you can have multiple sections of the cheek that you can inject and it truly changes how your face looks. I think people’s cheeks are what defines a face.”
While placement and technique are crucial for all filler procedures, Dr. Solish believes it’s especially important for the cheekbone area. “It’s all about placement — in the right place, for the right person,” he tells Allure. “It’s about balancing each unique face.”
And in the right hands, meaning a board-certified plastic surgeon or dermatologist, cheek filler can be tailored completely to your specific needs, goals, and anatomy.
For patients who are concerned about fine lines or the loss of volume over time, Dr. Solish explains that there are two ways that cheek filler can address these concerns. “One, we can change their face shape,” he says, adding that as we age, “our face doesn’t typically fall straight down,” but rather becomes a bottom-heavy reverse triangle. “I can re-flate the upper outer cheek to put it back to where it [was], and the other advantage is that I can place the filler in a way that will help lift up the cheek, which also makes the nasolabial folds less visible.”
Contrary to popular belief, says Dr. Solish, many dark under eye circles are related to a sagging cheek, and can be diminished by clever filler placement near the nose bridge, in an area he calls the “lid-cheek junction.”
For Dr. Liotta’s younger patients who haven’t lost as much cheek volume, the goal and technique are both often different. Instead of focusing on plumping, she evaluates where natural light would strike the patient’s cheek (usually the higher cheekbone area) and places filler exactly there to mimic contour and highlighter makeup. “Filler just raises that little spot,” she says. “It makes you look a little bit brighter, a little bit lighter, and makes [the cheekbones] appear more enhanced.”
Dr. Goodarzi explains that if a patient has lost cheek volume, it’s likely that their temples, an area without much of a fatty pad to begin with, have as well. “Everything has to be in harmony,” she explains and notes it would be a mistake to augment the cheeks without paying attention to the rest of the face, too. “Imagine you have a case where the temples are hollowed and you fill the cheek back, but what you’ve also done is make the temples look even [more pronounced].”
While it’s true that the temples are a totally different part of the face, Dr. Liotta points out that there’s a “crossover” in every facial region, as one feature becomes another, and that the spot where the lateral cheekbone and temple meet is “a gray area.”
A board-certified plastic surgeon or dermatologist with a deep understanding of facial anatomy will be able to properly evaluate the full facial canvas to determine whether a drop of filler could help to bring balance to this gray area.
Okay, so what are some things cheek filler can’t address?
As with all temporary solutions, cheek filler is not a replacement for surgery. Dr. Liotta finds herself managing patient expectations every day, explaining that it’s not a “solve-all” for facial sagging.
“Filler can get rid of shadows and bring up highlights around the eye, but a syringe of filler is a fifth of a teaspoon, and the amount a patient pulls up on their cheek to show me their goals for cheek filler is probably 15 syringes of filler,” she says. “If you’re [physically] pulling your cheeks up in the mirror, you’re in facelift territory, not filler.”
What does the procedure involve?
According to Pittsburgh-based board-certified dermatologist, Nicole Vélez, M.D., you’ll want to follow the same bruise-reducing protocols you would if you were getting filler in other common areas — that is, lay off NSAIDs for seven days before getting filler, skip the gym for 48 hours after your procedure, and pop an Arnica or Bromelain vitamin supplement before and after the appointment. She also asks patients to arrive on the early side if they’d like numbing cream to reduce any pain from injection pricks.
“It’s also important that you schedule your appointment during a time when you’re OK with the fact that you may have a bruise,” she cautions. “For example, you don’t want to schedule it the day before a wedding or an important work meeting.”
During the procedure, the injector places the filler “all the way down to the bone,” says Dr. Liotta, in order to make it “really look super natural” while simultaneously avoiding any filler migration issues. “The more superficially the filler gets placed, the more it can end up with that kind of weird, doughy look that we associate with too full of a face,” she explains.
Aftercare is minimal, although bruising and swelling are common but will subside within the week, says Dr. Vélez. “I tell patients to try not to lay on your face that night, but it’s hard to control how you sleep at night, so if you end up waking up and you’re on your face, it’s not the end of the world.”
How long will cheek filler last?
Most hyaluronic acid fillers last anywhere from nine to 12 months, but Dr. Liotta attests to Juvéderm Voluma’s longer-lasting formula, clocking in around a year and a half, she estimates. “There are a lot of genetic variables that do impact filler longevity and there’s nothing that they can really do, it’s their body chemistry,” explains Dr. Solish. “But, of course, smokers, heavy drinkers, people that don’t eat [nutritiously], that sort of thing, tend to burn it away a lot.”
In addition, serious athletes with sky-high metabolisms tend to need more frequent touch-ups. “They may get a month or two less out of it,” he says.
The blessing and the curse of the hyaluronic acid-based fillers, which make up the lion’s share of the type of filler that doctors tend to favor for the cheek area — 99.9%, in fact, estimates Dr. Solish — is that they are temporary. So if you love the result? That’s great news. But to keep it up, you’ll need to book a follow-up maintenance appointment in about nine to 12 months.
Hate it? Well, you have a safety net, as long as an HA-based filler was used. In fact, your doctor will be able to dissolve it with an injection of an enzyme called hyaluronidase, which will work its filler-dissolving magic within about 48 hours. You can also rest assured that even if you don’t ask your doctor to dissolve it, in about a year, any residual filler will have disappeared.
Of course, selecting a board-certified dermatologist or surgeon whose aesthetic matches your own is crucial, or else you’re setting yourself up for heartbreak, not to mention, a waste of money.
Are there any risks, side effects, or downsides to cheek filler?
One rare but serious risk of getting filler is vascular occlusion, which happens when a provider accidentally injects the filler into a blood vessel. Should a patient begin to show any red-flag symptoms, like blurred vision or skin discoloration, Dr. Vélez says she would quickly inject hyaluronidase to neutralize the filler and send them to the ER.
“I inject very small amounts, I observe the patient being injected, and I kind of pull back on the needle on each injection to make sure we’re not in a blood vessel,” she explains of her technique. Again, the good news is that these sorts of situations are very rare, and Vélez also explains that “with filler, you see the result right then and there,” so once you’re cleared to leave the doctor’s office after a bit of post-injecting icing, the occlusion risk window has closed.
But there is one demographic that filler is a no-go for. “We usually don’t do any cosmetic procedures on pregnant or breastfeeding women, just for the rare chance that something could happen,” says Dr. Vélez.
She adds that while complications (like an accidental injection into a blood vessel) are extremely rare, they’re also gravely serious, making it all the more critical to visit a credentialed board-certified dermatologist or plastic surgeon who understands where powerful blood vessels are located and how to mitigate risk.
How much does it cost to get cheek filler?
Cost is contingent on the experience level of your injector where you’re located, as well as the type of filler and number of syringes used. For example, in board-certified plastic surgeon Lesley Rabach, M.D.,’s New York City office, patients can expect to shell out around $1,000 to $1,500 per syringe, while Goodazri says that a syringe of filler on the West Coast typically starts at $1,000.
Most first-time filler patients receive about one to two syringes at their first appointment, according to Dr. Solish, but “with repetitive treatments over the years, the interval between the treatments extends.”
Originally published in Allure.com
