An adjustable patient interface for a breathing assistance system may include a shell portion and a cushion portion. The shell portion may include one or more shell connection portions. The cushion portion may include a face contacting portion configured to contact a patient's face, and an adjustment portion including one or more cushion connection portions. Each cushion connection portion may correspond to a region of the face contacting portion. Each cushion connection portion may be configured to interact with a corresponding shell connection portion such that a particular cushion connection portion may be manually adjusted relative to a particular shell connection portion to adjust the distance between a region of the face contacting portion corresponding to the particular cushion connection portion and the shell portion.