Stress can cause a lot of different effects on the body, but can it actually change your face?

Cortisol is the primary hormone produced by our adrenal glands during times of stress – hence why it is often dubbed “the stress hormone.” While short-term cortisol production can help keep us out of harm’s way by mobilizing our body’s fight or flight responses, chronic stress and continuously elevated cortisol are linked to a host of detrimental effects in the body.

Perhaps you have even heard that this hormone can change your physical appearance – a phenomenon known around the Internet as “cortisol face”?

Several internet influencers have pointed out that their puffy face and uneven complexion all improved when they learned to manage stress levels properly, yet some debate exists about whether these symptoms are related to the impacts of stress and elevated cortisol or something else entirely.

In this article we’ll explore some of the impacts of stress and how it alters our physiology, from the inside out, including its effects on how we age, our immune function, and yes, even how we look.

Impacts of stress on biological age

Biological age represents the impact that lifestyle, nutrition, genetics, and various illnesses have had on your body and vital organs, including your liver and kidneys. Your biological age might be lower or higher than your actual chronological age, depending upon the health of your internal operating system, so to speak. One way that scientists identify biological age is to examine changes to a cell’s DNA and DNA-associated proteins. A 2023 publication using DNA methylation-based aging clocks to analyze biological age in both mice and humans found that stressful situations, whether physical or emotional, significantly increased biological age scores.¹

Although stress can be the result of psychological or emotional experiences, physical stress such as surgery or childbirth can have an impact on biological age as well.

Researchers examined blood samples from patients undergoing emergency hip surgery and found that their biological age scores significantly increased the day following surgery compared to blood samples taken right before the procedure.¹ Interestingly, planned hip surgeries did not affect biological age scores in the same way, which could be due to pre-operative measures that support recovery, or even due to the perception of “emergency” surgery as a more stressful experience than a planned one.

Blood samples of pregnant women (and mice) revealed that pregnancy itself increased biological age, but the greatest changes to healthy methylation status were reported immediately after giving birth, likely due to the stress of labor and delivery.¹

The good news? In the examples above, when the stressor was resolved, the body fully recovered and biological age scores reverted to “pre-stress” numbers. Following hip surgery, patients’ biological age returned to pre-surgery levels about four to seven days post-op. And similarly, the biological age scores of postpartum women also bounced back to their pre-pregnancy scores eventually – usually around six weeks after delivery.¹

The takeaway? Biological age is not fixed. Rather, it is malleable – meaning we have the ability to shape it based on our exposures and our choices. Every day we have the opportunity to potentially reverse biological age with lifestyle changes and other interventions that help us manage stress in its physical and psychological manifestations.

Impacts of stress on physical appearance

But let’s get back to whether stress can change how we look. Social media influencers sharing photos taken years prior reveal faces that appear radically different than present day; with such influencers attributing their previously swollen appearances to their high stress levels at that time.

Facial changes and symptoms reported as a result of stress include:

Puffy face
Dark circles under eyes
Drooping skin
Adult acne
Oily or dry skin
Loss of facial tone
Uneven complexion
More grey hairs
Eye twitch

So, is “cortisol face” really a thing?

Well, some experts have weighed in to say that these influencers are misleading their followers, because weight loss alone could be the reason behind such facial changes. But because elevated cortisol has been linked to weight gain, could stress still be the culprit?

When cortisol is elevated, nonessential functions such as digestion and metabolism are slowed down, which, in cases of chronic stress, can lead to metabolic issues and weight gain.^2,3 Increases in food cravings or binge eating behavior is also one of the impacts of stress, at least in part due to activation of what is known as the hypothalamic-pituitary-adrenal (HPA) axis. And while cortisol itself cannot change the structure of your face, chronically elevated cortisol can cause water and sodium retention, which could very plausibly lead to the appearance of a puffy or swollen face – particularly when coupled with poor eating habits, which are often correlated with heightened psychological stress.

Lipogenesis – the formation of fat – can also occur at a more rapid rate during times of chronic stress.³ And while this excess fatty tissue most commonly accumulates around the stomach as visceral fat, it could also lead to increased fatty deposits around the face and neck.

There is also a specific medical condition known as Cushing’s syndrome that can cause what is commonly referred to as “moon face”− a condition where fat deposits on the sides of the face causing a rounded, “moon-like” appearance. With Cushing’s, fatty deposits often accumulate in other areas as well, such as between the shoulder blades, giving the appearance of a hump on the back. Cushing’s syndrome develops when there is chronically elevated cortisol circulating in the body; however, it is extremely rare for the condition to develop merely from one’s internal stress response. The most common cause of Cushing’s is the long-term use of high-dose corticosteroids that elevate cortisol levels. Make sure to consult with your health-care practitioner if you have any concerns regarding your risk of Cushing’s syndrome or are experiencing any abnormal changes to your face or body.

Impacts of stress on inflammation and the immune system

It is worth noting that facial swelling and water retention also could be the result of sluggish or inadequate immune system functioning. Since chronically elevated cortisol can impact our immune response and increase the risk of infection and inflammation,⁴ this could also be a factor related to “cortisol face.”

But what about the other facial changes reported above?

Well, because elevated cortisol can alter sleep cycles, someone in a chronically elevated stress state might notice dark circles under their eyes, for example. And when the body is under stress, there is a greater demand for certain nutrients, including B vitamins, vitamin C, zinc, and magnesium. Therefore, chronic stress is often associated with nutrient insufficiencies that can absolutely lead to effects on skin tone, complexion, and even lead to symptoms such as eye twitching.

Whereas the short-term impacts of stress might actually help to activate our immune defenses, chronic stress has been found to suppress immune system functioning – making us more susceptible to both acute infections – such as viruses that come our way – as well as putting our bodies’ at greater risk of long-term immune dysfunction, including inflammatory disorders.^4,5 A growing body of evidence now implicates chronic stress and cortisol dysfunction in pain-related conditions as well.⁵

Mitigating the impacts of stress

Ultimately, our perception and experience of stress plays a significant role in its damaging effects; and therefore, developing tools to support recovery from periods of occasional stress can help to mitigate its effects on both biological aging and physical appearance.

Managing your experience of stress would ideally include a daily practice in self-care. And whether your goal is to improve your physical appearance or your biological age, taking better care of yourself is a worthy pursuit. And regardless of whether or not the facial changes shared by social media influencers are the direct result of cortisol, the recommendations they are promoting to support stress are spot on:

In addition to lifestyle choices, it is imperative to ensure adequate intake of essential nutrients that can become depleted during times of stress. And adaptogenic botanicals, such as ashwagandha, used extensively throughout Ayurveda, India’s ancient medical system, can help to nourish the adrenal glands and enable the body to be more resilient in the face of stress.*

Ashwagandha might also benefit those seeking support for healthy weight management.* In a double-blind, placebo controlled trial, 52 adults (38 men and 14 women) experiencing stress were randomized to receive 300 mg of ashwagandha or placebo twice daily for eight weeks.² Without any changes to diet or exercise, patients supplementing with ashwagandha had statistically significant improvements in body weight and body mass index (BMI), as well as reductions in food cravings, serum cortisol, and perceived stress overall. On average, ashwagandha resulted in a healthier weight after eight weeks compared to those taking placebo (3.03-percent weight loss with ashwagandha compared to 1.46-percent in placebo group).²

Thorne’s Stress Balance is formulated to optimize the body’s response to stress* and features essential nutrients, as well as a variety of botanicals, including 150 mg of ashwagandha extract per serving.

You can explore all of Thorne’s formulas that support healthy stress resilience here, but to learn more about your unique stress response, consider Thorne’s Stress Test. This at-home saliva test provides valuable insights about your hormone levels throughout the day and provides personalized insights and product recommendations based on your results.

References

Poganik JR, Zhang B, Baht GS, et al. Biological age is increased by stress and restored upon recovery. Cell Metab. 2023;35(5):807. doi:10.1016/j.cmet.2023.03.015
Choudhary D, Bhattacharyya S, Joshi K. Body weight management in adults under chronic stress through treatment with ashwagandha root extract: a double-blind, randomized, placebo-controlled trial. J Evid-Based Complement Altern Med. 2017;22(1):96. doi:10.1177/2156587216641830
Dille M, Nikolic A, Wahlers N, et al. Long-term adjustment of hepatic lipid metabolism after chronic stress and the role of FGF21. Biochim Biophys Acta Mol Basis Dis. 2022;1868(1). doi:10.1016/j.bbadis.2021.166286
Dhabhar FS. Effects of stress on immune function: the good, the bad, and the beautiful. Immunol Res. 2014;58(2):193-210. doi:10.1007/s12026-014-8517-0
Hannibal KE, Bishop MD. Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Phys Ther. 2014;94(12):1816. doi:10.2522/ptj.20130597

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