Lets talk about ‘Pillow Face’!

I love hyaluronic acid dermal fillers, and a modest amount expert placed in one’s face can have a beautiful and rejuvenating effect. What I don’t like is our obsession with trying to look like we did in our 20’s.

This distraction with youth often leads patients and practitioners to keep filling and filling, trying to chase the unobtainable. We have all seen those faces. The ones that are filled to max capacity. They look unnatural and almost disfigured. Now I’m not saying that adding a bit of oomph to your natural features is a bad thing. We just need to know when to stop.

Dermal fillers essentially fill a pocket of tissue to create lift and volume. It seems obvious then that if you keep filling the pocket it will become overstretched and you’re going to lose some. Yes, I said it! The filler will start to spread to places you hadn’t intended it to be. So, lets break down what contributes to pillow face. Starting at the top.


Your forehead is covered in very thin layers of tissue, with slight concavity at the temples and gentle angles from the hair line to brow. In this area dermal filler can be used to smooth wrinkles and revolumise the temples. Because we are working with such a small space even a small amount of overfill can result in the loss of natural angles and rounded temples. Whilst the difference may be subtle, that fact that is very slightly odd-looking changes your overall appearance.


The angle from the forehead to the nose (nasofrontal angle) is an area the is most often filled when patients are hoping to achieve a straight, Eurocentric appearance with dermal fillers. It is very commonly overfilled, taking away that natural angle, creating instead and high and broad angle that quite frankly looks strange.


Cheeks can contribute to pillow face in 2 ways. 1. Overfilling the lateral aspect of the cheeks can create a ledge that throws out the balance of the face. We all want cheek bones and contour, but don’t need to look like Maleficent to get there. 2. As we age the apples of our cheeks flatten out and adding a bit of filler creates a feminine youthful look. It goes wrong when we keep filling. Again, the pockets have limited space so instead of creating definition we end up creating chub.

 Jaw and chin

So, we’re trying to create soft angles, but when we get to the jaw we want a razor sharp line? Don’t get me wrong, I think jaw revolumisation for older patients is transformative. But adding bulk to this area gives me Desperate Dan vibes and means the chin disappears somewhat.  In this case, instead of adding modest volume to the chin to create balance, we need to add much more, creating the typical witches chin that seems popular at the moment.

Honorable mention … Lips

The space in which your lips are housed is very small so when we overfill them the product needs to go somewhere (Russian lips, I’m looking at you!). Over time little bits of filler leak into the surrounding tissue. You may not notice it for a couple of years, but it’s happening. Then all of the sudden you notice that you no longer have lips, but a mound of tissue and dermal filler that starts under your nose.

What can we do to keep looking good without pillow face?

There are options.

1. Don’t do anything. You’re ageing and embracing this is healthy and empowering.

2. Use effective skincare recommended by your practitioner consistently. Healthy glowing skin is the cornerstone of aesthetics and is beautiful whether you have wrinkles or not.

3. Go to practitioner who believes in moderation and can skilfully place small amounts of dermal filler for maximum effect.

4. Consider consulting a plastic surgeon with a good reputation who specialises in natural looking facial surgery.

Whatever you decide to do with your face remember that any plan you embark on should be about self-love and not loathing. If you hate your appearance or are preoccupied by your features it is worth exploring this with a counsellor or therapist, as these are issues that cannot be resolved under the needle.

AND wear your bloody sun protection!

Disclaimer: No hate to those whose desired aesthetic is ‘pillow face’.

Helen Western

Advanced Nurse Practitioner– Independent prescriber – NMC registered – registered nurse – aesthetics – Harley trained – insured – wrinkles – dermal fillers – microneedling – skincare – Frinton – lips – cheeks – marionette lines – nasolabial folds – beauty – Walton on the Naze – Holland on Sea – Clacton – Clacton on Sea – Frinton-On-Sea – Colchester – Harwich – aesthetics – Frinton – fillers – Obagi – skin care – Mole checks – Cryotherapy – moles – skin tags – skin boosters

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