Menopause and the Face: Why Ageing Seems to Accelerate and What Helps

14 hours ago

5 min read

Many women describe the same thing: for years the face changed slowly, and then over two or three years around menopause it seemed to change much faster. That impression is not imagined, and the reasons are reasonably well described in the dermatology literature.

Deep plane facelift before and after
Neck lift before and after
Deep plane facelift before and after

Quick answer

The fall in oestradiol at menopause reduces collagen and elastin production, fibroblast activity and skin blood supply, while increasing the enzymes that break collagen down. Skin becomes thinner, drier and less elastic over a relatively short period. The face also loses deep fat volume and the tissue descends. These are three separate problems and each needs its own treatment.

What the evidence describes

According to PubMed, a review of menopause and the skin sets out the changes associated with the decline in ovarian oestradiol: loss of collagen and elastin, reduced fibroblast function, reduced vascularity and increased matrix metalloproteinase activity, leading to dryness, wrinkles, thinning and impaired wound healing and barrier function (Lephart and Naftolin, Dermatology and Therapy, 2020).

The same review notes that while topical oestrogen can reverse some of these changes, the effects of modern low-dose systemic hormone treatment on skin are not well established, and it discusses selective oestrogen receptor modulators and phytoestrogens as alternatives used in skincare.

A separate double-blind randomised pilot study of a topical compound metabolised in the skin reported significant improvement in dryness, laxity, atrophy and dullness at 14 weeks compared with vehicle (Draelos, Journal of Drugs in Dermatology, 2018, PMID 30500138). It was small, and larger trials are needed before firm conclusions are drawn.

The three changes, separated

Skin quality. Thinner, drier skin with finer lines and less elasticity. This is the change most directly linked to falling oestrogen.
Volume. The deep fat pads of the midface, temple and around the mouth shrink. The face reads as hollow, and the skin that covered that volume now has nothing to rest on.
Position. Ligaments loosen and fat pads slide downwards, producing jowls, a heavier jawline and a less defined neck.

Each needs a different answer, and using the wrong one is the usual reason for disappointment. Adding volume to a face whose problem is descent makes it heavier. Lifting a face whose problem is volume loss makes it look drawn.

What helps, in order

For skin quality. Daily sun protection, retinoids where tolerated, and resurfacing treatments. Discuss any hormone-related product with the doctor managing your menopause. Our non-surgical treatments page lists what is offered here.
For volume. Fat transfer replaces what has been lost with the patient’s own tissue; our article on fat transfer and nanofat explains how much survives and where it is placed.
For position. A deep plane facelift repositions the tissue rather than pulling the skin.

Practical points for this age group

Bone density, cardiovascular health and medication are all part of a surgical assessment at this stage of life. Bring a current medication list to the consultation.
Wound healing is slower in oestrogen-deficient skin, which affects expectations about recovery rather than the decision to operate.
Weight changes around menopause alter the face. A stable weight makes planning more accurate, and rapid weight loss has its own effects, covered in our article on GLP-1 medication and facelift surgery.
Smoking has a larger effect on skin at this stage and significantly raises surgical risk.

What to ask at the consultation

Which of the three changes is dominant in my face?
Is my skin thin enough that it affects what surgery can achieve?
Should I treat skin quality before or after any procedure?
Does my medication list affect the plan?
What would you do first if I only wanted to do one thing this year?

Frequently Asked Questions

Is it true that skin changes quickly after menopause?

Yes. According to PubMed, a review of oestrogen-deficient skin describes loss of collagen and elastin, reduced fibroblast function, reduced blood supply and increased matrix metalloproteinase activity after the fall in ovarian oestradiol, producing dryness, wrinkles, thinning and slower wound healing (DOI).

Does hormone therapy help the face?

That is a question for the doctor managing your menopause, not for a plastic surgeon. The review cited above notes that the skin effects of modern low-dose systemic hormone treatment are not well established, which is different from saying they are absent. Decisions about hormone therapy are made on overall health grounds, not on appearance.

Do topical oestrogen-like products work?

There is some trial evidence. A double-blind randomised pilot study of a topical compound designed to act on skin oestrogen receptors reported statistically significant improvement in dryness, laxity, atrophy and dullness at 14 weeks compared with vehicle, in postmenopausal women who had never used hormone therapy (PMID 30500138). It was a pilot study with a small sample.

Why do I suddenly look hollow as well as lined?

Two things happen together. Skin thins and loses elasticity, and the deep fat pads of the face lose volume and change position. Thinner skin shows the loss of underlying volume more clearly, which is why the change can feel sudden even though it has been gradual.

Is a facelift the answer?

Only for the part of the change that is position. Skin quality is treated with skincare and resurfacing, volume loss with fat transfer, and descent with a lift. Most women in this age group need a combination, in that order of assessment.

Is there a right age to do something?

There is no fixed age. What matters is which of the three problems is dominant. Treating skin quality early is useful at any age; surgery is considered when tissue position has changed enough that non-surgical options no longer address what bothers you.

About the Author

This article was written and medically reviewed by Prof. Dr. Suleyman Tas, a plastic, reconstructive and aesthetic surgeon in Istanbul with over 20 years of experience. He is the author of Rhinoplasty in Practice (CRC Press, 2020), has more than 40 peer-reviewed scientific publications and five patents, and teaches facelift and rhinoplasty techniques to surgeons at international courses. Read more about Prof. Dr. Suleyman Tas.

Individual results vary. Before and after photos and videos are shared with patient consent. This article is for general information and does not replace a personal medical consultation.

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