How Stress Affects Your Face—And What To Do About It

If you’re part of the majority of Americans who report chronically high levels of stress, you’re likely familiar with the adverse effects it can have on your body. But there’s a new phenomenon being talked about that suggests stress can also impact your face. The term “cortisol face” was coined on social media, according to celebrity women’s health and hormone expert Mindy Pelz, D.C., author of The Menopause Reset and Eat Like a Girl. “People share videos of themselves with round, puffy faces and swollen cheeks and proclaim it’s due to high cortisol from chronic stress,” she says. Other content creators post before and after montages, alleging that managing their cortisol levels by reducing stress is responsible for their changed facial profile. 

The widespread virality of the #cortisolface trend has left many wondering if, in fact, chronic stress can really affect the shape and symmetry of our faces. Ahead, a team of hormone health specialists explains how chronic levels of cortisol can impact your body, from head to toe. They also share why talking to your doctor is a must-do if you’re experiencing facial swelling. 

• ABOUT OUR EXPERTS: Mindy Pelz, D.C., is a celebrity women’s health and hormone expert, and the author of  The Menopause Reset and Eat Like a Girl. Dimitar Marinov M.D., Ph.D., is an assistant professor of preventive medicine at the Medical University in Varna, Bulgaria. Elena A. Christofides, M.D., F.A.C.E., is a dual board-certified endocrinologist and internal medicine specialist.

‘Cortisol Face’, Explained 

FYI: “Cortisol face is not a medical diagnosis,” says Dimitar Marinov M.D., Ph.D., an assistant professor of preventive medicine at the Medical University in Varna, Bulgaria. Instead, it’s a colloquial term that refers to the impacts that elevated levels of the body’s stress hormone, cortisol, have on your face, he shares.

The facial changes usually associated with out-of-control cortisol are facial swelling and bloating, leading to a rounder or fuller appearance (much like what you might experience following a high-sodium meal). However, because you won’t find the term in medical textbooks, the specific symptoms and shifts in appearance people attribute to unchecked cortisol can vary. 

Cortisol 101 

Cortisol may have become a notorious bad guy in recent years, but the hormone plays several essential roles in the body, according to dual board-certified endocrinologist and internal medicine specialist Elena A. Christofides, M.D., F.A.C.E. Produced by a part of the endocrine system known as the adrenal glands, a healthy body naturally pumps out cortisol to help you handle external threats. Spurts of the steroidal hormone lead to short-lived spikes in blood sugar and heart rate, which work together to give you the energy, alertness, and focus you need to get to the other side of a stressful situation, she explains. If you’ve ever felt “pumped up” before a work presentation or experienced pre-race jitters, you’ve enjoyed the perks that accompany this hormone when it functions correctly.

Read More: How To Achieve A Healthy Balance Of Cortisol—And Make It Work For You

Importantly, in healthy individuals, these natural ebbs and flows of cortisol have no harmful side effects. “The body is designed to respond to cortisol and its fluctuations,” Christofides says. In fact, without these cortisol ebbs and flows, you would die, as cortisol is needed for vital functions, such as immune and metabolic processes (including blood sugar regulation, among other things), she explains.

It is only when cortisol levels get thrown out of whack that the hormone causes problems, she says. More on this below. 

Yes, Stress Can Impact Your Face

Chronically high levels of cortisol can significantly impact your entire body—including your face, according to Marinov. The key word here: chronically. 

The body responds to stressors by activating the hypothalamic-pituitary-adrenal (HPA) axis, which triggers the adrenal glands to increase cortisol production, according to Marinov. If you are constantly coming up against emotional, mental, physical, or relational stresses that your body registers as dangerous, your cortisol levels can become chronically elevated. 

Should you reach this point, “you might experience weight gain, high blood pressure, muscle weakness, mood swings, anxiety, depression, fatigue, difficulty sleeping, and difficulty concentrating,” Marinov shares. Chronically high cortisol levels can also suppress your immune system, making your body more susceptible to infections, as well as disrupt your metabolic, cardiovascular, and nervous systems. 

So, how does all of this affect your face? For starters, it’s common for individuals to put on weight during periods of stress because high cortisol levels stimulate appetite and cause metabolic function to slow. In general, weight gain can lead to changes in face shape, as additional fat in the cheeks and neck can lead to a rounder appearance. That said, stress-induced weight gain is especially apt to cause facial expansion, according to Marinov. That’s because stress causes fat redistribution, which means individuals are likely to see fat deposit increases in their waist, abdomen, and faces, in particular. 

Further, low mood associated with stress often makes itself known on the face through frowns, a drawn-out expression, depression-induced acne, and even increased appearance of wrinkles, Marinov says. Not to mention, lack of sleep caused by stress can also appear on your face. Research published in Sleep found that sleep deprivation is correlated with hanging eyelids, redder eyes, swollen eyes, darker under-eye circles, more noticeable lines, and droopy corners of the mouth. 

How To Prevent Cortisol From Changing Your Face

Something you may already know to be true: “It’s often the compounding effect of stress—emotional, physical, and environmental—that leads to elevated cortisol levels,” says Marinov.

That said, because the stress comes before the cortisol, “it doesn’t make sense to put your energy specifically into lowering cortisol levels,” Christofides says. That would be like focusing only on placing lots of buckets beneath your leaky roof instead of patching up the holes. Instead, the most effective remedy for stress-related facial changes is to manage your exposure to all of the stressors in your life. “Once you achieve balance, your hormone levels will follow,” she explains. 

Of course, how you tackle your stress depends on its underlying cause(s). Typically, interventions involve several different lifestyle edits that help lower stress levels over time.

Most emotional and mental stress stems from work pressures and relationship issues, according to Marinov. He suggests taking inventory of your relationships, including workplace relationships with clients, co-workers, or higher-ups. Then, make moves to communicate productively about any unmet needs, edit the intensity of those relationships, and erect boundaries to relieve stress. 

Meanwhile, “physical stress often stems from illness, injury, and chronic pain,” says Marinov. Addressing any underlying medical condition at play will support your overall health and well-being, which will then help right your cortisol levels, he says.

Another common cause of excess physical stress is over-exercising. “While regular physical activity supports a healthy weight, releases feel-good endorphins that help you manage stress, and protects your muscle mass from the catabolic effects of cortisol, too much exercise paired with inadequate recovery can lead to chronic stress,” Marinov says. Often known as over-training syndrome (OTS), over-exercising causes symptoms like excess fatigue, weight gain, worsened performance, and mood disturbances. Rest is the key to treating OTS while prioritizing recovery is vital to preventing it, he says. 

Read More: How To Prioritize Adrenal Health During Times Of Stress (And Why You Should)

Finally, poor nutrition and lack of sleep can also lead to elevated stress. A diet filled with alcohol, caffeine, and highly processed, multi-ingredient, and high-calorie foods can lead to systematically high stress, according to Marinov. Meanwhile, “a diet rich in whole foods such as fruits, vegetables, lean proteins, and whole grains supports overall health and can mitigate the impact of stress on the body,” he says. Similarly, while lack of sleep can trigger the body’s stress response, “getting seven to nine hours of quality sleep per night in a restful environment free from distractions can help regulate cortisol levels and enhance your body’s ability to cope with stress,” he adds. 

There’s no question that lifestyle interventions are the most effective tools for managing your stress and ultimately fixing your so-called cortisol face, as well as any other symptoms of high cortisol you’re experiencing. Just remember that while these interventions can lead to near-immediate mood changes, it may take a few weeks to lose weight (including water weight) and see noticeable changes in your facial symmetry and shape.

Remedies For Immediate Relief Of Cortisol Face

While real, lasting shifts take time and consistency, for short-term relief you could try using a cold compress, dunking your face in a bowl of ice water, or using an ice roller, suggests Pelz. The cold restricts your blood vessels and minimizes fluid build-up, she explains. 

“You can also try intermittent fasting in the morning, as after about 14 hours without food, your body turns on all kinds of signals that decrease inflammation,” Pelz says. In fact, one review published in Nutrients found that fasting effectively lowered levels of two markers of inflammation, which could be good news for what you see in the mirror. 

Making an effort to reduce overall salt intake can also help, as high sodium intake can lead to swelling that will compound any preexisting puffiness, she adds. 

Just remember: Directing all of your focus toward lowering cortisol levels without addressing stress inputs isn’t going to move the needle in the long-term. On top of making lifestyle shifts to manage stress, consider adding adaptogenic herbs to your daily wellness routine. Ashwagandha is particularly popular for this purpose, as research suggests it has a significant impact on cortisol levels after 60 days of consistent use. Rhodiola is also popular for working against excess cortisol while supporting energy, stamina, and focus.

When To See A Doctor 

If you notice profound changes to your face’s shape, including newfound fat deposits in your cheeks, go to your primary care physician or endocrinologist immediately. While high stress levels may cause slight puffiness, sustained and pronounced facial roundness and fullness are symptoms of a much more serious condition known as hypothyroidism or Cushing’s syndrome, says Marinov. 

Also known as hyperadrenocorticism, Cushing’s syndrome is a rare autoimmune condition characterized by an imbalance in thyroid hormones as well as an excess of cortisol. “One of its hallmark symptoms is medically known as ‘moon face’, which refers to a pronounced roundness and fullness of the face resulting from fat deposition,” says Marinov. Other symptoms include weight gain around the abdomen and upper back, thinning skin that bruises easily, purple or pink stretch marks, muscle weakness, high blood pressure, high blood sugar levels, and libido changes, he says. 

If your provider suspects that you have Cushing’s syndrome, they will likely do a series of diagnostics tests. A blood test, urine test, and salivary cortisol test can all assess your hormone levels, says Marinov. Additionally, an “MRI or CT scan of the pituitary and adrenal glands may be used to identify any tumors or growths,” he says. 

The exact treatment of Cushing syndrome will vary based on its cause (for example, a pituitary tumor, adrenal gland malfunction, or steroidal medication) and may include surgery, chemotherapy, or medication. If diagnostics tests reveal that another hormonal, lymphatic, or circulatory condition (which could also cause bloating in certain instances) is causing your symptoms, your provider will suggest a treatment that addresses that instead. 

If it turns out that you have no underlying conditions and your facial swelling is caused by stress, your doctor will likely suggest stress-management protocols and lifestyle tweaks like those mentioned above. The good news is that it won’t just be your face that reaps the rewards of reduced stress, but your entire being.