Menopause And Perimenopause Can Change Your Face Shape - What To Know

The changes that occur in your body during menopause aren't just skin deep. To understand this complex process and how to thrive through it, Glam spoke exclusively to dermatologist Dr. Morgana Colombo and board-certified family nurse practitioner Vanessa Coppola, DNP, FNP-BC, MSCP. In addition to being the founder of Bare Aesthetic Medspa, Coppola is also a Menopause Society certified practitioner who specializes in integrative aesthetics for women in perimenopause and menopause, and in how the hormonal shifts of this transition change the face and body.

She explains the impact of menopause and perimenopause on the face by debunking one myth: estrogen receptors, which directly affect the face, aren't only present in the skin; they are also present in the bone. "... which means that when estrogen declines, we see coordinated change across every structural layer of the face simultaneously: skin, fat, ligament, and bone," she explains. On the skin, the loss of estrogen leads to reduced collagen synthesis, in addition to the loss of elastin, hyaluronic acid, and sebum production. "Clinically, that presents as dryness, thinning, crepiness, and loss of elasticity," she says.

Beneath the skin, the facial retaining ligaments, aka the parts in charge of keeping your skin's tissues attached to your bones, become weaker. "And critically, the facial skeleton itself remodels. This is the piece most miss," Coppola says. The upper jaw bone (maxilla) resorbs and slowly moves back, the bony eye sockets (orbits) deepen and widen, and the angle of the lower jaw bone (mandible) changes, which makes the lower part of the face seem wider. But that's not all, the expert notes: "With the skeletal foundation receding and the ligaments loosening, the overlying soft tissue falls forward and down." In other words, all these changes lead to sagging features.

During our exclusive interview with dermatologist Dr. Morgana Colombo, founder of Vidaderma, she revealed the face gradually begins to change years before perimenopause. "You start losing collagen 1% per year at age 25," she explains. "By perimenopause (around age 43 to 44), the gradual collagen loss that started earlier in your 20s hits a threshold where you start noticing visible aging signs on the skin." The neck and eyes become more wrinkled, and it only gets worse when you lose 30% of your collagen in the first 5 years after menopause.

The reduction in estrogen also causes skin dryness, sensitivity, and dullness. With these changes, coupled with the changes in the skeletal foundation, the shift becomes impossible to miss. The structure underneath weakens and the skin atop sags. Vanessa Coppola puts it this way: "Everything that descends has to land somewhere, and it lands along the jaw." Dr. Colombo adds that the changes are why "women end up feeling like they significantly aged a few years after menopause."

With the structural issues outlined, we had to wonder: Can a sagging face shape be treated? The good news is that it can, but the not-so-great news is that it's not a simple process — at least not without expert help. Coppola explains that the fact that estrogen loss goes as deep as the bone means that surface treatments can only fix one part of the problem. "... treating this well is never about filling the place that looks full," she shares. "It is about restoring width and projection up high, in the temples and the midface and along the cheekbones, so the weight moves back to the top where it belongs, and the taper returns on its own."

Beyond knowing how your estrogen levels may be affecting your skin health, Vanessa Coppola emphasized during our exclusive interview that prevention is much easier and more effective than cure. "Starting sooner, closer to the transition, preserves what a woman still has rather than trying to rebuild what she has already lost."

In some cases, hormone therapy is recommended for those who experience changes in their skin during menopause, but Coppola emphasizes that it isn't for everyone. "Hormone therapy is a medical decision, not a cosmetic one, and it belongs in the hands of a clinician who knows your history, your risk profile, your symptoms, and your goals," she firmly states. For cosmetic cases, Coppola explains that there are other options.

"Without surgery, we work in three complementary categories," she reveals. The first is using biostimulating treatments like poly-L-lactic acid to stimulate the patient's body to produce collagen. Secondly, experts use hyaluronic acid fillers to support collapsing structures at the bone and deep fat level, and finally, they also use skin-tightening treatments like radio frequency and fractional resurfacing. These "remodel existing collagen and improve skin quality and firmness," she says. "When we understand the hormonal physiology underneath these changes, we stop chasing individual lines and start restoring architecture. That distinction is everything."

Although the changes to the face happen from down below, Dr. Morgana Colombo explains that menopause-focused skincare can help tip the balance in your favor. The first tip is to start as early as your 40s, if possible. Next, she advises following a skincare routine that addresses what she calls the "four pillars of skin longevity." She says, "You want to restore the skin barrier, promote collagen, decrease free radical damage, and promote cellular regeneration." To restore the skin barrier, invest in ceramides and hyaluronic acid and know the behaviors to avoid so you don't damage your skin barrier. Then promote collagen with vitamin C, peptides, retinols, and topical estrogen promoters. "Antioxidants and sunscreen use decreases free radical damage. Retinols and growth factors promote cellular regeneration," Dr. Colombo explains exclusively to Glam.

Beyond skincare, she advises lifestyle changes, noting, "... good sleep, strength training, stress reduction and good diet will optimize your skin." Additionally, she suggests skin-tightening treatments and biostimulators to "take the clock backwards in your skin."

Finally, she reminds women going through perimenopause and menopause to focus on optimizing their skin, not looking younger. "Overly aggressive skincare regimens are not beneficial," she confirms. "Also, with any approach, the goal should not be to look younger. The goal is to optimize your skin health and longevity at whatever stage of life you are at."