A Doctor Schooled Me On Cheek Filler Before I Book In

As I've gotten older, the idea of eventually getting some type of facial filler has become less intimidating. It’s not just age that has shifted my personal perspective, but the research I’ve done in my line of work and the improvements in the world of injectables I’ve seen along the way. Some types of filler products, like Sculptra, are even bio-stimulatory, meaning they trigger the skin's natural collagen production to rebuild itself, rather than just filling the fat pads with hyaluronic acid gel. Others, like Redensity, a “resilient” form of hyaluronic acid, have been fine-tuned to be softer, lighter, and injected into the face via micro-droplets. This is all to say that filler technology has advanced rapidly over the last few years, and the results have the potential to look better than ever.

It also helps that people whose opinions I trust are having positive experiences getting filler and sharing them. I recently read a profile in The Cut where Cyndi Ramirez, the founder of Chillhouse, cited upper-cheek filler as one of her favourite beauty treatments. Content creator Tefi Pessoa has also shared her experiences with facial filler injected in the nose, lips, and cheeks. In her newsletter, Anxiety Beer, beauty editor Hannah Baxter talks about her routine cheek filler injections, where she gets them, and why.

I have genetically flat cheeks and undereye hollowing that I’d like to change, so cheek filler has piqued my interest. Still, before I book in for my own consultation, I have a lot of questions best answered by the pros. Here, we get into some of the most common cheek filler inquiries, from placement and level of pain to the cost and the likelihood of filler migration that everyone on TikTok is talking about.

Cheek filler is a catch-all term for a hyaluronic acid product that's injected into the cheek — into the deep malar fat pad, close to the bone — to add volume support to the area.

The TGA (Therapeutic Goods Administration) indication for most soft-tissue facial fillers (so, the way doctors are formally trained to use these products) is for the treatment of nasolabial fold wrinkles, which occur closer to the mouth. However, facial plastic surgeon Jennifer Levine, MD, explains that what causes the nasolabial fold wrinkle is the depression of these malar fat pads that reside in the cheek. "We don't want to treat the fold, we want to treat the cause of the fold because that looks more natural," Dr Levine explains, hence the attention to the cheek.

Given how the cheek supports the face anatomically, cheek filler is used to address all sorts of signs of ageing, or even non-age-related "tiredness" in the face. "The changes in the mid-face start in the mid to late 20s; that's when people comment that they start to look more tired," says Dr Levine. "Cheek filler can be a correction of that problem with a lateral placement, like the side of the face, and a higher position." Think of where you apply highlighter to draw attention to your cheekbones.

This area is also close to the undereye area, and many surgeons find that cheek filler can help treat hollowing under the eyes as well. Some even suggest that a supportive cheek filler may be a better option for some patients than direct tear-trough filler (which has a higher likelihood of migration — we'll get to that). "With the majority of people, augmenting the cheek has a good effect on the undereye area," explains Vanessa Coppola, a nurse practitioner. Dr Levine adds, "For that hollowing, we always want to treat the cheek first because we want to minimise the amount of filler that we're placing underneath the eye. By starting in this area, we're going to get a better correction and require less product."

This may seem “duh” to most people, but it was a genuine concern for me. In reality, the depth of the filler (as mentioned, it's injected into the deep fat pads of the cheek) would mitigate any superficial stretching at the surface of the skin.

"The majority of providers inject fillers in the cheek area subperiosteally, so on top of the bone," explains Coppola. "You're putting this filler way, way down, on top of the bone and under the muscle, which is where the deep fat compartments are. The superficial fat compartments are the ones that are closer to the surface of the skin. Superficial fat compartments tend to sag or fall downward as we get older; deeper fat compartments tend to deflate." Supporting those deeper fat pads allows for volume that is not stretching the skin. "You shouldn't look dough-y or overfilled," says Coppola. "Cheek filler should allow for natural movement because it's under the muscle."

The first time someone explained their experience of cheek filler to me, they said they loved the results, but warned me that as the filler was injected it sounded like a "crunching" under their skin — which put me off right away. However, both Dr Levine and Coppola attest that their patients generally do not experience pain with cheek filler. There's topical numbing provided before the procedure, and many of today's filler products actually come with a numbing agent infused in the formula. In fact, if you experience pain with any injectable procedure, tell your provider right away.

That said, filler can be a bit uncomfortable. "What my patients complain about is, because the cheekbone terminates in the ear, sometimes you can hear the filler going in," says Coppola. "It makes a crunching or popping sound that usually bothers people more than the needle. That's simply because of the anatomical area where it's being placed, because it's right near the ear and you can hear it. Patients say it feels weird."

On the pain scale, a cheek filler is considerably less painful than getting filler in the lips, which are much more sensitive. Dr Levine also notes that there's often some anticipatory nerves around a filler appointment that contributes to any discomfort. "For most people, it's that first-time injection where there is a lot going on," Dr Levine says. "It's the first time they've been injected, they're nervous. It's not so much the pain; it's more like they hope they're doing the right thing and that it's going to look okay."

The answer to this question depends on each patient. It's important to speak with your trained and licensed provider and go through your concerns to determine if cheek filler is the best approach and, if so, how it can be customised to you. Dr Levine notes that a common misconception around filler is that it can be "sprinkled" around the face, rather than concentrated at the area, for the best, most natural result.

"Yes, we want to be conservative, but we also need to put in enough product for the patient to see a result, otherwise the person doesn't really see the benefit of doing the treatment,” says Dr Levine. “We also want the treatment to last. We don't want to treat with such little product that you can't really see anything and it doesn't correct the area." As a starting point, Dr Levine says a syringe in each cheek would be where she'll start with a patient, though sometimes it takes two to three syringes to see what Coppola calls "appreciable results."

Compared to your average forehead Botox, cheek filler will last longer; generally around six to nine months. "Usually it's closer to a year," notes Dr Levine, "but if you use less product, you'll see a lower duration and it won't last a year." Of course, the longevity will depend on a lot of factors, like age, how many treatments you've had, your skin integrity, etc.

You might've seen TikToks where people talk about their experience with filler moving around, and yes, filler migration is real. As it pertains to cheek filler, though, migration is a rare occurrence. It’s much more likely to occur in thin-skinned, mobile areas like the lips and in the tear trough under the eyes.

Why does migration happen? "Obviously the face is a very mobile area; we have a lot of muscles and motion," explains Dr Levine. "In areas like the mouth, which you’re moving a lot, it's possible that your filler could move or migrate." The lip is a small area that requires more precision and less product. As such, says Dr Levine, "If the person is over-injected or the injection is not perfectly in the right plane, which is not super easy [to pinpoint], then [migration] can happen."

When it comes to the undereye area, migration can happen if there's not enough cheek support. "With the under eyes, if there isn't good cheek support, the filler has a tendency to migrate down," says Coppola. "Providing cheek support filler is preferable to applying undereye filler, and that's one of the reasons why."

The good thing to note about filler mistakes, migration, or overdoing it is that HA fillers can be dissolved through an injection of an enzyme called hyaluronidase. This should help resolve the problem right away, though Coppola notes that it might take a few sessions. Be aware, however, that while filler may resolve visually, it can stay in the body for a long, long time because it's placed so deep into the skin. "We've actually seen filler in cadaver studies 10 years after the fact," says Coppola. "A small amount, even if invisible to the naked eye, still might be in there."

While there's a lot more to unpack about facial fillers, these were my top-line questions for the experts. There are no pros or cons, per se, but a lot to consider — which is why we always recommend seeking out a trained and trusted provider.