Cheek Filler (Dr. Michael Aicken’s method)

Cheek filler is a great treatment for instant facial rejuvenation. The method I typically use for cheek filler is highlighted in a video I did a few years ago. Some practitioners will augment anterior to the zygomatic arch but my preference is to focus on the arch itself as a safer and more aesthetically pleasing option. 

  1. Firstly start off by marking the patient symmetrically on the top of the cheekbones. You can use a make-up pencil to do this, drawing box shapes high on the cheek –  this will be the injection site – for 3 injections on each side. Mark the box overlying the bony prominence (the zygomatic arch). When determining the injection site, feel the flat surface of the zygomatic arch, as well as visually assessing their facial contouring.
  2. I usually use 1ml of filler per cheek, however, if this is the patient’s first time, they may prefer to go for 0.5ml each side instead. This can always be topped up. Every patient’s face is different and their facial contours may determine the volume – some patients even know from the outset they want bigger cheeks – that’s for you to discuss with them during the consultation. Our patient here is looking to add volume and definition. In the video example, you can see that the patient’s zygomatic arch comes back quite far and so I have assessed her and placed the injections nearer to the side of her face.  Equally, if the patient’s cheekbones sit rounder or further forward on their face then the injections can be placed in different positions to resculpt the cheeks. Be careful going too far forward, close to the infraorbital foramen which transmits important structures to be avoided such as the infraorbital artery, vein and nerve.
  3. Start towards the front of the face and work backward. The first injection is going to be at the front perpendicular to the skin. As mentioned in the video, I use 1ml filler for each side. So in this example, this first injection is 0.4ml. The aim is to give this injection right on top of the bone. Once in, always aspirate (pull back the plunger) to make sure you aren’t inside a blood, then slowly inject the filler. It’s important to always insert the filler slowly, so that if the patient were to suddenly experience increased pain, you could stop the procedure before doing any further damage. Rushing gives you less chance to act upon a reaction like this from your patient. You will feel the needle start to push back as the filler is inserted, but hold the needle steady and in position. 
  4. The second injection is 1cm back along the cheekbone, and I use 0.3ml of filler here. Again inject perpendicular to the bone in the same way as the first, aspirating first to check for blood, and then injecting slowly and carefully. 
  5. For the 3rd injection, I then go 1cm back along the cheekbone again following the zygomatic arch. 0.3ml of filler is used for the final injection. Follow exactly the same injection technique as above.
  6. Once the filler is in on one side – look at your patient – it’s instantly pleasing to see the resculpting of the face! At this stage don’t massage or manipulate the filler.
  7. Repeat the process on the other side, ensuring you balance the injections along the zygomatic arch in the same way.
  8. Once finished remove the make-up marks on the cheeks so you can assess the patient. At this stage, I don’t massage the filler down as massaging can result in lost volume. The filler will merge and flatten (see below diagram.) Leaving the 3 injections creates the best results for volume and the most effective use of the filler.
  9. Next, look at the patient head-on and assess the symmetry of the face. The filler can be moved slightly after injecting. (Why you should never go to sleep on your cheek immediately after your appointment!) Using your fingers the filler can be edged forwards and backward and up and down to position correctly. Feel over the top to the point of the lateral canthus at the front of the cheekbone. 
  10. Have a final visual scan for lumps and check the patient is happy, further moulding can be done if requested.

Tips

  • Feel your patient’s facial anatomy as well as visually assess their facial contouring ahead of injecting.
  • Slow injections ensure control and minimise discomfort to the patient.
  • Be aware you can feel the filler pushing the needle away as you inject. Ensure the needle is held steady and doesn’t move.
  • Resist massaging the filler as this will flatten it.
  • Always aspirate the needle to ensure you aren’t in a blood vessel.

We don’t stock the Dermal filler as mentioned in the video here, however, we do now sell Phillex Sub Q Plus which we recommend for augmentation of the zygomatic arch. https://dermalrevolution.com/product/phillex-impression-sub-q-plus-1-1ml/

@academyvisage