Cheek Filler: Can it Go Wrong?

Cheek filler
Cheek filler

What is cheek filler?

Cheek filler, also known as a cheek augmentation dermal filler treatment, is a non-surgical cosmetic procedure that gives the cheekbones more volume and definition. This treatment may provide a lift to the face, improve facial proportions and restore youthful contours to the cheeks. Cheek filler is great for the individual that would like to freshen up and rejuvenate their whole face. The clinician of choice will choose the best kind of filler for your cheeks in the initial consultation – duration results may vary.

Are there risks or side effects?

Although cheek filler treatment is considered a lower risk injection area, it is still not free from possible complications. These include the common risks and side effects of:

Asymmetry – It is important to be aware asymmetrical swelling is normal after treatment. However, if it continues to remain asymmetrical that is when it is considered a side effect and will need to be attended to by the clinician. Patients are generally asymmetrical to start with and injectors try to improve symmetry when they are injecting

Bruising– Unfortunately bruising is common with cheek filler,   particularly if the clinician is using the needle technique (injecting on the bone). When the needle punctures through a blood vessel under the skin that is when bruising occurs. This is temporary.

Swelling– This is a common temporary side effect as it is the body’s natural healing response and will improve within 3 days and will usually completely  by about 4 weeks. It occurs due to the trauma to the area site after injection.

Lumping – Lumping is usually a temporary side effect that is often caused by swelling and bruising. It may be seen at the time of injection or several weeks later. It can also cause the face to appear asymmetrical. However, it should subside once the healing process has finished. Some clinicians may advise their patients to massage the area. The product should integrate into the tissue by about 4 weeks

More serious, but rare risks and side effects include:

Infection– As this is uncommon, it can still occur even if the clinician is being extremely careful with their techniqu. In some cases it may not occur straight away and can become evident weeks later. The signs of infection include redness, hot to touch, pain, swelling of the area and fever or an abscess.

Allergy– This is fortunately extremely rare

Vascular occlusion– Accidentally injecting filler into a blood vessel can be life threatening and will need immediate resolution. It can result in tissue death and vision loss or stroke in the worst of cases. We treat this by dissolving the filler with hyalase and monitoring the patient until all filler has gone and the occlusion has resolved. If the occlusion is not adequately treated there may be skin necrosis which can lead to scabbing and scarring or the skin

Aesthetic Risks

Overfilled Cheek Filler – How can we avoid this? 

Most patients who request cheek filler from highly trained and experienced clinicians will be left with a subtle enhancement in the area to improve their facial aesthetic. However, too much cheek filler can result in a “chipmunk cheek appearance” and will not give a more youthful appearance. Overfilled cheek filler can also make the face appear more swollen giving a “pillow face” and causing “sunset eyes” (where the eyes look smaller and slightly squinted) – this will leave the face looking distorted. This can be avoided by going to a trusted clinician who is able to assess your face and choose how much filler you need, and knowing when to stop! . Using a small amount of cheek filler and gradually adding more will avoid overfilled cheek filler. Other treatments such as bio-remodeller can accompany cheek filler enhancement.

Poor Placement of Filler

Face design is everything in determining the aesthetic results of cheek filler. It is important for the designer to look at so many things, which can include:

  • Symmetry of the face
  • The length and width of the face
  • The balance of upper, middle and lower thirds
  • The profile
  • Surrounding structures like the temples, sub cheek and jawline and troughs

It is very important to avoid too much in the front cheeks, if that will look worse and also to avoid too much in the outer cheeks for those who  don’t want a wider face

The consultation is very important in determining the design.

Undesired Result – Can I remove the filler?


If you do not wish to correct your prior dermal filler treatment with more filler, there is an option to remove the filler by using hyalase, a dermal filler dissolvant. Luckily the majority of fillers are not permanent and can be removed if necessary. Hyalase is an enzyme which effectively breaks down the filler into smaller polysaccharide chains. The dose one requires will vary depending on the amount of filler the patient has had and what type of filler it is. The clinician will also advise the patient to have hyalase if cheek filler has migrated which can occur over time or from poor injection technique. Migration in the cheek is uncommon, Some clinicians may do a test patch on the skin before using the hyalase due to allergy risk

There is a risk of anaphylaxis (a severe allergy) with hyalase, so it is best to avoid the use of it. Building the cheeks slowly and steadily is importan