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

why did my face look like a pillow after cosmetic fillers volume loss is one of
the first significant signs of facial aging as we age the appearance of full
and defined 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 augment or 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

I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic
and reconstructive surgeon I’ve been in practice in Manhattan and Long Island
for over 20 years in addition to performing all types of surgical
procedures such as facelifts and eye lifts

I perform non-surgical facial
volume enhancement procedures every day in my practice people come in
periodically after a facial filler procedure done elsewhere and they
complain about looking soft like a pillow or looking doughy the volume
augmentation does not look firm and often with some random dimpling in the
cheeks they end up looking bloated rather than defined and youthful so what
causes volume augmentation to result in a pillowy look it’s anatomy specifically
the level and the techniques applied most doctors place cosmetic fillers just
below the surface of the skin or under the dermis fillers are commonly placed
in the fat and soft tissue space underneath the dermis and rely on the
sent an 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 spreads and creates a doughy look
some doctors actually intentionally placed a larger volume of fillers to
balloon the skin to fully 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 with
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 actually occurring it’s 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 2.n approach

I approach facial rejuvenation from an
inside to 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 acid fillers at the bone level usually
with minimal to no bruising often times I find the results to be superior to
what would have been achieved on that same individual if they were to have
even a facelift the facial fat and soft tissue layers now lay over the
foundational structure volume looking contoured and is natural and soft to the
touch

I routinely let my patients know in consultation that if you’ve had
facial filler done and you’re unhappy with the results 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 enzyme hyaluronidase after the
dissolving I can place the facial fillers in a more anatomic and aesthetic
way patients can look pretty good right after this procedure which only takes
minutes for the full face including the chin jawline and cheeks

I normally see my patients about two weeks after the procedure for follow-up if your face
looks like a pillow after undergoing filler placement you still can achieve a
natural look with structural volumizing at the bone level many times patients
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 first dissolving the filler
and starting over with structural volumizing techniques to achieve a more
structured contoured and natural-looking result I hope you found this information
helpful thank you for your question

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 facelift. 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, 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
Conclusion:

If your face 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 Structural Volumizing technique to achieve a more structured, contoured, and natural-looking result.

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