Is ‘cortisol face’ a real thing?

Does the amount of cortisol in your body change how your face looks?

Yes and no!

Plenty of influencers on social media seem to think so, though. Especially on TikTok, wellness influencers attribute rounder, puffier facial features to high stress. Let’s go a little deeper into this social media term and explain what’s true about their claims.

What is cortisol?

Cortisol is a hormone made by the outer layer of the adrenal gland. The amount of cortisol the adrenal gland produces every day is tightly controlled by higher centers in the brain, like the pituitary gland and hypothalamus.

Although the cortisol is often called the “stress hormone” because it helps us deal with stress, it’s the hormone that keep us going — it helps our body function in the best way possible.

Without cortisol, our body shuts down and goes into what we call “adrenal crisis.”

High levels of cortisol are correlated with high levels of stress, and they can be helpful in the short term so we can survive a stressful situation. But, like anything in life, too much of a good thing can be harmful.

“Cortisol face” isn’t an official diagnosis

There’s no medical condition called “cortisol face.” It is a misconception that the actual cortisol buildup is leading to a puffy face. But this facial feature has been described in the medical field — we’ve called it “moon face” — and it absolutely can be induced by high cortisol levels.

It’s a combination of fat accumulation and soft issue swelling, associated with thinning of the skin. All of this can lead to a more round-looking, puffy face with pinker cheeks.

This can happen if the body gets exposed to sustained high levels of cortisol for a long period of time, such as when we use high doses of steroid-containing medications, or it can be induced by a tumor in our body that keeps secreting cortisol without control.

What can cause puffy “moon face”?

This can be a very hard question to answer. Here are some possible causes:

High corticosteroid levels, such as from steroid medications

Some people might assume that cortisol from stress builds up and causes facial puffiness in the same way that high corticosteroid levels do.

When people take steroids for a medical condition, or they have a tumor causing Cushing’s syndrome, they can develop especially high corticosteroid levels, leading to a rounder face. Weight gain, belly fat accumulation and thin legs are typically associated with multiple metabolic dysfunction.

But can high corticosteroid levels due to general stress levels cause the same effect? Simple stress alone is unlikely to cause these changes in face or skin texture. Sustained high levels of physical or psychological stress can lead to some body and skin changes, but it’s to a lesser extent. General stress beyond doubt can lead to weight gain and hard-to-lose weight despite eating healthy.

Cushing syndrome

Cushing syndrome is a disorder that can lead to excess cortisol in the body because of tumors in the pituitary or adrenal glands. Two thirds of the Cushing’s tumors are found in the pituitary gland. In a third of the cases, the tumor is in the adrenal gland. In rare instances, the tumor can hide in other parts of the body, called “ectopic Cushing’s”.

For people who have Cushing’s, too much cortisol leads to a rounder face, pink/red cheeks, thinner skin that bruises easily, puffy neck and a worsening upper-back hump.

Cushing syndrome symptoms also include abnormal, excessive weight gain in the abdomen, thin arms and legs, worsening fatigue, muscle weakness (especially in the thighs and shoulders), high blood pressure and high blood sugar.

Cushing’s is relatively rare, affecting about 40 to 70 people out of every million, according to the National Institutes of Health.

Appearance changes often aren’t just in the face

It’s not just the face that can undergo fat redistribution and skin texture changes when you have these health conditions. This can happen around the shoulder area and neck. Widening thick dark pink, purple stretch marking can be seen at the belly, back, upper arm and thighs, too.

When to seek medical help about a puffy face

The increased puffiness of the face becomes more concerning if it’s associated with other features such as worsening acne, increased facial hair growth in the chin area for women, increased bruising or increased skin infections that are harder to heal.

It's recommended to seek medical advice if you start to have high blood sugar or high blood pressure in addition to the body, skin and facial changes.

It can take meticulous medical evaluation and careful laboratory testing to differentiate between stress-induced versus tumor-induced body changes and high cortisol levels.