I only saw like one person draw something with the same idea.
So here's my contribution, enjoy.

So I sculpted James' face and felt that the pieces fit together. The thought that if Pyramid Head ever took off his helmet, James would only see himself with a look of utter disgust and self loathing.
I was surprised I didn't see a whole lotta people use this theory or something similar.

Our teacher made us do a body first to practice our anatomy THEN fit it with some simple clothes or armor...it wasn't until AFTER I showed my progress was when she said "Oh you need to sculpt a face too".
I was already dead set on making Pyramid Head and was completely lost on what to do for a face.

Context: I actually made this last year for my final in a Zbrush class I took.
I originally wanted to make his robes more accurate to how he looked in the game but our teacher wanted us to show off the anatomy we sculpted and I ran out of time to make the finer details so he has his tiddies out.

The tired salty old bitch