In line with the rise and rise of many injectable procedures, dermal filler is being increasingly used in the cheek areas for aesthetic purposes. Whether with the aim of profile balancing, restoring youthfulness or emulating a more contoured appearance, it can do different things for different faces. And it should: key to good cosmetic tweakments, always, is a true bespoke approach.
To understand the various benefits, as well as the potential risks involved, we spoke to Dr Ashwin Soni, a plastic and reconstructive surgeon and founder and owner of The Soni Clinic where he performs cheek filler procedures among other non-surgical and surgical treatments.
Here he explains why you might, or might not, want to explore the idea of having cheek filler, how it works, what it feels like, and what to expect before and after going under the needle.
What are the benefits of cheek filler?
"The benefits of cheek filler are to create a natural contour of the cheekbone, sometimes when that definition has been lost due to age, and other times, to add a little contour when a patient does not have much definition of the cheekbones. Another benefit of cheek filler is to restore volume when volume has been lost, either due to the natural process of ageing or if, genetically, someone never had much volume in the cheeks to begin with."
Who is a good candidate for cheek filler?
"A good candidate would be someone who doesn’t have prominent cheekbones, so you can use cheek filler subtly to be able to give them a natural contour—similar to the definition that some people aim to achieve with make-up. From experience, my patients who have had cheek filler, need much less (if any) make-up after the procedure to obtain the appearance of a contoured cheek. Another good indication for cheek filler would be if someone had a lack of volume in the centre of the cheek or flatness of the cheeks, which they want to address. You can restore these with filler."
Who isn’t a good candidate for cheek filler?
"Patients who have prominent and high cheekbones would not be a good candidate, and those who have a good amount of volume in the cheeks, as they would be at risk of looking unnatural and obviously ‘overfilled’. Another important point, which I hear from a lot of patients who come to me from other aesthetic practitioners, is that many patients who have deepened smile lines (known as nasolabial folds and marionette lines, which run from the corner of the mouth down to the chin), but also have good volume in the cheeks are often offered cheek fillers to give this area a lift in an attempt to soften them. But from experience, you should go to a provider with a deep understanding of the anatomy and who can directly target those smile lines, rather than do cheek filler in patients who don’t actually need any more volume in their cheek area."
How should the use of cheek filler vary from person to person?
"The amount used and placement will vary and this really depends on what areas need treating, and what the patient’s own aesthetic goals are. I have patients who are over 60 who want a little more volume centrally as their cheeks have flattened with age, and a little more contour. I also have younger patients who have good volume centrally but have a lack of contour from their cheekbones. For me, it really depends on the person, and it’s something we discuss in detail at the time of the consultation. My technique also changes depending on the patient, and I adapt to give them the result that goes hand in hand with their own goals.
"I often see cheek filler being injected too high or too low by other providers, which makes things look very unnatural."
What should you look for in a practitioner when considering cheek filler?
"Key to achieving natural results is the provider that you choose, their technique, and the quality of product that they inject with. The most important factor would be picking the right provider. I cannot stress this enough: please do your homework when researching a provider so you know who you are trusting with your face. They should have expert knowledge of anatomy, and have significant experience—here, ensure that they are medical providers who are registered, for example a doctor in the UK would be registered with the General Medical Council and you can check there to see that they have a lisence. Also, read their reviews and look at their before and after photos, and make sure that you would be happy to look like their patients. If you know someone who has been treated by them, think if you would be happy to have that type of result.
"Also check that they use the highest quality filler which does not interfere with dynamic facial movement, meaning that it will not affect your muscles when you smile or frown. Poor quality filler may cause lumps or bumps, and may not look natural when you animate your face."
Looking at a face holistically, what other treatments tend to work well in combination with cheek filler?
"This depends on the patient’s goals, but there are certain treatments that can complement cheek filler. One area, already mentioned, is nasolabial and marionette line filler (coined smile line filler) if those lines are deepened. I often see those patients just getting cheek filler from other providers, but this can sometimes make these lines look more prominent if not treated effectively.
"Cheek filler can also help with under eye hollowing in certain patients and can be combined with tear trough fillers to improve a patient’s under eye area quite dramatically.
"Skin boosters—such as Profhilo—are another popular treatment that help with skin quality, elasticity, hydration of the skin, and the overall glow of the skin. They work very well in all areas of the face, and around the cheek area. They are packed with vitamins, minerals, hyaluronic acid, antioxidants, and amino acids."
What does a cheek filler procedure involve?
"I begin the procedure by cleansing the treatment areas. Next I apply a fast-acting numbing cream which is left on for approximately 10-to-15 minutes. I then apply ice packs to the areas that I will inject in, and begin the procedure. The technique can involve needles and a cannula which is essentially a blunt-tipped longer needle, but is not sharp and can help to add volume in certain areas that are needed. The procedure itself takes approximately 20 minutes total to do."
What does it feel like to have cheek filler?
"In my practice, I do many things to minimise discomfort, such as the application of fast-acting local anaesthetic cream in order to numb the areas that we are treating, and using ice packs on the areas that I inject. Plus, there is local anaesthetic in the filler itself. As a result, I have not yet in my practice had someone say that it was painful, but there are a couple of points that people may feel some pressure. Patients mostly describe the sensation when I contour the cheekbone as a ‘weird’ sensation, but one that is comfortable. The majority of patients say they were pleasantly surprised, which is always great to hear."
How can you prepare for a filler treatment?
"My advice prior to filler is to speak to your provider if you are taking any medications or supplements and know which ones to hold off on. If you bruise easily, I recommend you take arnica tablets two-to-three days before and after your procedure."
How long do the results last?
"In my practice, given the quality of filler I use is, the results last on average between 12 and 18 months, so you get great longevity out of this treatment."
What are the risks involved in cheek filler?
"The more common risks include mild bruising, mild discomfort, and some mild swelling post-procedure.
"The serious risks can include bleeding, vascular occlusion (which is when filler can be injected into a blood vessel, and can cause an area of skin or tissue to lose its blood supply—this is an emergency and would require to have the filler dissolved immediately), filler migration, and overfilling. Ensure that your provider is using a hyaluronic acid-based filler, in case there was ever an issue and it needed to be dissolved, and you want to make sure you are seeing someone extremely experienced, in case any of these very rare risks did occur, as they would know how to take care of it in an expeditious and safe manner.
"Ensure that your clinic provide you with a number that you can call day or night in case of any issues.
"It is also important to note that these procedures cannot be offered to pregnant or breastfeeding women."
Is there anything you advise against after a cheek filler procedure?
"I advise my patients to avoid intense exercise for five days after your procedure, to minimise any chances of the filler being displaced, and just allowing time for any mild swelling to settle and for the filler to nicely incorporate. I would also not massage the areas of the face where we placed the filler for several days, and would not go to have a proper facial massage until you see your provider for a follow-up appointment."
How much do does a cheek filler procedure typically cost?
In India, the procedure starts at Rs 20,000 and can cost up to Rs 1,00,000.
This piece originally appeared in Harper's Bazaar UK.