Cortisol face: Can stress cause a puffy face?

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Cortisol face, a condition that can make your face look more rounded, and puffy, has been trending on TikTok. Many users of the platform are claiming that it is a prominent side effect of having high levels of cortisol or stress hormone in the body. To prove their point, TikTok users are showing their “cortisol face" along with an “after” photo of a less bloated face. When it comes to our body, cortisol has many functions. Mediating the stress response is one of its key functions. But is daily stress to be blamed for facial bloating or is it just a misconception?

What is cortisol face?

The literal meaning of the term "moon face" or "cortisol face" is the appearance of puffiness or rounding of facial features, shares dermatologist Dr Neha Khuraana. There is no medical diagnosis referred to as "cortisol face". Rather it is just a symptom that involves physical changes in the facial features due to certain underlying health problems such as Cushing’s syndrome. It can cause weight gain in the face.

Can everyday stress lead to cortisol face?

Attributing cortisol face to stress levels is a partially correct statement. The main cause of such a facial appearance is Cushing's Syndrome, in which the body endogenously produces more cortisol hormone, says psychiatrist Dr Ashish Bansal.

Cushing's syndrome is due to prolonged exposure to high levels of cortisol, according to a research published in StatPearls in 2023. But this syndrome is rare, as its annual incidence ranged between 1.8 and 3.2 cases per million population, according to a research published in Best Practice and Research Clinical Endocrinology and Metabolism in 2021.

Everyday stress undoubtedly raises the body’s cortisol levels, but these are short-lived and may not cause cortisol face, says Dr Bansal. If the cortisol levels are high, they can cause water and sodium retention in facial tissues, and lead to a puffy face. But these physical changes won't be prominent.

As for Cushing's syndrome, it is attributed to other reasons too -

Pituitary adenomas: Tumor cell growth that is benign in the pituitary gland leads to the production of high levels of ACTH (adrenocorticotropic hormone), which makes the body produce more cortisol hormone.

Adrenal tumors: Benign tumor growth in one or both the adrenal glands disposes the body to high risk of excess cortisol production, says Dr Bansal.

Ectopic ACTH syndrome: Any tumor growth outside the pituitary gland may be in the lungs, which in turn produces more adrenocorticotropic hormone triggering cortisol production.

Corticosteroid drugs: When corticosteroids such as prednisone or dexamethasone are used for a long term, they lead to high levels of cortisol in the blood. Such drugs are usually prescribed in autoimmune disorders such as asthma, rheumatoid arthritis or lupus.

How to get rid of puffy face?

The main task is finding the cause of facial puffiness.

1. Cushing’s syndrome

The treatment options available for dealing with Cushing’s syndrome include a surgical intervention, radiation therapy or medications to decrease blood cortisol levels, says Dr Bansal. For the tumor cell growth in the pituitary gland, a surgery via nose is performed named transsphenoidal surgery. For cancer cell growth in the one or both adrenal glands, the affected part or gland is removed via adrenalectomy. If due to certain conditions mainly widespread tumor growth, surgery is not an option, radiations are given in order to detect and kill the tumor cells. Certain drugs such as ketoconazole, metyrapone, and mifepristone can be prescribed by your doctor. They either stop the production of cortisol hormone in the body or inhibit its action.

2. Lifestyle changes

Have a wholesome diet inclusive of whole grains, fruits, vegetables and protein, says Dr Khuraana. Limit sodium intake, which may lead to water retention and more facial puffy appearance. Also, high cortisol levels are attributed to overweight, so engage in regular physical exercise to manage body weight.

3. Refrain from drinking alcohol

Have moderate consumption of alcohol so that you don't end up with a puffy face. Women who indulge in heavy drinking (more than eight alcoholic drinks per week) are more likely to have puffy faces than others, as per a study published in the Journal of Clinical and Aesthetic Dermatology in 2019.

4. Eat less inflammatory food

Inflammation may lead to swelling, and so, it can contribute to face looking bloated. Reduce intake of foods that may cause inflammation in the body. The list includes ultra-processed foods, sugary drinks, and refined carbohydrates.

5. Sleep well

Poor quality sleep may negatively affect your health. It can make you feel irritable, and also cause an inflamed face. Try to have a 7 to 8 hours of sound sleep at night, suggests Dr Bansal.

Everyday stress cannot give you a "cortisol face", but the stress hormone may play a role in your face being puffy. It can be due to Cushing’s syndrome, which is rare.