Every day, a new health concern seems to make the rounds on TikTok, with the inevitable “solutions” doled out by influencers and the medical community alike. Stress has increasingly been blamed for skin issues, such as thinning, fine lines, and dullness. Recently, the complaint of “cortisol face”—a puffy face attributed to high stress levels—has been prevalent.
“When we experience chronic stress, our body releases more cortisol, which can directly impact our skin,” says Hannah Kopelman, DO, a dermatologist at Kopelman Aesthetic Surgery in New York. Because cortisol is a stress hormone, hormonal balance, and stress management are worth pursuing as they affect everything from mood to sleep to skin health. But social media isn’t necessarily the best place to learn about medical conditions or treatments for high cortisol.
Plus, the trend has created opportunities for brands to sell products targeting stress reduction, which muddies the waters and makes it more confusing. And it’s tricky to determine if anything you see on your screen is backed by credible science. We talked to several experts about how to manage this cortisol face. Here’s what they had to say.
What Is Cortisol Face?
Also referred to as “moon face,” cortisol face typically describes an excess of fatty tissue and swelling that builds up on the sides of the face, making it look round, swollen, and puffy, according to Dahlia Rice, MD, a board-certified plastic surgeon and founder of Chicago-based DMR Aesthetics. “It is not a disease but can be a sign when there is an excess of body fat or fluid from too much cortisol, a hormone made by the body.”
However, high stress does not cause cortisol levels elevated enough to result in a puffy, swollen face. Typically, this facial symptom is a result of taking high doses of steroids, certain tumors that increase cortisol, and diseases such as Cushing’s disease and hypothyroidism, says Caroline Messer, MD, a board-certified internal medicine and endocrinology physician. “Stress eating [also] may lead to weight gain in the face that mimics cortisol face.”
That said, high cortisol levels for a prolonged period can still affect the skin’s appearance. This can cause skin to look tired or prematurely aged.
“Cortisol can lead to a breakdown of collagen and elastin, which are the proteins responsible for keeping skin firm and youthful, so you might notice things like thinning skin, sagging, fine lines, or a dull complexion,” says Dr. Kopelman. “It can also make the skin more inflamed and puffy, especially around the eyes, and in some cases, even cause breakouts or worsen pre-existing conditions like acne.”
How To Know if You Have Cortisol Face
While you may want to self-diagnose, schedule an appointment with a healthcare provider. They will likely run blood and urine tests to check cortisol levels to see if they are elevated and how your body responds to steroids. If they are elevated, Dr. Rice says you may need additional testing, including an MRI or CT scan, to ensure elevated levels are not from a tumor.
Is There Science to Support Cortisol Face?
Excess cortisol causes the body to retain salt and water and accumulate fat in the face, says Dr. Messer. This condition is medically known as moon-like facies (MLF) and is understandably linked to developing poor body image. “Stress does not cause high enough cortisol levels to manifest as cortisol facies.”
Actual cortisol face or moon face is a symptom of a medical condition. Chronically increased cortisol levels can create puffiness and potentially change the shape of the face.
“There are several things other than cortisol that can make us feel swollen and puffy—alcohol, a high sodium diet, not sleeping, or general stress as a whole,” says Paul Jarrod Frank, MD, a board-certified dermatologist, and founder of PFRANKMD. “It’s not one particular thing, and certainly, cortisol isn’t the only thing to blame when our faces feel round and puffy.”
How Stress and Elevated Cortisol Levels Affect Your Skin
According to Dr. Kopelman, elevated cortisol levels for prolonged periods can exacerbate some skin issues. “Chronic stress can worsen acne due to the inflammatory response triggered by cortisol, and can also lead to flare-ups in conditions like rosacea, where inflammation plays a major role.”
Some people also might notice slower wound healing, increased skin sensitivity, and dryness because cortisol can affect the skin’s ability to retain moisture she says. “It’s not uncommon for patients to come to me experiencing dull, dry skin or breakouts and be surprised to learn that stress and hormone levels might be behind it.”
Of course, not all cases of acne or rosacea are stress-related, but since the symptoms overlap, it can be tricky to tell the difference. For example, stress-related acne might look similar to hormonal acne, but the context matters. Dr. Kopelman says cortisol levels may be partly responsible if you’re experiencing breakouts and other signs like puffiness, dull skin, and increased sensitivity.
Cortisol also weakens the skin’s extracellular matrix, speeding up the formation of wrinkles and causing the skin to sag, adds Saami Khalifian, MD, a double board-certified dermatologist from Som Aesthetics. “Elevated cortisol can slow down the skin’s natural healing process, making it more susceptible to infections and slow to recover from injuries.”
Feeling constantly tired, getting easily upset, or having trouble sleeping also can be caused by cortisol levels, especially if you have skin issues alongside stress, says Dr. Khalifian. “While regular acne or rosacea can have various triggers, cortisol-induced skin changes often come with a broader set of symptoms related to ongoing stress.”
A dermatologist can help you pinpoint the cause through a detailed examination and discussion about your lifestyle and overall health notes Dr. Khalifian. “The key is looking at the big picture of your health and stress levels alongside the skin changes.”
What You Can Do About Cortisol Face
If you feel like stress is taking its toll on your skin, even without a medical condition, there are actionable steps for managing “cortisol face” and keeping your skin healthy under stress.
“If someone suspects their skin is impacted by stress and cortisol, I recommend focusing on reducing stress overall,” says Dr. Kopelman. “But from a skincare perspective, I’d recommend products that support collagen production and hydration.”
Talk to a healthcare provider if steroids are causing a puffy face. They can decide whether reducing the dosage would be enough or if you should stop the medication entirely, says Dr. Rice.
Skincare Routine
Dermatologists recommend gentle, hydrating skincare routines, stress-relieving treatments, and products that support the skin barrier. “Opt for gentle, non-irritating skincare products that don’t clog pores,” advises Dr. Khalifian.
Look for antioxidants and hyaluronic acid, which can revive dull skin and help with dryness and puffiness. Depending on the severity of your skin symptoms, your dermatologist might also recommend specific treatments to target these conditions.
You also may want to incorporate peptides and retinol. Gentle exfoliation can help brighten your complexion and alleviate dullness, says Dr. Kopelman. “I also suggest focusing on anti-inflammatory ingredients like niacinamide, which can help calm redness and puffiness.
In-office treatments, like microneedling or laser therapy, can help stimulate collagen if the skin shows signs of sagging or premature aging.
Nutrition Changes
In terms of nutritional habits, Dr. Messer says that while stress eating may lead to weight gain in the face that mimics cortisol face, there are no foods to avoid despite many claims to the contrary all over social media.
However, salty foods can cause water retention, which could show up as facial puffiness—just not enough to mimic the moon face appearance of someone with a medical condition. That said, keeping your sodium levels in check, staying hydrated, and sticking to a nutrient-rich diet are good practices for improving overall health.
Exercise Habits
Exercise also is a fantastic way to reduce stress. But beware of TikTokers pushing high-intensity workouts suggests Dr. Messer. “Higher-intensity exercise activates the flight or fight system and stimulates the release of cortisol.”
Though high-intensity exercise can help release stress, it’s also easy to overdo it, potentially worsening your health and putting too much stress on your body. This is especially true if you have a lot of other stressful life events or habits. Find a fun way of moving your body and stick to it. Exercise can significantly improve your health and your stress levels.
Sleep Quality
According to Dr. Kopelman, rest and recovery are major players in managing stress and looking refreshed. “Don’t underestimate the power of sleep—your skin repairs itself when resting.”
A lack of quality sleep can prematurely age your skin, weaken skin barrier function, and lead to dissatisfaction with your appearance, according to a study published in the journal Clinical and Experimental Dermatology. So, it’s worth prioritizing those precious seven to nine hours of undisturbed slumber.
Stress, skin, and overall health are interconnected and while cortisol face is not a medically-recognized condition, there is a legitimate link between stress and skin issues. Addressing any lifestyle factors that cause you to feel less chill and sticking to a solid skincare routine can help manage and improve those pesky stress lines and breakouts you might be battling.
As Dr. Frank succinctly puts it: “Eat well, sleep well, meditate, exercise—do things that decrease your stress.”
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