Marking Up for Cheek Filler

We talk a lot about injection techniques but sometimes it’s important to go back to basics. Here we’re looking at marking up for cheek filler with some help from one of our senior clinical trainers.

Dr Jess Srivastava is an experienced cosmetic doctor with her own practice in London and Wales. She is a Level 7 graduate and senior clinical trainer at Harley Academy. 

We spoke to her about your most frequently asked questions on marking up for cheek filler…

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Key considerations for cheek filler patient assessments


“We know that ageing begins in the mid-face with loss of bony support and atrophy of most fat pads, albeit we experience hypertrophy of the jowl and nasolabial fat,” Dr Jess reminds us. “Furthermore, we also know that from our late 20s we get a decline in collagen production and skin experiences a loss of elasticity.”

“Given this, we have to assess all layers of the skin when a patient presents with concerns regarding volume loss or when wanting to enhance the cheeks.”

She notes, “Generally, cheeks need assessing and treating in multiple areas to replace volume and give support. For example, in the zygoma, pre auricular, deep medial cheek and medial SOOF .” 

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“Females tend to have higher, more contoured cheekbones and fuller deep medial cheeks than males,” says Dr Jess. “We tend to see flatter mid-faces on males and it’s important not to over-feminise or over-volumise these patients,” she explains. 

When treating gender neutral aesthetics patients or those who wish to have a non-gender normative or degendered appearance, it is vital to confirm their goals. Ensure you perform a thorough clinical consultation to discuss these. You can then work together to devise a treatment plan that meets their expectations and you are both comfortable with.


“There are huge variations between different ethnicities when it comes to facial appearance,” Dr Jess points out. “These need to be assessed on an individual level and treated appropriately.”

She continues, “For example, East Asian patients have a naturally flatter deep medial cheek, often combined with full, sculpted cheekbones. Therefore, it would be inappropriate to assume or create volume in the deep medial cheek in the same way you might for Caucasian patients.”

Knowing how to properly assess patients of different races, with an innate understanding of the proportional differences between ethnicities can really mark you out as an aesthetics specialist. 

Whilst you are learning, try to treat as many different patient types as possible under the guidance of your mentor. Explore treating patients of various ages, genders, races and those seeking beautification as well as anti-ageing solutions. Each has their own unique quirks that your mentor can guide and support you through, answering any questions you may have. 

Building this wide range of patients into your mentoring cases allows you to become more confident in treating a broad client base before you start practising unsupervised. 

White pencils for marking up

We are frequently asked what the white pencil used to mark up injectables patients with is and where to buy them. “You don’t need anything too complex here,” advises Dr Jess. “It can be a white eyeliner! I buy mine from the pharmacy but some filler companies actually give you white pencils when you start using their brand.”

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How to mark up for…

Lateral cheek filler 

“Find the lower border of the zygoma, then find the upper border,” explains Dr Jess. “Draw horizontal lines on the cheek to demarcate these landmarks.” 

“The next thing to do is draw on your standard 3 points. These should be 5-10mm apart and it’s important that they don’t impinge on the orbital rim,” she warns. “This can create an unnatural fullness in this area and lead to excess oedema forming due to the hydrophilic nature of the fillers.”

Anterior (apex) cheek filler 

“There are many different ways to mark up the apex; at Harley Academy we teach you to start with a line from the lateral canthus down to the oral commissure,” says Dr Jess. 

“The next line to draw on is one from the ala of the nose to the tragus of the ear. The point at which these two lines intersect is your apex of the cheek. Again, this shouldn’t be too close to the eye and it should be more inferior than your lateral cheek points.”


Cheek filler training for healthcare professionals

Whether you’re a beginner or a more experienced aesthetics practitioner, we have cheek filler training options available. These are open to doctors, dentists, nurses and midwives.

Starting out

Our entry level training sets you up in the fundamentals of aesthetic medicine and allows you to obtain the insurance you need to practise injectables. These short courses are suitable for complete novices and should be seen as the starting point for your aesthetics education. Both cover the basics of cheek filler treatments.

Foundation Training in Botox and Dermal Fillers

Core Training in Botox and Dermal Fillers

Healthcare professionals who have successfully completed this level of training – with us or elsewhere – and are licensed to practise aesthetics, can then progress to more hands-on learning. 

Level 7 Diploma courses

Our industry-leading postgraduate qualification, the Level 7 Diploma in Botox and Dermal Fillers, is the next step. This combines an engaging mix of self-paced, user-friendly eLearning with observed treatment demonstrations and one-on-one mentoring as you treat your own patients. Designed to prepare you for safe and effective, real world clinical practise, this Ofqual regulated course is also backed by the Joint Council of Cosmetic Practitioners (JCCP).

Not only will your Level 7 training allow you to fully immerse yourself in the anatomy, skin and facial ageing involved in mid-face treatments, such as cheek filler. It also builds your confidence as an injector through expert mentored learning as you treat patients in a real clinic environment.

The Level 7 Diploma qualification can be combined with our Cosmetic Dermatology course for a holistic approach to aesthetics. Furthermore, for experienced practitioners looking to formalise their aesthetics training ahead of the UK’s anticipated regulatory requirements, a Fast Track Level 7 Diploma course is also available.

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Cheek filler mentoring sessions

One-to-one mentoring is a standard element in our Level 7 Diploma courses – with the exception of the Fast Track option. However, for aesthetics practitioners who are not undertaking this qualification, or those who perhaps wish to refresh their techniques, we offer dedicated area-specific 1:1 Injectables Training options. 

These allow injectors to hone in on certain zones to really sharpen their skills in particular areas of concern. For those wishing to improve their cheek filler skills, our 1:1 Injectables Training in Mid-Face and Cannula is the course for you!

Concentrate on improving your approach to cheek filler and build your confidence as you treat your own patient under the guidance of a specialist mentor. This one-to-one time allows for a truly enhanced learning experience for accelerated comprehension.

If you’re unsure which course options are right for you, simply book a call with our Student Recruitment team. They’re always happy to answer your questions and guide you through the options that best suit your remit. Whichever pathway you choose, we look forward to welcoming you and helping you to become #HarleyTrained!