Deep Bolus Injection
Important points to note when carrying out a deep bolus injection for cheek enhancement:
- Discuss with clients on how they will look following the procedure and manage expectations. To demonstrate how the cheeks will look, you could push their existing cheek pad upwards from underneath to show them, this will also lift and in some cases eradicate the deficit that they get under the tear trough – as the cheek supports the trough.
- As with all treatments, take oral and written consent.
- Apply local anaesthetic prior to the procedure. Assess patients individually to determine tolerance.
- You can make from three to six injections in the cheek, depending on the patient’s needs.
- Draw a curved line along the malar eminence, approximately 2cm below the infraorbital rim. Along this line, mark three appropriate points for injection.
- A second line can be drawn 1cm below and parallel to this, again with three appropriate injection points (usually directly below the points marked on the line above).
- Using high viscosity hyaluronic acid, inject at 90° to the bone, just above the periosteum. ‘Grabbing’ and gently squeezing the tissue to be injected can aid in pain relief as well as assisting with the direction of the needle.
- Inject an appropriately sized bolus below the muscle layer and withdraw the needle, do this slowly to reduce bleeding and keeping safe.
- Gently mould the material to create a gentle contour along the face.
- Approximately one syringe (1ml) of high viscosity filler can be split between the cheeks for a subtle highlight or use 1ml each cheek for volume. The product can be shared between the three to six marked points. This again will depend on the individual patient’s needs.
- Most of the dermal filler is usually distributed over the most lateral point of malar eminence, then secondly the most medial point towards the nose. Use the least filler in between the two extremities, as this area will include some overlap.
- Remember that men’s faces have different contours, and caution is needed not to feminise a male face (unless this is the desired effect).
Cannula can also be used as a choice for cheek augmentation, however a lot of practitioners choose to use the bolus technique as it is more accurate to gain the shape you are trying to achieve.
Using the same injection points a cannula is used and linear threads are left instead of bolus injections, following the angle of the next injection point
As hyaluronic acid injections of the mid face are also associated with an increased feeling of attractiveness, patients should not only look younger, but also experience an increase in self-esteem. Overall it appears that the approach to dermal fillers may slowly be changing. Practitioners are delivering non surgical facelifts rather than simply filling in lines. Client education is needed to appreciate the cost-effectiveness of enhancing the face in this way, and to communicate its virtues as a safe and efficacious treatment.