If you don't care about looks you can get a porcelain repair paint and just dab it on the spot. It comes in a bottle similar to nail polish.

They do settle if they stay flat for several days, but a quick fluffing or just resting it on it's side when you aren't sleeping stops that from happening. It has a hypoallergenic cover that comes off to be washed. I washed the whole pillow once and ending up having to take all the foam out and let it air dry for two days. You can also put the whole thing in the dryer for a few minutes to really refluff it. I've had mine for two years and haven't had an issue with it going flat.

Firmness is a little hard to gauge because it is memory foam, and customizable. It does provide great support and doesn't go flat through the night. I guess the best way to put it is they are soft but very supportive. I just use one, and I have added foam to it. My husband uses the other with foam removed from it as he is a back sleeper.

The pillows I have are made with shredded memory foam, and came with extra foam to adjust the height of the pillow. DreamyBlue premium pillow on Amazon. I've had them over a year, and they are still going strong.