08/02/2026
This is why facial assessment matters.
This client came in asking for cheek filler because she felt the apples of her cheeks had “sunk”.
But on assessment, the primary issue wasn’t volume loss in the cheek itself.
The appearance was being driven by reduced support in the piriform fossa (the deep concavity beside the nose that anchors the midface). When support here is compromised, the cheek can appear flattened or descended even when cheek volume is still present.
Anatomically, the piriform fossa lies close to key vascular structures, including branches of the facial artery and angular artery, which makes product placement in this region highly technique-dependent.
That’s why the plan was:
• Structural support in the piriform fossa using a cannula. The blunt tip allows navigation around vessels rather than piercing them. This significantly reduces the risk of intravascular injection. Cannulas are widely cited as carrying a ~70–80% lower risk of vascular occlusion compared to needles (though no technique is ever zero-risk and with cannulas smaller than 27g the risk is equal to a needle.)
An added benefit here is mechanical subcision: the cannula helps release tethered or fibrotic tissue, improving mobility of the overlying soft tissue and allowing the filler to integrate more naturally
• Subtle projection at the apex of the zygoma using a needle.
This area benefits from sharp precision. Needles enable controlled placement to restore highlight and cheekbone definition
No overfilling.
No cookie-cutter cheeks.
Just anatomy, structure, and proportion.
When you treat the cause rather than the request, the result feels natural…
Save this if you value anatomy-led, safety-first aesthetics.
