Hollow Face
Hollow Face is a visual anomaly that is not always hostile. During its recovery stage it is guaranteed to perform a Death Ritual, so the room and its candles need careful handling.
Quick Answer
Dark hollow eyes, sunken facial features, twitching, and a hunched posture.
Reject unless you intentionally handle the event route. If a Hollow Face begins a Death Ritual, stay in the room and use IV Drops, Eye Drops, or coffee to put out candles without losing sanity.
What Hollow Face actually is
Hollow Face is a visual-layer anomaly defined by dark, hollow eyes and sunken facial features, usually accompanied by twitching and a hunched posture. Three separate tells appear together rather than one, which makes it one of the more detectable visual entries — but it also carries an event route in which it begins a Death Ritual, and mishandling that route can cost sanity across the room.
When it shows up
It appears on ordinary arrivals and is not tied to a specific shift type. The distinguishing feature is the escalation: while most anomalies end when you reject them, a Hollow Face can start a Death Ritual, which turns a patient decision into a room-management problem.
Which layer catches it
The window view catches the anomaly itself. The interesting part is what happens afterwards, because the Death Ritual is handled with items rather than detection, and the response is the opposite of rejecting and walking away.
How Hollow Face reads in each layer
| Detection layer | What you see |
|---|---|
| Window | The primary layer. Dark hollow eyes, sunken features, twitching, and a hunched posture. Multiple simultaneous tells make this an easy visual rejection. |
| Clipboard photo | Supporting evidence. The photo can show the sunken features, which helps distinguish a real Hollow Face from a patient that merely looks tired under bad lighting. |
| CCTV | The hunched posture and jerking movement read clearly on the feed, and the posture change is often easier to see on camera than through a doorway. |
| Document | No documented interaction for detection. Documents are not part of resolving this entry. |
Step-by-step: a real Hollow Face encounter
- A patient arrives with a normal species and colour, but the posture is hunched and the movement is jerky.
- You look at the face. The eyes are dark and hollow and the features are sunken rather than merely shaded.
- You check the camera feed, which shows the same hunched posture and twitching without revealing anything new.
- You reject before treatment rather than admitting the patient.
- If a Death Ritual begins instead of the patient simply leaving, you stay in the room and extinguish the candles with IV Drops, Eye Drops, or coffee rather than retreating and taking the sanity loss.
False positives
Normal things players reject by mistake while hunting this entry.
- Rejecting a patient for a hunched posture alone. Posture changes with animation state; the tell is a hunched posture together with dark hollow eyes and twitching.
- Confusing the twitching with the standalone Twitching anomaly, which is erratic movement without the sunken face.
- Rejecting Ratthew for staring or unusual appearance, which the anomaly list explicitly warns against on a different entry.
- Leaving the room when a Death Ritual starts, which the recorded guidance warns against.
Often confused with
Entries that share a tell with this one, and how to separate them.
- Frequently confused with Twitching, because both involve movement. The differentiator is that Hollow Face pairs the movement with dark hollow eyes and a hunched body.
- Connected to the Death Ritual event: if one begins, the recorded response is to stay in the room and use IV Drops, Eye Drops, or coffee to put out candles without losing sanity.
- Shares the hunched-posture tell with the Unnatural Body CCTV entry, so posture alone should never be the deciding signal.
What a wrong call costs
There are two distinct costs here. Admitting the patient is a standard wrong call. Mishandling the Death Ritual is worse: leaving the room, or ignoring the candles, drains sanity across the shift and turns a single patient into a run-wide problem. The recorded guidance is explicit that you stay in the room and extinguish candles rather than retreating.
Recorded appearance and response
Appearance: The patient has dark hollow eyes and a sunken face, and usually also twitches with a hunched posture.
Tell signs: Dark hollow eyes, sunken facial features, twitching, and a hunched posture.
How to handle: Reject unless you intentionally handle the event route. If a Hollow Face begins a Death Ritual, stay in the room and use IV Drops, Eye Drops, or coffee to put out candles without losing sanity.
Last re-checked against the live game on September 16, 2026. Last verified 35 days ago — re-check pending.
Hollow Face FAQ
What do I do if a Hollow Face starts a Death Ritual?
Stay in the room. The recorded guidance is to put out the candles using IV Drops, Eye Drops, or coffee, which clears the ritual without the sanity loss you would take by leaving. Retreating is the mistake, not the safe option.
Is Hollow Face the same as Twitching?
No. They are separate entries. Twitching is erratic movement without facial change, while Hollow Face combines twitching with dark hollow eyes, sunken features, and a hunched posture. Several tells together is what separates them.
Is a hunched posture enough to reject a patient?
Not on its own. Posture is also a tell on the Unnatural Body CCTV entry and varies with animation state, so it should be paired with the facial features before you call it.
Can I handle a Hollow Face on purpose?
The recorded guidance allows for intentionally handling the event route, but only if you are equipped for it. If you are not carrying IV Drops, Eye Drops, or coffee, rejecting is the cleaner decision.
Related Guides
Other Appearance Check anomalies
Crooked Face · S
Crooked smile, sharp teeth, large mismatched eyes, or eyes positioned unusually high on the face.
Three Eyes · A
Three glowing red eyes, extra eye placement, or an eye count that does not match the patient's normal model.
Smiling with Creepy Eyes · B
Large black-pupil eyes, heavy under-eye bags, and a fixed oversized smile that does not match the normal patient.
Twitching · C
Erratic jerking movements, unnatural head/limb twitches, movement pattern different from all normal patients.
Staring · B
Sustained direct eye contact, head rotation that follows the player, and a gaze that does not break normally.
Tiny Anomaly · C
Unusually tiny body size, high-pitched voice, short-tailed pink bunny model, or multiple glowing red eyes.
X-rayed Face · B
Small wide circular eyes, black pupils, realistic teeth, or an X-rayed-looking face that appears only in one expression.