The Art of Framing the Eyes: A Story of Beautiful Cheeks
Patients often ask for higher, more defined cheeks. Look at the supermodels, and the reason becomes clear. When cheeks are dominant in a female face—wider than the jawline, well-defined, with a catch light that frames the eyes—they create what I call the presentation box for the eyes. Everything is drawn toward the eyes through the interplay of catch lights and shadows as you work down the face. This is where it becomes crucial to see the cheeks as part of the overall context of the face. We simply cannot outcompete the lower face by just adding more and more filler in the cheek. The best before-and-after results you'll see use multiple modalities to achieve the ideal outcome. That could mean weight loss or liposuction to remove volume that competes with the cheeks in the upper face, or simply being naturally slim with smaller cheeks that can then be corrected by adding volume. Always consider the ratio between cheek and jawline as one of the defining characteristics of beautiful faces.
The Anatomy of Light and Shadow
Whenever you see a beautiful cheek, observe the light reflexes. What you'll typically notice is a catch light on top of the cheek. This bright reflective light—because most light comes from above—essentially frames the eyes. It creates a dramatic contrast between the eye itself and the cheek, making the eyes really stand out. As soon as shadows creep in here, or there is a flatter cheek that doesn't catch the light, the eyes actually look less vivid in our mind's eye. A catch light comes from a projection underneath. This is the key understanding: cheeks need a projected point that shifts a plane outward so that it catches light and causes that contrast between the eyes. That is core to creating beautiful treatment plans. We need to be purposely shifting the shape of the cheek to frame the eyes.
In female cheeks, there are three core projections. There is an anterior projection on the front of the cheek. There is the angle of the zygoma. And then there is the widest point of the cheek, which is more superior and upward-facing in females. In men, you often see almost nothing there at all. This is therefore one of the most feminine parts of the face and cannot be overlooked when doing cheek treatments. Notice in the example of Kate Moss how the cheek looks separated from the rest of the face, but in the most subtle way possible. There is clearly a separation between the cheek and the jawline, the cheek and the lip, and the cheek and the eye. But the distinction between these structures is very gently faded in youth. As you get older, nasal labial folds and other lines and volume loss make these boundaries more harsh. A beautiful cheek is both distinct but also very gently blended in with the rest of the face. The shadow underneath then frames the upper part of the cheek and separates the cheek from the jawline. That shadow should ideally not cross beneath a line that runs an inverted line between the corner of the mouth and the midpoint of your ear. Imagine the skin being held on by the nasal labial fold ligament, the masoteric ligaments, the lateral orbital thickening, and then having bone and fat underneath projecting the cheek outward. It is these structures that form a beautiful female cheek. And the part we can control as injectors is the volume in each of those components. So we can add volume anteriorly, volume to the angle, and volume to that most feminine and most beautiful part of the cheek that most models have in abundance—this projection here laterally.
A Case in Point: Transforming the Midface
Let's look at a particular case. In this patient, there is a little bit of lateral orbital volume loss, which means the cheek is slightly separated. The cheek is also relatively flush with the lateral part of the face. There isn't much of a lateral projection here. So the temple and the lower face essentially hide the shape of the feminine cheek. Our goal, therefore, is to increase the volume laterally, increase the definition of the defining point of the cheek, and thereby increase the light underneath the eyes while also altering the proportion subtly to increase the femininity of the midface. In the after, you can see a better catch light defining the cheek, fewer shadows laterally, and then a more distinct boundary between the cheek, the shadow that forms underneath the cheek, and then the jawline, as well as the temple superior to it. It is these defining lines—with shadows and catch lights above—that essentially frame the eyes. Once you are aware of the aesthetic goal, you can identify the aesthetic gap with your patients. We all have different amounts of potential, and it is one of the skills of the injector to establish what that might be. This then informs where you inject. The typical place to inject to make a more feminine cheek would start around the defining points. The angle of the zygoma is crucial, as is the lateral part of the cheek where the zygoma meets the temple bone. We then want to create a roundness to that shape. So injections that are slightly lateral to the angle of the zygoma are often where we spend most of our time and attention. But never forget that projection of the cheek anteriorly also gives a three-dimensional shape reflecting good prominent cheekbones.
The Challenges and the Truth
What are the challenges when treating cheeks? The first thing is that if there is already excessive volume or proportion, we should not try to solve problems by adding more. It is quite tempting, and many injectors will cross this line at various points, trying to create definition when the underlying problem is excess volume. All you do is change the proportion, and the patient looks overtreated. So be careful of patients who have relatively full cheeks, but they are full above and below as well, because you cannot always compensate with more volume. This is where your patient likely needs to lose a little bit of body weight. They are almost certainly already aware of this, and what they are looking for is a kind and supporting person who can do something to help them. Now, if you are focused entirely on aesthetics, you might only focus on injections, but good advice is always worth having. You may produce a leaflet that helps patients lose weight in the most evidence-based way, for example. Later on, you may also be providing weight loss injections or other protocols that help your patients. This is how facial aesthetics can lead into health and longevity for your patients. Because ultimately, it will benefit them in many ways if you solve the underlying problem rather than trying to cover everything up with short-term simple solutions that don't actually solve anything.
In these situations, I am reminded constantly that in the long arc of time, the truth is your only friend. You cannot avoid the reality of the situation. If you treat patients who don't need it with filler to try to solve a problem that requires weight loss, you will pay a price. Similarly, if you are not honest with them about why you don't want to treat them, they will also pick up this dishonesty and not want to see you again. The only solution is with love to give them the truth. And this is something you can practice and get better at. Most patients, if you do it well, will be grateful for it or at least patient with you, even if they decide to ignore your advice. But at least you have said something that brings integrity to you as the practitioner. Also remember to see your patients as part of a journey. Every consultation does not have to solve every problem, but you can be the start of solving much more important problems years down the line. It is often the case that little conversations you think don't mean much turn out to be a turning point for some of your patients. Always empower them with the truth, which will lead to a better result in the long run. If you want to learn more about how to create natural, defined cheeks for your patients, the links in the description offer further training.