Who is She?
Illustration by Goce Ilievski/Stocksy.
By Leslie Price
Aging, if we’re lucky, comes for us all. And we’ve been told to expect changes, wrinkles among them. But wrinkles are one thing. Waking up and looking in the mirror and not recognizing the face that’s looking back is different. Is it the shape? The skin tone and texture? Are things…migrating?
As I began researching this piece about women’s faces changing shape as they age, I found a preponderance of advice for combating this natural evolution. Interventions ran the gamut from mild (retinol, at-home face laser-type devices) to significant (surgery). But this is not a prescriptive piece, as there is plenty of that to go around. If you decide you do want to adjust whatever is happening – thanks to gravity and the sun and being a person who makes facial expressions – that’s a conversation best had between you and a dermatological professional.
This is more about the why, and the how. It’s confirmation that, if you’ve been surprised by your appearance in photos, you aren’t the only one.
“I take care of a lot of perimenopausal and postmenopausal women, and that’s when you see the most substantial change because of the precipitous decline of estrogen,” says Dr. Melissa Levin. “It’s really when people start to see these structural changes in their face and skin. It’s a pretty difficult time for women.”
“In perimenopause, there are so many changes that often the skin is kind of on the bottom of the list for medical providers. Women tend to focus on [things like] periods being all wonky, mood changes, hot flashes. But then, once they come out of menopause, they’re like, oh gosh, I look so different now.”
“I have a lot of patients who come in to tell me, ‘over the course of a month, I do not recognize myself’,” comments celebrity dermatologist Dr. Shereen Idriss on TikTok. “In your early to mid-40s…something shifts and you wake up and you do not recognize yourself. I know it sounds tragic, but that is truly what I have noticed in my practice.”
Weight changes, including those incurred by pregnancy, can affect our faces. As The New York Times reports, women on weight-loss drugs are seeing increased signs of facial aging. Said one, “I remember looking in the mirror, and it was almost like I didn’t even recognize myself. My body looked great, but my face looked exhausted and old.” Per a Manhattan dermatologist in the piece, “Generally, it’s people in their 40s and 50s who are losing significant amounts of weight and are concerned about facial aging and sagging that occurs as a result.”
The most disorienting thing about seeing your face shape actually change is that you can’t quite put your finger on what is different.
“Our face naturally changes shape from an inverted triangle to a triangle,” says Dr. Levin. “It gets heavier at the base. That’s gravity.” But there are multiple factors at play. As you age, “you lose bone — and if you think about it, our face bones provide structural support and hold things up. So as [bone] gets smaller, you don’t have that support as much. Things start to sag, or shift downward, and that inherently changes the shape of your face,” she adds.
Also, “we have fat pads all over the face. And as we age, the fat pads (which actually get smaller as well) bulge out. The laugh lines around the mouth is the fat pad that used to live further up in the mid cheek. And then, we lose structural support in our skin. That’s collagen, elastin, different structural proteins that provide integrity in the skin.”
“Even those with a full face in their 20s may notice a loss of fat volume in their late 30s,” says dermatologist Heidi Waldorf. As we get closer to menopause, “the volume changes become worse” – changes exacerbated by skin laxity. (The phrase “skin laxity” comes up an uncomfortable amount in these discussions.)
As we wake up to these changes, people decades younger than us are embracing more and more interventions to stave off the slightest sign of age. Mashable reports that, “demand for cosmetic surgery surged since the pandemic began, driven by women under 45.” Under 45! Meanwhile, women of means are flying abroad for the newest (and as of yet, not FDA-approved) injectable “skin booster” called Profhilo. “It’s definitely noticeable,” said one. “There’s a big difference. You get that fullness back in your cheeks. It’s just sort of youthful.”
The older I get, the harder it is to feel like a purist about anything age-related. At 25, it’s easy to scoff at a 40+-year-old woman desperate to erase the age from her face – after all, those sorts of dilemmas are all hypothetical at that point.
Even though I haven’t done anything to my face, I can’t judge those who do. After all, we live in a very ageist society. As Heather Corinna wrote in her book about perimenopause, What Fresh Hell is This?, “Doing things about these changes is often about what we want…It’s okay to do things when it comes to our bodies, skin, hair, and nails…and it’s equally okay not to do things. It is also okay not to do them not just because you can’t afford to or you worry about judgement but because you just do not want to.”
Beauty editor Val Monroe tackled this topic in her newsletter this week, writing that women want anti-aging tips – but she feels conflicted about doling them out. “I’m not against taking great care of your skin or receiving aesthetic treatments, in-office or otherwise,” she says. “But it isn’t easy to stay balanced and upright while navigating the slippery slope of managing expectations in a beauty culture that prizes youth and hypersexuality. The way I see it, if you have a face, you’re going to have lots of feelings about it — and the point is to learn how to be comfortable and familiar with all the feels.” Easier said than done.