Facial ageing in women versus men and the correlation to hormones

Hormones: the unseen architects of aesthetic ageing

‘Aesthetic endpoint’ is a familiar statement heard at conferences, training and among colleagues. A broad spectrum based on ideal facial ratios and our treatment experience determines the product, number of sessions and maintenance. When a patient presents we assess their face for skin changes, volume distribution and hyperkinesis - do they fit a pattern such as vertical maxillary excess or are we treating the signs of ageing?

Our industry appreciates the impact that facial morphology can have on an individual’s self-esteem and interaction with society; our faces are a representation of our capacity to contribute and whether we are deemed consciously and subconsciously as approachable. Our faces can be a point of friction or freedom. 

The largest portion of our patient cohort is women in their 40s and 50s, where ‘life’ starts to chip away at the face of their youth. A morphological syndrome develops: ‘My skin quality is declining, I feel like everything has just dropped, I am tired all the time and ache.’ The question is, why is it that the 4th and 5th decade for women is particularly hard on their appearance whereas men seem to continue to age as a steady decline? It’s the rapid loss of the foundation building sex hormones - oestrogen, progesterone and testosterone in women during the perimenopause and menopause transition.  

At the cellular level, oestrogen receptors in dermal fibroblasts regulate collagen synthesis, glycosaminoglycan concentration and water retention. Hypo-oestrogenism therefore precipitates a measurable fall in  skin thickness, elasticity and hydration, promoting wrinkling and dullness. (Raine-Fenning, Brincat & Muscat-Baron, 2003). Furthermore accelerated bone resorption at the mandible and mid-face, flattening contours and exaggerating soft-tissue descent. As shown in the following figure, facial morphometric analysis shows that male and female faces follow a similar ageing trajectory until around 50 years; thereafter, the female path deviates sharply, correlating with menopause (Windhager et al., 2019). 

In addition to the loss of tissue integrity, impaired modulation of GABA, dopamine and serotonin leads to altered mood states which affects the individuals sense of self and their experience of treatment results. We all have the patients whom we achieve a noticeable improvement in the patient yet they are still ‘unhappy’ or ‘never satisfied’ - negative self-appraisal during peri-menopause correlate more strongly with anxiety and low mood than with their biological age. (Greendale et al., 2011).

Integration of guideline supported approach to management of hormones within aesthetic practice is highly rewarding as patients feel heard, feel better and treatments provided (especially biostimulator) have better success in degree of response and longevity. Research around both the role of sex hormones at a cellular level and the deleterious outcomes (increased risk of stroke, cardiovascular disease, mood disorders) of withholding treatment in indicated patients is rapidly expanding (Glynne 2025). As aesthetic practitioners we wouldn't treat someone with uncontrolled hypothyroidism or diabetes, so why do we treat patients with uncontrolled ovarian dysfunction?

References

• Navarro-Pardo E., Holland C.A. & Cano A. (2018) Sex hormones and healthy psychological aging in women. Frontiers in Aging Neuroscience, 9:439.

•  Raine-Fenning N.J., Brincat M.P. & Muscat-Baron Y. (2003) Skin aging and menopause: implications for treatment. American Journal of Clinical Dermatology, 4:371-378.

•  Windhager S. et al. (2019) Facial aging trajectories: a common shape pattern in male and female faces is disrupted after menopause. American Journal of Physical Anthropology, 169:678-688.

• Glynne, S. (2025) Understanding the long-term benefits and risks of HRT. Stratford-upon-Avon: Newson Health. [PDF] Available from Newson Health menopause service.