Fillers: The hidden risks of the "pillowface" phenomenon

Fillers were supposed to be a non-invasive recipe for "eternal youth." It turns out they can be problematic.

Injecting fillers (most commonly hyaluronic acid) is currently one of the most popular medical procedures. Fillers are injected into the lips to enlarge them but also into the cheeks and other parts of the face to minimize the visibility of wrinkles. Hollywood stars and influencers of both genders, for whom signs of ageing are unacceptable, have popularised these procedures.

For some time now, some people who have been using fillers for a long time have started to look similar and not necessarily favourably. This is the "pillowface" effect, which results from excess substances stretching the skin. Dr. Carl Truesdale, a plastic surgeon from Beverly Hills, explained to the Betches portal that it is about an "unnatural appearance in which the face’s natural contours and anatomy are blunted." The face looks more like a fluffy pillow than a sculpted masterpiece.

The reason for creating "pillowface" can be not only the injection of too large a quantity of fillers at once. As it turns out, assurances that hyaluronic acid is absorbed over time might have been unfounded, so "pillowface" may also result from accumulation from multiple procedures. Recently, a video went viral on TikTok in which plastic surgeon Dr. Kami Parsa showed an image from an MRI scan of one of his patients.

The MRI showed the face of a woman who had hyaluronic acid injected twelve times over the past six years. This is the standard frequency of procedures. In the 3D image, it is visible that the fillers occupy most of the lower surface of the patient's face. Not only did they not absorb, but contrary to the surprise of the surgeon, who calculated the volume of hyaluronic acid in the face of the 33-year-old, it was greater than what resulted from the injections. Dr. Parsa explained that hyaluronic acid "loves water" and increases its volume when it is available.

The fillers in Dr. Parsa's patient's face more than doubled in volume and migrated throughout the lower half of her face. They were under the eyes, on the temples, and on the chin, which are places where they were not injected. This stretches the tissues throughout the face and can lead to "pillowface." It's a trap that is hard to escape. After dissolving the fillers, the face may look "worse than before," compared to the natural ageing process.