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Show Notes
On today’s episode of AP Class, we’re reviewing an anatomy-based injectable technique for correcting the midcheek groove with hyaluronic acid filler. This study emphasizes structural understanding in anatomical precision. We’ll explore how technique, depth, and product placement grounded in anatomy can enhance outcomes and why that foundation matters for both safety and results.
Episode participants:
Radiance Wellness | radiance.well
Megan Ucich | the.skin.practitioner
Aayesha Patel | aaestheticsbyaayesha
Sarah Pertschuk | beautyinjectorsarah
Downloads:
- Radiance Wellness one-pager: Download Here
- Article review: A New Approach in the Correction of the Midcheek Groove: The Liquid Malar-lift Technique
Why This Study Matters
In aesthetic medicine, the most visible concern is rarely the true problem.
Patients point to a line, a fold, or a groove—and understandably want it gone. But as injectors, we know that facial aging rarely presents as an isolated surface problem. More often, visible changes are symptoms of deeper structural shifts happening beneath the skin.
In this episode of AP Class, we review an anatomy based injectable technique for correcting the midcheek groove using hyaluronic acid filler. This study introduces what’s referred to as the liquid malar lift technique, reframing the midcheek groove not as a line to be filled, but as a consequence of volume loss and structural collapse in deep fat compartments.
The question at the heart of this discussion isn’t whether filler works—we already know it can.
It’s whether how and where we place filler matters more than the appearance of the line itself.
Spoiler: it does.
The Midcheek Groove: More Than a Line
The midcheek groove is one of the most commonly misunderstood features of the midface. It frequently presents as a tired, hollowed appearance that patients often mistake for an under-eye issue.
Historically, treatment trends leaned toward superficial filling directly within the groove. While this approach may offer immediate smoothing, it often leads to:
- Anterior heaviness
- Facial distortion
- Short-lived or unnatural results
This study pushes us to zoom out and recognize the midcheek groove as a consequence of structional deficiency, not a target in isolation.
An Anatomy-Driven Approach to Aging
Facial aging is characterized by:
- Atrophy of deep fat compartments
- Skeletal remodeling due to decrease in bone density
- Loss of structural support
As these deeper structures shrink or descend, overlying tissue follows—revealing grooves and folds tethered by ligaments such as the zygomatic cutaneous ligament.
The takeaway?
If support is lost below, surface correction alone will never fully restore balance.
This is where anatomy based injection techniques become essential.
The Study at a Glance
This paper is best understood as a technique driven, anatomy focused case series, rather than a comparative efficacy trial.
Population
- 64 patients
- Ages 25–60
- Mixed genders
- Patients with age and volume related midcheek grooves
Importantly, congenital midcheek grooves were differentiated from age related changes.
The Liquid Malar Lift Technique
This approach prioritizes structural restoration before superficial refinement.
Key Concepts
- Anatomy first injection strategy
- Deep before superficial
- Support before smoothing
Injection Strategy
- Cannula entry point placed laterally to reduce vascular risk
- Filler placed on periosteum within:
- Deep medial cheek fat compartment
- Deep lateral cheek fat compartment
- Small boluses (approximately 0.2–0.4 mL) used to restore projection and support
- Superficial fat compartments addressed secondarily using retrograde linear technique
By reestablishing projection and support at depth, superficial tissues repositions more naturally which reduces the need to “fill” unsupported space.
Outcome Measures and Imaging
There was no formal comparison group in this study. Instead, outcomes were assessed using:
- Pre- and post-treatment clinical photography
- MRI imaging (performed in one subject)
The MRI demonstrated:
- Restoration of intended deep fat compartments
- No evidence of inferior migration
- Increased projection measured objectively
While limited, this radiologic data supports the concept that deep placement provides stability, a major concern for both providers and patients.
What They Found
Visible Clinical Improvement
Patients demonstrated:
- Improved midface contour
- Smoother transitions from anterior to lateral cheek
- Reduction in the appearance of the midcheek groove
These findings were described qualitatively rather than with validated scales.
Structural Support Matters
The study reinforces existing anatomical literature suggesting that deep fat compartments act as structural pillars. When they are restored, overlying tissue repositions more naturally and harmoniously.
This represents a noticeable shift away from treating the midcheek groove like a nasolabial fold—and toward treating the cause, not the consequence.
Limitations to Keep in Mind
As with many anatomy-based technique papers, there are important constraints:
- No control group
- No statistical analysis or p-values
- MRI performed on only one patient
- Short follow-up period (one week), where swelling may influence outcomes
- No clearly defined inclusion or exclusion criteria
Because of this, the study does not establish superiority over other midface techniques. It is a great demonstration of anatomical reasoning applied in practice.
Clinical Takeaways for Practice
This Is Not a Protocol—It’s a Framework
This technique should not be interpreted as a universal protocol. Its value lies in reinforcing a structured, anatomy –first approach to midface assessment and tertment.
Anatomy Before Lines
Treating the midcheek groove requires:
- Understanding deep fat compartment anatomy
- Respecting facial support structures
- Resisting the urge to inject superficially “where the patient points”
Patient Education Is Essential
This approach requires trust. Patients must understand why you’re treating an area they may not have identified themselves.
Clear explanation is essential to align expectations.
What This Means for Aesthetic Providers
This study validates a foundational principle of modern aesthetics:
Natural results come from respecting anatomy—not chasing lines.
While more evidence is needed before widespread adoption as a standardized technique, the liquid malar lift concept reinforces that well-placed, minimal filler in the right anatomical plane can outperform superficial correction every time.
Closing Thoughts
The midcheek groove is not a standalone problem—it’s a visible marker of deeper structural changes.
This anatomy-based approach reminds us that our role as aesthetic providers isn’t to react to symptoms, but to diagnose underlying causes and treat them intelligently.
As always in AP Class, we’re less interested in quick fixes—and more focused on:
- Evidence
- Anatomy
- Long-term outcomes
Class dismissed—for now.
