I purchased this because I was concerned about my baby's head shape and positional plagiocephaly. My baby is now 1 year old, and has a perfectly round head◎ Comes with a spare pillowcase◎ (I will include another one of the same in the photos) The fabric has no noticeable stains or tears, and I don't think there's any shape distortion, but please understand that this is a used item before purchasing.