Cosmetic Surgeons Reveal Three Tips To Avoid ‘Pillow Face’

The term “pillow face” has been gaining traction on social media, with Google searches for the unfortunate transformation more than doubling since early July. But what is pillow face, and how can you avoid it?
Newsweek spoke to two cosmetic surgeons to find out.
“In the past five years, dermal filler procedures have more than doubled their annual numbers,” Samuel Lin, an associate professor of surgery at Harvard Medical School and board-certified plastic surgeon, told Newsweek. “The ASPS Statistics Report 2023 reported 6.2 million…filler procedures in the year 2023—that’s 17,000 fillers per day.”
The procedure is generally performed to plump-up wrinkles, smooth over fine lines and restore or amplify volume in the face, and typically lasts between 6 to 18 months depending on the site of the injection, board certified plastic surgeon, Ari Hoschander, said. “For example, lip fillers need to be injected more often because we are constantly moving our lips and it will disintegrate faster,” he told Newsweek.
Both Hoschander and Lin said that, in most cases, previous filler does not need to be dissolved before re-injection. However, it is possible for the injected filler to migrate to other parts of the face, resulting in an uneven or swollen appearance, which, when combined with repeated injections over time, can produce the puffy, bloated look characteristic of “pillow face.”
“There are many different factors that can contribute to filler migrating away from the site of the injection,” Hoschander said. “It can be a cause of the injection technique. If the filler is injected too quickly, with too much pressure or too close to the surface of the skin, it can migrate. It the patient’s skin is too thin, the filler could also migrate as well.”
Lin added that some injection sites may be more vulnerable to filler migration than others. “Filler migration occurs most often in highly mobile areas of the face with a lot of muscle activity, such as the forehead, around the lips, and the cheeks,” he said. “Assisted by gravity, the muscle pushes filler through subcutaneous tissue away from the injection site. Patients with slack skin and surplus subcutaneous tissue may be more likely to experience migration.”
So, what can you do to minimize your risk of developing “pillow face”? Lin shared the following tips:
Choose a qualified and experienced practitioner: “Ensure that the practitioner is a board-certified plastic surgeon or dermatologist with extensive experience in dermal fillers. An experienced technician will have a robust knowledge of facial anatomy to avoid inadvertent injection into vessels and will follow strict aseptic techniques to prevent infections.”
Follow post-procedure care: “Minimize making facial expressions or massaging the treated area immediately after the procedure to prevent migration of filler. Additionally, avoid activities that cause vasodilation, such as exercise and sun exposure, to help reduce swelling afterwards.”
Avoid overcorrection: “A conservative approach with gradual enhancements rather than a single large volume injection reduces risk of complications. Patients should schedule regular follow-ups to monitor results, address any issues promptly, and decide if additional filler is necessary.”
Of course, pillow face is just one of several, more severe side effects that may result from this procedure. “More serious complications occur when filler is injected into or near a blood vessel,” Lin said. “When blood flow is obstructed by filler, you can get tissue necrosis, blindness, and even stroke. Although vascular complications remain extremely rare, they have become more common from 2014 to 2020 and require prompt recognition and management.”
As the procedure has risen in popularity, the demand for cheaper, more accessible options has also increased, which Lin said has “opened the door for counterfeit products.”
“A nationwide survey distributed to members of the American Society for Dermatologic Surgery (ASDS) and the American Society for Laser Medicine and Surgery (ASLMS) found that 41.1% of practitioners have encountered counterfeit injectables, and 39.7% have had patients with adverse events from them. Counterfeit dermal fillers are unregulated and can contain many harmful ingredients such as lead and mercury, causing serious health problems. There are now DIY Botox and dermal-filler kits available online, further endangering patient safety.
“It is vital that consumers remain wary of too-good-to-be-true prices and verify product authenticity when it comes to dermal fillers.”
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