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. 

Fake, unnatural, and pillow face looking results are not so much due to 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. I would recommend an in-person consultation and evaluation with an experienced physician provider to determine which treatments would be most appropriate for you. Best wishes.

Keep in mind, there is initial swelling with both fillers and fat. It will take up to 6 months to see final results with fat transfer. Fat transfer technique is what is important for successful fat transfer and the fat is processed. I recommend water-assisted fat harvesting which gives pure fat to transfer and combine with platelet rich plasma (PRP) to get the most viable and sustainable fat cells. I then combine with Sculptra, depending on area, to improve final results. recommend getting a formal evaluation with an expert. Best, Dr. Emer

hi Jellyb.  The answer is it depends.  It’s really more about how the procedure is done than which one it is.  With that said fat transfer can have prolonged swelling and has a risk of not lasting.  Swelling could last months and many patients that have facial fat transfer do not achieve long term results.For this reason, we utilize fillers far more frequently.  The shaping process is consistent and products like Sculptra can provide a 2 year result and beyond.

This is a great question, thanks for asking! The type of product that you choose—whether a certain filler or fat transfer procedure—makes less of a difference than the provider who administers them when it comes to getting a smooth, natural look. Start by doing some research and scheduling a consultation with a cosmetic surgeon or two who have a proven track record of providing exceptional results. Once you’ve found a skilled provider, you can discuss your treatment options with them to ensure you get the results you’re looking for.

I would say hyaluronic acid dermal fillers are a safer bet as they can be easily corrected using hyalase to dissolve them. Fat transfer is harder to correct. Pillow face usually occurs if too much product is injected and in the wrong area.

The outcome from fat grafting or any  other filler depends strictly on the skill and the artistic ability of the plastic surgeon. Fat grafting in my opinion is the single best way to revolumize the face of an individual. I always look at the photographs of the patient many years prior their consultation with me, sometime between the ages of 16 to 25. I would recommend you do the same when you see your plastic surgeon. Please look at the page for Rejuvenation of the face using fat grafting on my website. There's plenty of good information you can read and photographs to evaluate. The results in most of the patients are seen many years after the surgery has been performed. Most of the patients are at least four years after the fat grafting procedures. Good luck from New York City

Thanks for your question. We should all have a moment of silence for Courtney Cox's face...however, I think Jennifer Aniston introduced her to her own injector and she's been looking like her beautiful self again! Hooray! 
As for the "fake" look, this is highly injector-dependent. Fat transfer done well can look incredible, as can fillers. Both are temporary and address the symptom of volume loss and not the cause, which is decreased collagen and bone loss. So I would recommend doing either one with an experienced provider and also adding a treatment like Sculptra and PRP to boost your own natural collagen production so that you'll get better results and slower volume loss over time!
Best,
@DrKatNP.trilogy