I got these because I pinched something in my neck and a week later I was still hurting. Our pillows were in need of replacing anyway, so I ordered these. The price was EXCELLENT as we were paying close to this price for lesser pillows. My neck pain was gone within 3 days after receiving them. They do take some getting used to as they are much flatter than a standard pillow. I tend to be more comfortable laying on my back with them, but they are good for side sleeping too. I would say to definitely get the oversized ones (24"). I would think the shorter ones would take more getting used to. I gave appearance a "4" as they do look flat in standard pillow cases (personally, I could care less as they work, but some people might).