The Art of Injecting – Part 1

This three part series is meant as a guide for beginner or intermediate injectors looking for new concepts or interested in advancing their techniques. These concepts apply for injectable fillers as well as with Botox/Dysport. I also invite my patients to review these topics in order that they can be knowledgeable about their treatments. These are concepts that I frequently reference when performing trainings. I perform my own injections of filler and botox in my Southlake and Fort Worth, Texas offices.

The Art of Injecting – Part 1: Symmetry over Size

Symmetry over size has been something I recognized early in my injection career and is something I feel is not always emphasized. Always inject for symmetry over volume. Patients come to my office wanting to look “better” not “bigger”. To make them look better we must understand that our eyes are attracted to symmetry – whether we realize it or not. As a trained injector, it is important to be able to recognize lack of symmetry in order that we can correct it.

Step 1: Perform Facial Analysis to recognize symmetry.

This is the most important step. If you do not recognize that one cheek has a volume deficit compared to the other or that it sits slightly lower on the face, then it is impossible to correct it! Take the time to take pictures prior to touching a patient and study/review them.

Step 2: Review treatment goals with your patient, including pointing out asymmetries you are planning on correcting.

Although many patients may not recognize a lack of symmetry between the two sides of their faces, they should be noted prior to starting in order that you can show them where you are planning on using the products. For example “I will be using more product on your right side, in order to even the appearance of the two sides”. This allows them to feel comfortable if you are working more on one side or using more product. This also helps them understand why they may have more swelling on one side after the injections if you had to use more product

Step 3: Fill the deficient side first

In some patients, they may come to me desiring cheek volume. If they have significant flattening of one side compared to the other, it would be a mistake to put equal volume in both cheeks. Clearly this would have done nothing to address the fact that one side is more flat. Instead, you should start injecting filler on the side that needs more volume and correct to the level that the cheek volumes are equal. From that point, you can then add the volume that patient is desiring.

If I am using one syringe for a patient’s cheeks, it is not uncommon for me to inject 2/3 of the syringe in one side and the other 1/3 on the other side. As long as you can achieve that symmetry, the patients will notice the improvement right away.

Step 4: After asymmetry has been corrected, add desired volume

Only after both sides have been “evened” out to the extent possible, do I start adding desired equal volume. This prevents further distortion or more assymetry as a result of starting on the larger side, for example, and using too much product on that side, and then not having enough to catch up on the already deficient side.


Patients notice improvements in symmetry, and although not always a drastic change, patients will be happy with their results. As injectors we have the responsibility to make our patients look better – not just add volume because they tell us to! And always remember – Keep It Natural!

Thank you for reading.

Jordan Rihani, MD


About Dr. Rihani: 
Dr. Rihani is considered one of the top injectors in the Dallas Fort Worth area. Specially trained in head and neck surgery, he is a double board certified facial plastic surgeon. His dedication to education is evidenced by performing trainings across the country on injectable fillers and dysport to his peers and lecturing at national conferences. 


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