Do you have ‘cortisol face’? If you do, here’s why you should be worried...

Combating facial puffiness has become the latest health trend on TikTok, but, as Miranda Levy discovers, having too much of the stress hormone cortisol coursing through your body can have more serious consequences than just a baggy jaw-line…

When a ‘cortisol imbalance’ is discussed on TikTok these days, it is connected to ‘adrenal fatigue’. (iStock)

You’re not fat, you just have ‘cortisol face’.” All over TikTok, women are convinced they have found the solution to facial puffiness – by turning their attention to their levels of cortisol, the natural “stress” hormone, produced by the body.

Proudly parading a series of puffy “befores” and chiselled “afters”, social media influencers vow the solution lies in a number of simple lifestyle tweaks. These include cutting back on early morning caffeine and high-intensity workouts, taking supplements such as magnesium, even reducing their scrolling. By destressing lifestyle habits, so the theory goes, we can apparently lower cortisol surges through our bodies and ta-da a tighter jawline.

But could “cortisol face” hint at more serious problems being caused by having too much cortisol coursing around our body?

“Cortisol is a steroid hormone released by the adrenal cortex above the kidneys,” says Dr Nicky Keay, a senior lecturer at UCL and the author of Hormones, Health and Human Potential. Scientists describe it as the “body’s alarm clock”, a vital component that regulates metabolism, reduces inflammation and helps with the formulation of memory.

Cortisol is similar to adrenaline, the other “flight or flight” hormone released by our bodies. “Adrenaline is the fast stress response – it will help you if you see a tiger and have to run, for example,” says Keay. “Cortisol has a slower mechanism and it’s useful in generally getting us going. 

“We have diurnal peaks of cortisol production – it’s higher in the morning and goes down in the afternoon and closer to bed.”

When functioning normally, the body gets on with the business of producing cortisol as we need it, and we don’t even notice. But, produce too much of it and there could be a problem.

The danger signs

Cortisol is also dubbed the “stress hormone”, and while some stress is natural and vital to get us going in the morning and to motivate us throughout the day, too much can have serious consequences for our health.

Jane Ollis is a medical biochemist and the founder of Mindspire, a company which investigates how technology can help our wellbeing, explains: “Our stress response is 10,000 years old,” she says. “The cortisol mechanism was designed to make us move, to release glucose into the bloodstream so that we could run away from danger, or kill to feed our family. But the stress response hasn’t changed and we no longer have to run from danger, so it’s a fundamental problem.”

It is the equivalent, she says, of a “relentless fire drill. Just as constant alarm bells disrupt your peace, chronic activation of your body’s hormone system leads to persistent cortisol secretion, disrupting bodily functions”. 

Tik Tok started the Cortisol Face trend (@itsbrookeelle/@nutritionistkristen (via TikTok))

And while stress is not listed as a medical condition per se, it underpins physical conditions like IBS, depression and weight gain. Nicky Keay adds: “Whether the stress is from bad sleep, psychological stress, an upset body clock while doing shifts being stuck in traffic, over-exercise, or financial worries – your body doesn’t distinguish.”

According to Ollis, too much stress can lead to higher levels of pro-inflammatory cytokines (cytokines are proteins), which raise the risk of cardiovascular and autoimmune diseases, and diabetes. “Cortisol influences glucose metabolism. These elevated levels can lead to raised blood sugar and promote insulin resistance, exacerbating inflammation.”

Puffy face syndrome

Medical experts are less than certain about the TikTok diagnosis, but say there are cases when a puffy face could be a sign of raised levels, but this is in extreme circumstances. “I would say this trend is a myth with an element of truth, says Keay. “There is a very specific medical condition called Cushing’s syndrome, where a person produces too much cortisol. As a result, their blood pressure goes up, they get fluid retention, and they form a deposition of fat on their face. 

“Take a look at paintings of Henry VIII at the end of his life: there’s a theory that he had Cushing’s syndrome, so you could say that Henry VIII may have had ‘cortisol face’.”

However, Keay says it’s unlikely that the excited TikTokers have a similar serious condition. “Cushing’s is diagnosed by a blood test, and anyone would need a blood test to discount it,” she says. “However, there are so many other things that can cause a puffy face: for example, fluid retention if you’ve just got off a flight. The luteal phase of your menstrual cycle can also cause facial puffiness – or maybe some of these women had just put on weight, and now have simply lost it because they have addressed poor lifestyle habits.” 

Facial bloating can be caused by a raft of medical conditions (Getty)

“Blaming cortisol for a puffy face is like blaming the last slice of pizza for your entire diet,” says Ollis. “It oversimplifies the issue and ignores other significant factors.” 

Facial bloating can be caused by a raft of medical conditions such as thyroid issues, allergies or a sinus infection, so it’s always a good idea to get these checked out. 

“A few studies have shown that taking a magnesium supplement of 200-400 mg a day can help balance your sodium levels, lowering inflammation and puffiness in people who retain a lot of water.”

Ollis adds the extra glucose manufactured by relentless cortisol production can lead to weight gain. “We turn the glucose back into fatty deposits, but these tend to turn into visceral [belly] fat, or adipose fat elsewhere on the body. Your face doesn’t tend to be the first place you gain weight,” she says.

“In my opinion, we should be more worried about the effect of chronic stress on our heart, blood pressure and emotional health than whether it gives us a puffy face or not.”

Take back (cortisol) control

“You can’t necessarily avoid stress – and while it is true that individuals respond to stress differently, you do have a choice about how you respond to it,” says Keay. So, if you are in a traffic jam, you can make a conscious decision about whether you become a raging, screaming mess, or calmly sit and wait for the lights to change. 

For Ollis, the quickest way to destress physically and emotionally is to alter your breathing patterns.

“This is the best way of using your body to control your brain, and it costs nothing,” she says. Deep breathing can help quiet your sympathetic nervous system – the part responsible for the fight or flight response – and therefore reduce feelings of stress or anxiety, as well as improving the quality of your sleep. 

Deep breathing can help quiet your sympathetic nervous system (Getty)

“If you find yourself in a stressful situation, moderate your breathing to five or six breaths a minute,” she says. “You can download a breath counter app, for example.”

Other experts recommend the 4-7-8 breathing technique. This involves breathing in for four seconds, holding your breath for seven seconds, and then exhaling for eight, or the “box breath” – in for four, hold for four, out for four, then rest for four before starting again.

“A well-rounded approach to stress management is also essential,” says Ellis. “This includes adequate sleep, balanced nutrition, regular physical activity and mindfulness practices like meditation or yoga. All these habits help regulate cortisol levels and reduce the effects of the hormone on the rest of the body.”

And a few simple tweaks can help with puffiness. “Water retention is often caused by a diet high in processed foods and low in essential nutrients,” says Ollis. “A poor diet  can also exacerbate inflammation.” Experts often recommend the Mediterranean diet, high in fruit, vegetables, “healthy fats” such as avocado and olive oil, and lean meats. 

“Lack of sleep can also disrupt the body’s fluid balance and can lead to a puffy appearance,” says Ellis. “Pay attention to your lifestyle, and you should find the puffiness recedes.”

And breathe.