Generally with Voluma, is it the injection site or is it amount of filler that can cause "pillow face" or chipmunk cheeks?

Question

I am considering Voluma to address my smile lines and under eye area. Is pillow face avoidable with just not overfilling? Or is it the injection site that makes filler look off? I have a trusted provider in mind. However, I am terrified of looking like I have pillow face or chipmunk cheeks. I am not concerned with my provider using too much, it's more of a fear of looking weird after.

Michael A. Persky, MD · Answer

Hi Mo,

I have been using Voluma in my patients since it was FDA approved in 2013.  In hundreds of patients I have not had a single patient with the dreaded "pillow face" over filling.  Voluma is one of my favorite facial rejuvenation fillers. With any aesthetic treatment it is the physician performing the procedure that determines the result. Anyone can technically inject, yet without artistic vision there will be aesthetic failure.  In the case of Voluma, it needs to be placed properly in the proper amount.  It is essential to choose your injecting physician carefully based on their skill, experience, knowledge, and most importantly their natural artistic vision. Good luck and stay well.

Michael A. Persky, MD
Encino, CA

Jonathan Kulbersh, MD · Answer

Thank you for your question. Dermal filler treatments require a tremendous amount of precision in needle placement and dosing amount to achieve the most result. The experience, training, and qualifications of your provider cannot be overstated. I highly recommend working with an injector who has the expertise necessary to ensure you receive an optimal outcome.

Phillip Chang, MD · Answer

Hi Mo_SD

Voluma was the second  hyaluronic acid filler created by Allergan. They made Voluma so that it would last up to 2 years. Although soft, it is slightly thicker than Juvederm Ultra and is therefore not as appropriate for the lips. Commonly used in any areas of the face including the temples, eyelid-cheek junction, and around the mouth.  To learn more about this procedure, please visit our website.

Jason Emer, MD · Answer

yes fillers can and this is related to poor technique or "over doing" of fillers. you need to see an expert and someone who does small subtle changes over time. also combine filler with emeragecosmetics peels like cosmelan, enlighten, Aerify; Dermarolling; and proper medical grade skincare. Best, Dr. Emer.

Camille Cash, MD · Answer

The amount of filler as well as the injected site can make your filler results either wonderful or undesirable. The injector you select is important as she/he will suggest the correct product and amount to get the look you are wanting and then be the artist to create it.  Each component is important.

Amy Y. Paul, DO, FAAD · Answer

Thanks for your question.  I would generally not recommend Voluma directly under the eyes - it is quite a bit thicker and gives more fullness than the finer hyaluronic acid fillers, such as Volbella and Belotero.  It might make the under -eye area too puffy and give you lumps where one tends to look hollow, or make puffy under eye fat pads even more noticeable.  Voluma is terrific for the chin and upper cheeks along the cheekbones and can help restore youthful fullness subtly to the cheeks.  It is true, the more filler used at once, you will have more volume, so proceed conservatively if you are worried about being over-filled and looking unnatural.  You can always add a syringe later if one or two is not enough after settling for a few weeks.  Please see an expert and best of luck!

Ahad Mahootchi, MD · Answer

Location, the indication, and amount of filling all play a role. I would take some photos of negative results and ask them how they think the injector created them.

Knowing what goes wrong and what to do to avoid problems is a sign of an experienced and knowledgeable injector.

Johnson C. Lee, MD · Answer

Puffy Cheeks can be due to where the filler is injected, the amount used, and even what type of filler is used. It is best to have a thorough discussion with your injector to make sure they address your concerns of having puffy cheeks. The good thing about hyaluronic acid fillers such as Voluma is, if you don't like it, you can always dissolve it instantly with an enzyme called hyaluronidase. Hope this helps!

Johnson C. Lee, MD
Board-Certified Plastic Surgeon

Johnson C. Lee, MD 
Board-Certified Plastic Surgeon​

Michael J. Yaremchuk, MD (license resigned) · Answer

There is an art to placing filler. This includes knowing where to place the product as well as knowing how much to place. I think as you are going to a well-trained, trusted provider, you can simply state your concerns in order to avoid such a look.

Robinson Facial Plastic Surgery - Alpharetta · Answer

Hi there! The answer to both of your questions is "yes". Both overfilling and poor placement can make Voluma, or any filler for that matter, look less than desirable. The best course of action, particularly for someone that may be a little anxious about getting filler, is to first see someone you trust, and that has a lot of experience, particularly with treating the area under the eyes, and second, go SLOW. One syringe of filler is 1mL, or about 1/3 of a teaspoon, so one syringe to the cheeks, which is a large area, is most likely not going to give the "pillow face" appearance. There is no harm in being conservative and adding as needed. On another note, while I love Voluma and use it frequently, it is not, in my opinion, the filler of choice for under eyes or the smile lines. Your provider should be able to explain the differences in the fillers and why some are better in specific areas versus others. Best of luck and enjoy!
Ivette M. Ballara, RN, BSNAdvanced Aesthetic Injector

Generally with Voluma, is it the injection site or is it amount of filler that can cause "pillow face" or chipmunk cheeks?

Answers (13)

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