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What Causes “Pillow Face” from Fillers, and How to Avoid it

Facial volume loss is one of the first significant signs of aging. As we age, the appearance of a full and defined face becomes more flat or sunken. Facial volume loss due to aging is caused by loss of bone, muscle, fat, and soft tissue. The application of cosmetic filler is a popular treatment to restore facial volume, but many people find themselves looking soft and pillowy after this type of procedure. I’ll discuss different aspects of adding facial volume, and how that pillowy look can be avoided.

People come in periodically after a facial dermal filler procedure performed elsewhere complaining about looking soft like a pillow, or looking doughy. The volume augmentation does not look firm, and often have some random dimpling in the cheeks. They end up looking bloated like “chipmunk cheeks” rather than defined and youthful.

Pillow Face from Fillers

What Causes "Pillow Face"?

What causes volume augmentation to result in a pillowy look? Most doctors place cosmetic fillers just below the surface of the skin, or in the fat or soft tissue layer. Fillers commonly placed in the fat and soft tissue space underneath the dermis rely on the overlying skin to hold them in place. This space has limited ability to maintain the shape of a filler, even when precisely placed.

In the office, it can look good initially, but the filler migrates, and creates a doughy look. Some doctors actually intentionally place larger amounts of filler to balloon the skin to fill the potential space in such a way that the cheeks end up looking large and disproportionate. From my perspective, this exaggerated and unnatural appearance makes rational people afraid to consider cheek volume enhancement, in many ways comparable to the fear of having duck lips like some well-known people in the media.
Many doctors who perform these procedures are not surgeons with any experience working at the level of the bone structure. Early in my career, I worked as a division chief of oculoplastic surgery at a level one trauma center, and performed surgical reconstruction for facial trauma and tumors routinely.

In addition, in my cosmetic practice, I’ve routinely performed facial implants, which need to be placed directly on the bone. When it comes to facial rejuvenation, what is overlooked by many doctors particularly dermatologists is where most of the volume loss from aging is occurring – at the bone level. A few millimeters of bone loss corresponds with a significant loss of volume. Yet, filler placement is routinely placed just under the skin, which reflects an outside-to-in approach.

How Dr. Prasad Avoids a Pillow Face

I approach facial rejuvenation from an inside-out approach. By applying my knowledge and experience as a cosmetic and reconstructive surgeon, I place specific fillers at the bone level with minimal trauma to create a more structured, and youthful appearance. Essentially, applying the principles used in facial implant surgery to the placement of resilient and long lasting hyaluronic acid fillers at the bone level, usually with minimal to no bruising.

before and after liquid facelift - female patient three-quarter view
y lift before and after

Oftentimes, I find the results to be superior to what would have been achieved on the same individual if they were to have a facelifts. The facial fat and soft tissue layers lay over the foundational volume, looking contoured, natural, and soft to the touch.

How to Get Rid of Pillow Face from Fillers?

I routinely let my patients know in consultation that if you’ve had facial filler done, and you are unhappy with the result, as long as the material is a hyaluronic acid filler such as from the Restylane or Juvederm families of fillers, the results can be reversed with the injectable enzyme hyaluronidase. After dissolving, I can place the facial fillers deeper in the anatomy for a more defined result.

Patients can look pretty good right after the procedure, which only takes minutes for the full face, including the chin (View Chin Filler Before and After), jawline, and cheeks. I normally see patients about two weeks after the procedure for follow-up to see if any further enhancement is needed. It’s better to add filler later on if needed, than to add too much in the initial treatment, then having to dissolve it.

how Dr. Prasad avoid pillow face - y lift before and after recovery
how Dr. Prasad avoid pillow face from fillers - liquid facelift or y lift before and after recovery

If your face fillers gone wrong or looks like a pillow after undergoing filler placement, you still can achieve a natural look with Structural Volumizing at the bone level. Many times, people blame the filler for their outcome. It’s important to see filler as a material, just as clay is to a sculptor – it is the sculptor that determines how the sculpture looks, not the clay. As I stated earlier, I often start with patients who have a pillowy look from their previous procedure by dissolving the filler, and starting over with the Y-lift technique to achieve a more structured, contoured, and natural-looking result.

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