Do You Actually Have Cortisol Face? An Expert Weighs In

TikTok often exaggerates health concerns, causing people to self-diagnose or seek unnecessary medical treatment. As the term "cortisol face" rapidly spreads, various myths and misconceptions have emerged regarding how common it is, what causes it and how to address it. 

While a cortisol imbalance can impact your facial appearance, is the fear-mongering overblown or is there a genuine reason for concern? To demystify cortisol face, we consulted with naturopathic specialist Dr. Saru Bala to clarify the facts and debunk any myths surrounding this trending topic. 

What is cortisol?

Cortisol, often called the "stress hormone," is a hormone the adrenal glands produce that influences nearly every organ and tissue in your body. According to the Cleveland Clinic, cortisol plays a role in the following: 

Inflammation suppression: Short-term cortisol release reduces inflammation, but chronic high levels can impair immune function. Stress response: Cortisol is released during stress to maintain alertness and provide quick energy by releasing glucose from the liver.
Blood pressure regulation: Elevated cortisol can lead to high blood pressure, while low levels may cause low blood pressure.
Metabolism regulation: Cortisol helps control how your body processes fats, proteins and carbohydrates.
Sleep-wake cycle: Cortisol levels typically peak in the morning and decline in the evening, influencing wakefulness and circadian rhythm.
Blood sugar control: Cortisol raises blood sugar by releasing stored glucose, counteracting insulin. Prolonged high levels can lead to diabetes.

Cortisol levels typically fluctuate throughout the day, peaking in the morning and declining by evening. Chronic high levels of cortisol can lead to various health issues.

What is cortisol face?

The term "cortisol face" refers to changes in facial appearance attributed to elevated cortisol levels, such as puffy or swollen face, particularly around the cheeks and jawline. However, are people getting this confused with moon face? 

Cortisol face vs moon face

You may have heard "moon face" frequently used interchangeably with cortisol face. While both terms describe the same physical characteristic of a puffy face, cortisol face has questionable roots. 

"Cortisol face is a made-up term from the media. What is real is moon facies, a condition in which the face appears round, puffy and moon-like," Bala told CNET. "This can be secondary to disorders like Cushing's disease, long-term steroid usage, specific hormonal issues or tumors, which can cause similar problems with cortisol production. Prolonged levels of high cortisol is what causes this appearance in the face."

One sign of moon facies is that if you look at the patient directly, face to face, you can't see their ears. Other symptoms associated with excess cortisol include a buffalo hump (dorsal fat pad), obesity, rash and fatigue.

Cushing's is rare, with only 10 to 15 people affected per million every year, as reported by the Endocrine Society. That being the case, another medical issue or unrelated cause may be more likely for many people reporting cortisol face. 

VladimirFLoyd/Getty Images

Potential causes of cortisol face, moon face and/or puffy face

Not everyone with facial puffiness has an underlying condition, but it is possible, so serious signs and symptoms shouldn't be ignored. 

"Although nutrition, sleep, stress, inflammatory levels, etc., can also cause puffiness in the face, they will not cause moon facies," said Bala. 

We'll take a look at specific causes of moon face and general puffy face. 

Causes of cortisol face/moon face

Moon face tends to be long-term and remains present until whatever caused it subsides. 

Causes of moon face include: 

Corticosteroid medications: Long-term use of drugs like prednisone.  Cushing's syndrome: Long-term, excessive production of cortisol.
Hypothyroidism: An underactive thyroid gland can lead to facial swelling.

Causes of general puffy face

Unlike moon facies, a general puffy face tends to be temporary. It can also be more noticeable in the morning and go away by midday.

Causes of general puffy face or facial swelling may be linked to:

Fluid retention: This can result from diet, sleep patterns or hormonal changes. Allergies: Allergic reactions can cause temporary facial swelling. Seasonal allergies cause more eye irritation, runny nose and throat irritation. An allergic reaction can also cause the face to swell, but it could also lead to lip swelling, tongue swelling and, if severe, trouble breathing.
Infections: Certain infections can result in facial puffiness due to inflammation.

How to get rid of cortisol face and/or puffy face

To effectively address and reduce cortisol face or puffy face, consider implementing these tips:

To get rid of moon face/cortisol face:

Adjust medications: Consult a healthcare provider about adjusting corticosteroid dosages or exploring alternative treatments. Treat underlying conditions: Address any hormonal imbalances or pituitary disorders.
Manage stress: Techniques such as meditation, exercise and therapy can help lower cortisol levels.
Medical treatment: If cortisol face is due to a medical condition like Cushing's syndrome, treatment options may include medication or surgery.

To get rid of general puffy face:

Hydrate: Drinking plenty of water can help reduce fluid retention.  Healthy diet: Reducing salt intake and eating a balanced diet can alleviate puffiness.
Good sleep: Ensuring adequate sleep can prevent or reduce facial puffiness.
Cool compress: Apply a clean, cold, wet cloth to the face for a few minutes to reduce puffiness.
Avoid allergens: Avoiding allergens that trigger your sensitivity can help prevent a puffy face. Elena Noviello/Getty Images

When should you see a doctor for cortisol face and/or puffy face?

"I think many of us think that having high stress levels and waking up with a puffy face is equivalent to cortisol face aka moon facies. And I want to make it clear that they are not the same thing," explained Bala. "Many of us have chronic levels of oxidative stress in our bodies that cause us to feel congested and wake up with a puffy face that subsides throughout the day."

However, a puffy face that is constant and doesn't go away could potentially signal hypothyroidism, Cushing's, pituitary tumors or other underlying issues, so seeking medical help ensures proper treatment and prevents further complications.

"These need to be diagnosed by a trained healthcare professional who can order labs. These can include blood work, 24-hour urine testing, dexamethasone suppression testing, MRI or other imaging. If you suspect chronic health issues, fatigue, issues with your period, hormones, sleep, etc., it's always best to consult with a healthcare professional for further workup, diagnosis and treatment," Bala recommended. 

How to prevent cortisol face and/or a puffy face 

Incorporating a few simple practices can make a significant difference in addressing and preventing facial puffiness. 

Manage stress

Managing your mental health can help maintain normal cortisol levels, especially when engaging in regular stress management practices such as yoga and exercise. 

Balanced diet

Eating a diet rich in nutrients and low in salt can reduce fluid retention and prevent puffiness.

"Eating a balanced diet with protein and fiber in each meal to regulate blood sugar and insulin levels can help regulate cortisol rhythms as well," said Bala.

Adequate sleep

Ensure you get enough restful sleep to prevent facial puffiness. According to the Sleep Foundation, adults need at least seven hours of sleep every night. 

Bala also suggested, "Waking at the same time every day to help regulate your circadian rhythm and cortisol awakening response." In addition, "going to bed around the same time daily, limiting screen time before bed and limiting overhead light exposure after dark" can help with sleep. 

Drink more water

Hydration is key to helping the body release retained fluid and reduce puffiness.

"Staying adequately hydrated with at least 80-100 oz of water and getting plenty of electrolytes and minerals, especially if you spend a lot of time in the sun or sweating," Bala said. 

The bottom line 

The constant discourse surrounding cortisol face can be overwhelming, but before getting worried or seeing a doctor, consider possible reasons for your puffy face or facial swelling. That's not to say that Cushing's syndrome or another medical condition isn't the cause, but understanding the many potential causes, differences and management strategies can help address these issues effectively. 

Of course, for ongoing or severe problems, consult a healthcare professional to ensure appropriate diagnosis and treatment.