What is more likely to cause the “pillow face” look, fat transfer or fillers?

Even celebrities aren't perfect at gauging how their faces should look. Although many get some terrific results from fat and or fillers, some simply go overboard.WHAT you use to fill and shape is less important than the expertise of your doctor and what you expect to achieve. Fillers are somewhat more predictable since we know about how long they'll last and how much firmness or softness they will impart. That said, there are many plastic surgeons who take advantage of "natural filler" when a patient is undergoing other procedures and there is fat available to harvest.You must be mindful that at a certain stage or age, if there is severe skin laxity, no amount of filler or fat will do justice. It's easy to assume fillers can fill up the skin envelope in every case, but that's not always possible and in some instances, attempting to do so will in fact lead to the "pillow face" you want to avoid. If you're a face lift or neck lift candidate, then those surgeries combined with a filler material can take off decades.Facial tissue anatomy and bone structure is of importance since a square face can more easily look "fattened" than a more narrow face. Choose your injector or surgeon carefully. A good doctor will take into account ALL of your face in creating a natural balance. Sometimes that means a neurotoxin to reduce jaw muscle size or lift the brow and/or filler in additional areas you'd not thought were deficient to achieve a fully natural balanced look.

We can always spot fake, unnatural, results faster. It's never the product used but the skill, experience, and artistic vision of the injector or physician. If you are overfilled with fat or fillers, or if they are placed in the wrong place then the results will be unnatural and fake looking. In general, fat transfer results are more unpredictable when compared to fillers. Best,Dr. Anil Shah MD FACS

You would be more likely to get the "pillow face" with a fat transfer because, the injector has a seemingly unlimited amount of "product" to work with. The key to a good fat transfer is to know when to stop and to know exactly where to place it for maximal impact. In the right hands, a fat transfer can give you the most natural results especially when treating the under eye area, but it has to be done by someone who really knows what they are doing. Unless you have carefully researched your injector, you should go with the filler because most fillers are reversible.