Cortisol face - social media myth vs medical reality

What is cortisol?

We all like to look our best, and our face is often the first sign to show how healthy we look. But a viral social media term, ‘cortisol face’ has made us look at ourselves a little closer. Do we see an extra-puffy face staring back at us in the mirror? And if so, could the cause be high cortisol?

Cortisol is your body’s main stress hormone. It’s produced by small, triangle-shaped organs at the top of your kidneys (adrenal glands) and plays an important role in keeping your body functioning.

The amount of cortisol your body produces and uses fluctuates throughout the day, following a natural 24-hour cycle - peaking in the morning and dropping at night. Beyond responding to stress, cortisol is crucial for regulating blood pressure, controlling blood sugar levels, suppressing inflammation, and keeping your metabolism and immune system working as they should.

What is cortisol face?

‘Cortisol face’ is a term popularised on social media to describe a rounder, puffier-looking face, which is said to be linked to stress and higher levels of cortisol in your body.

But is cortisol face a real condition, and should we be concerned about it?

Dr Mohammad Bakhtiar, GP and Clinical Lead at Medical Express Clinic, UK, helps to clarify what is myth and what is fact.

“Cortisol face is not a medical diagnosis,” he says. “But people use it to refer to a rounder, puffier face they blame on stress and high cortisol.

“The finding that gets mixed up with this is ‘moon face’ - a genuine change in facial fat and fluid that we see when someone has been exposed to high cortisol for a long time.”

Taking steroids for a prolonged period - or being diagnosed with Cushing's syndrome - can cause changes in your face. However, Bakhtiar adds that most people using the online phrase ‘cortisol face’ have neither of those.

He emphasises that cortisol is an essential hormone, with levels naturally rising in the morning to help get you out of bed, and again when you’re ill, injured, or under pressure.

“A short-lived rise is how the system is meant to work,” says the London-based doctor.

Dr Mohammad Bakhtiar

Why is my face puffy? - common causes of facial bloating

If your face is feeling - or looking - puffy, it is more down to lifestyle choices, and not due to a medical excess of cortisol.

Everyday stress and fluctuating cortisol levels are unlikely to cause puffiness in your face. Ordinary facial puffiness comes and goes. Bakhtiar explains that cortisol goes up for minutes or hours, and then comes down, but does not sit in your cheeks.

Common causes of facial puffiness include:

• Poor sleep - however, any puffiness will usually fade once you are awake and moving.

• Allergies - such as hay fever, dust mites, and sinus congestion can lead to inflammation.

• Salt - eating foods that are high in salt may affect how your body retains water.

• Medicines - such as steroid tablets, and some blood pressure medications might lead to puffiness.

• Alcohol - triggers dehydration, so may disrupt how your body maintains its fluid levels.

• Underactive thyroid - can result in a fuller face and weight gain.

The above may cause temporary water retention in your face. Bakhtiar explains that this is why a person could look puffy after a bad week and better after a few decent nights' sleep.

“The hormone is in the background,” he says. “But the habits influenced by the hormone are doing the work.”

Cushing’s syndrome - what clinically high cortisol looks like

Only prolonged cortisol excess - such as Cushing’s syndrome - changes the shape of your face, and keeps it that way.

Cushing’s syndrome is a medical condition that leads to an excess of cortisol. The condition is relatively rare, and can affect your whole body. Ordinary life stress does not cause the extremely high cortisol levels seen in Cushing’s syndrome.

“The face is round and often red,” Bakhtiar explains. Other symptoms to look out for are fat sitting around your stomach, neck, and between your shoulders. Your arms and legs look thinner by comparison, and your skin may bruise easily, and heal slowly.

“Stretch marks, when they appear, are wide and purple. Not the pale lines many of us have after weight change. The muscles at the top of the arms and thighs weaken. Blood pressure and blood sugar climb. Moods can swing, periods may stop, and bones can thin.”

The most common cause of Cushing’s syndrome is from taking a high dose of steroid medicine for a prolonged period - which can create an excess of cortisol in your body.

If this is the case, a one-off blood cortisol test is not the most effective thing you can do. Cortisol swings through the day, so one result is unlikely to tell you anything significant.

“It cannot be diagnosed from an unflattering selfie,” notes Bakhtiar. “The tests that matter, if the story fits, are a late-night saliva cortisol, 24-hour urine collection, or an overnight dexamethasone suppression test, arranged by a doctor. Then, if those are abnormal, an endocrinologist takes over.”

How to reduce facial puffiness

If you feel your face is looking a little bloated or puffy, there are some simple tips that can help you. You don’t need to turn to the nearest online wellness influencer for advice.

Bakhtiar advises treating the most common causes of stress, and managing your general health as a first step.

In the short term, look at:

• Sleep - try to get seven to nine hours if you can.

• Salt and alcohol - cut out late salty meals and evening alcohol.

• Hydration - keep your fluid levels topped up by drinking plenty of water.

• Exercise - try to move your body a little every day.

• Allergies - use an antihistamine and a steroid nasal spray if appropriate.

If you believe a medicine you are taking is negatively affecting your health, always speak to a healthcare professional before you make any changes.

If the puffiness lasts, or other symptoms have joined it, Bakhtiar recommends you see your doctor.

“Thyroid blood tests are a useful first step for many people, rather than a cortisol screen,” he says.

Bakhtiar concludes that you can’t hack a stress hormone with a drink, or a viral supplement. However, you can exercise, eat, drink, and sleep more sensibly, which may help you.

If you’ve tried the above lifestyle changes, and your face continues to look more than just a little puffy, always seek help and advice from your doctor.