Docs unpack your patients' next fear: ‘Cortisol face’ is trending on TikTok
Key Takeaways
Influencers are claiming their puffy, swollen faces are due to high cortisol levels.
Experts say the term "cortisol face" is being misused. True hypercortisolism, such as seen in Cushing's syndrome, is a serious medical condition characterized by a constellation of symptoms.
While elevated cortisol levels can lead to facial puffiness due to fluid retention and fat redistribution, it's important for physicians to clarify that not all facial edema is caused by cortisol.
A new trend is sweeping the internet, convincing people that their bloated faces are due to a condition called “cortisol face.” As a result, many folks are sharing photos of themselves, claiming stress is the reason they look so puffy.
But what exactly is cortisol face? According to TikTokers, it’s when your face becomes swollen due to too much cortisol—the stress hormone released by the adrenal gland.[] High levels of cortisol, they claim, causes water retention, bloating, and consequently, a moon-shaped face.
According to Raj Dasgupta, MD, FACP, FCCP, FAASM, an internal medicine, pulmonology, critical care, and sleep medicine physician affiliated with Keck Medicine in California, there’s some truth behind the claim that cortisol can trigger swelling, but the messages on social media are often oversimplified.
“Chronically high cortisol levels can cause puffiness in the face due to fluid retention and fat redistribution, but the idea that all facial puffiness is linked to cortisol is misleading,” Dr. Dasgupta tells MDLinx.
Multiple factors cause bloating or facial edema, he says, and cortisol isn’t always the culprit. Here’s what to know about the latest misinformation trending on TikTok.
Is this a legitimate health problem?
When a person experiences pressure or stress, cortisol is released to help them stay alert. It plays an important role in regulating metabolism, the inflammatory response, and immune function,[] and it ebbs and flows with our circadian rhythm.
Many factors can drive up a person’s cortisol levels, including stress but also poor sleep, exercise, and illness.[] Prolonged levels of cortisol can lead to bloating, but this isn’t as common as some of your patients may have been led to believe. There are many other health conditions that can cause a person’s face to swell—Dr. Dasgupta notes that kidney issues,[] long-term use of steroids like prednisone,[] and hormonal imbalances can all lead to fluid retention and bloating.
It’s unlikely that your patients are developing “moon face” from the cortisol in their bodies. True “cortisol face” is indicative of a more severe disorder of hypercortisolism, aka Cushing’s Syndrome. “This is a serious condition, and it is not the same as simple facial puffiness or swelling that may occur as a result of generalized edema, poor diet, weight gain, insufficient sleep, or hypothyroidism,” says Jennie Stanford, MD, FAAFP, DipABOM, a family medicine and obesity medicine physician and medical contributor for Drugwatch.
Hypercortisolism, or Cushing's disease, is a hormonal disorder caused by long-term exposure to excess cortisol. It may be caused by taking hormonal medications or by the presence of tumors that produce cortisol.[][]
In addition to swelling, symptoms of Cushing’s include weight gain, hypertension, muscle weakness, hirsutism, and reduced bone density.[] “Weight gain often occurs in the face and abdomen, and excess fat deposits are usually seen on the back of the neck and shoulders and around the abdomen,” says Dr. Stanford.
Counseling patients on high cortisol
For those who do not have an adrenal gland disorder, there are many research-backed recommendations to share with patients to help lower cortisol levels, including relaxation techniques such as mindfulness or meditation.[] People may also benefit from speaking with a mental health expert about effective coping mechanisms.[]
According to Dr. Dasgupta, regular exercise and healthy sleep habits also help regulate cortisol levels. For those who take medications or have a health condition like Cushing’s, adjusting treatment might bring cortisol levels down, he says.
Amy Myers, MD, a functional medicine physician and founder of Amy Myers MD, says it’s possible to reduce cortisol levels through your diet.[] Dr. Myers says foods high in omega-3 fatty acids—like walnuts and wild-caught salmon—reduce inflammation and may reduce cortisol levels. Magnesium, which can be found in pumpkin seeds, spinach, and avocado, is also thought to lower cortisol.[] Antioxidants, like those found in berries, green tea, and dark chocolate, help combat oxidative damage in human cells, which can bring down cortisol, says Dr. Myers.
There are many reasons for facial edema, and while heightened cortisol can contribute to bloating, the best course of action is to run the necessary diagnostics tests, advises Dr. Dasgupta. Blood work or evaluations of kidney and thyroid function will help to rule out a more serious condition.
What this means for you
"Cortisol face" is trending online, with influencers suggesting that facial puffiness results mainly from elevated cortisol due to chronic stress. Experts point out that while cortisol can cause fluid retention, this view is oversimplified, as factors like diet, sleep, kidney function, and hormonal imbalances also contribute to facial swelling. Serious conditions, such as Cushing's syndrome, involve significant hypercortisolism and should not be confused with common puffiness. Physicians are urged to educate patients about these distinctions and recommend lifestyle changes and diagnostic testing to effectively address facial swelling.