The 5ml Protocol

We divide the 5 mL of filler into several targeted regions. The exact allocation varies depending on individual anatomy, but the principle is consistent: restore volume where it has been lost and support adjacent structures.

1. Mid‑face and cheek lift

The mid‑face is often the first area to show volume loss. Ageing in this region is characterised by loss of cheek projection and the flattening of the “ogee” curve, leading to accentuated nasolabial folds and tear‑trough (under eye) shadows. Restoring volume in the malar (cheek) region has a powerful lifting effect on neighbouring areas: when filler is placed deep over the bone – starting laterally and moving medially – it can improve the appearance of the tear trough and the upper nasolabial fold without directly injecting them.

Cheek filler also enhances the shape and contour of the cheeks; patients often describe their face as looking more youthful and “lifted”. We typically use 2 mL of filler split between both cheeks. Treating both the lateral and medial cheek compartments ensures balanced results.

2. Nose‑to‑mouth lines (nasolabial folds)

Nasolabial folds (NLFs) deepen with age due to several factors: mid‑face and lower‑face bone resorption, reduced projection of the maxilla, ligament laxity and descent of the malar fat pads. Using small amounts of filler (typically 1-2mls split between both sides) along the nasolabial groove adds support without over‑bulking. Although restoring the cheek can provide a little lift to the NLF indirectly, most patients still require some volume directly into the fold itself.

3. Lower face, pre‑jowl sulcus and marionette lines

The pre‑jowl sulcus is the shallow trough between the chin and the jowl. It remains subtle in youth but becomes more pronounced with age as the surrounding skin loses volume and sags. Filling this area softens the transition between the chin and jawline and improves the appearance of early jowls. Dermal filler is particularly effective here. We also restore volume along the lower canine, which is an area of volume loss noticeable by a depression at the side of the chin. When this is corrected, it provides an excellent reduction in the appearance of jowls. It is critical that during this step we avoid adding volume directly into the jowl fat – doing so may create heaviness.

As part of the 5mls protocol, the lower face typically receives 2mls of filler, distributed between the pre‑jowl sulcus, mandibular canine and marionette lines via a blunt cannula to minimise trauma.

4. Optional areas and complementary treatments

The 5‑mL Protocol delivers an overall refresh that is suitable to address the early signs of ageing for most patients. If you want to enhance the results further, some additional treatments may also be added either at the same time or a later date to gradually build on the results. Examples include:

• Tear‑trough and temples – Some patients have significant under‑eye hollowing or temple concavity.

• Lip and perioral lines – Subtle lip enhancement or smoothing of lipstick lines can complement the refreshed mid‑face.

• Neuromodulators and lasers – Botulinum toxin type A is widely used to soften dynamic wrinkles, especially on the upper part of the face although it can also be used to rejuvenate platysmal bands on the neck.

• Laser skin rejuvenation: Whilst injectables are excellent for restoring the contours of the ageing face, additional treatment with lasers like BBL or Halo laser are an excellent adjunct for patients who want to achieve more improvement in the surface of the skin – fine lines, texture, pores, pigments, blood vessels for example.