One of the most striking things about menopause is how quickly skin changes can happen. A jarring fact: “Women can lose up to 30 percent of their skin’s collagen in the first five years after menopause, followed by about two percent each year after that,” says Chapel Hill, NC dermatologist Dr. Payvand Kamrani, pointing to a study from Clinical Interventions in Aging. That collagen loss doesn’t happen in isolation, either; it often coincides with a decline in facial fat, leading to more laxity, thinning, or changes in facial structure over a relatively short period of time.
Ahead, we spoke with dermatologists about how best to address the fat loss and facial structure changes that come with perimenopause and early menopause.
Featured experts
- Jody A. Levine, MD is a board-certified dermatologist in New York
- Dr. Payvand Kamrani is a board-certified dermatologist in Chapel Hill, NC
Why does fat loss in the face happen during menopause?
“Aging naturally causes the fat pads of the face to shrink and shift downward,” explains New York dermatologist Jody A. Levine, MD. At the same time, collagen and elastin production decline, bone structure gradually remodels and the ligaments that support the face become less resilient,” together reducing both volume and structural support.
“Women may begin to notice subtle changes in facial definition, such as more prominent cheekbones, a sharper jawline and a slightly more angular appearance overall,” even as early as women’s late 20s, says Dr. Levine. It’s really only once perimenopause hits and estrogen begins to fluctuate that it starts to affect collagen production, skin thickness and the amount and positioning of facial fat.
“Menopause affects much more than just fat—we’re simultaneously seeing changes in collagen, skin thickness and even the underlying bone structure, which can make the face look like it’s losing support more quickly,” says Dr. Levine.
Apart from these biological changes, significant weight loss can also help to accelerate this process, thanks to the popularity of GLP-1 medications. “We’re seeing weight loss increasingly become a concern. It's the rate and amount of weight loss that contribute to a more hollow or gaunt appearance,” says Dr. Levine.
The most common areas of the face that experience fat loss
“The areas that most commonly lose volume include the temples, cheeks, undereyes and the area around the mouth and jawline,” says Dr. Levine. Loss of volume in the temples, which can create a more skeletal appearance, and the midface are what can really change the overall youthful look of the face—reducing facial projection and contributing to deeper nasolabial folds. “Under-eye hollowing can make patients appear tired, even when they’re well rested. Around the mouth, volume loss contributes to marionette lines and a downturn of the corners of the lips,” she adds.
Interestingly, though volume loss causes a hollowed appearance, the lower half of the face can actually look heavier because the volume that was present functioned as the support that was holding everything up. This diminished support can soften definition and contribute to the appearance of early jowls.
Hyaluronic acid fillers can help restructure the face
Hyaluronic acid filler can replace lost volume, provide structural support, and improve facial contours immediately. “Hyaluronic acid can help attract water and improve hydration while also softening those fine, etched-in lines that start to become more noticeable with age,” adds Dr. Kamrani.
Instead of treating a specific area of the face, dermatologists we spoke with prefer to consider the face as a whole. “The temples and cheeks are common areas where restoring volume can make a big difference, but sometimes supporting the lateral cheek, chin or jawline can improve the overall facial balance as well,” explains Dr. Kamrani. She prefers to use a smaller amount of product in several strategic areas, rather than overfill one area.
Dr. Levine also points out that there is no universal injection pattern because facial aging is highly individualized, but she stresses that she does not simply treat lines and folds. Though it depends on the patient's needs, she often focuses on an often overlooked area—the temples—“which can have a significant impact on overall facial harmony.” She also likes to restore volume along the face's border, “going up into the sideburns, to lift the sides of the face and create a more defined jawline.”
The overall goal with utilizing hyaluronic acid filler to restore volume isn’t to simply add volume everywhere, rather to restore the natural facial balance and proportions that have gradually changed over time and choosing the right product for the right layer and restoring support in a very natural way, Dr. Kamrani says.
Other in-office options
Dr. Kamrani also recommends collagen-stimulating injectables, which encourage the skin to gradually produce more of its own collagen. “Rather than giving an immediately filled appearance, the change develops over time and can help restore some of the support and structure that we naturally lose with age.”
For women with more significant volume loss, fat transfer is another option where a patient's own fat is used to restore volume. “I also like to incorporate energy-based treatments that stimulate collagen and improve skin quality. They don't necessarily replace lost fat, but they can help strengthen the skin and improve how the face looks as a whole,” says Dr. Kamrani.
