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You know about the Mommy Makeover—that tummy tuck, breast lift/augmentation, and liposuction some women opt for post-childbirth to mitigate the body-altering effects of pregnancy. Well now, a new generation of women is going under the knife to combat changes triggered by another major hormonal event in a woman’s life: menopause.
“Some people say 50 is the new 30, and I think that’s because many menopausal women today have taken great care of themselves,” says Dara Liotta, MD, a board-certified facial plastic surgeon in Manhattan. “They were in their twenties and thirties when Botox and fillers first became popular, and they’ve been doing subtle ‘tweakments’ for decades. But even with all that good care, the quick and acute shift of hormones during menopause can age the face in a way that noninvasive treatments can’t completely address, leaving some women looking in the mirror at a face that’s incongruous with how they feel.”
“At 51, I felt young and vibrant and was still working and engaged in all areas of my life. But my upper eyelids looked like Roman shades, and I was self-conscious about it,” says Susan, 58, a designer and entrepreneur, who said she’d taken to wearing sunglasses in photos because she hated the way her eyes looked when she smiled. “I just wanted to look the way I felt, and that’s really what propelled me to do an upper eyelid lift.” After the surgery, Susan says she “felt so much better about myself—“lighter, brighter, more like the version of myself I wanted to project to the world. The procedure didn’t take 15 years off my face. But my goal was not to look younger. I just wanted to look healthier…and less tired.”
According to American Society of Plastic Surgeons (ASPS), Susan’s surgery (a blepharoplasty, surgery that removes excess skin from the upper and/or lower eyelids) is currently the top facial cosmetic surgery in the U.S.—and growing. Between 2019 and 2022, the number of blepharoplasties performed jumped 13%.
It’s the most common procedure in Dr. Liotta’s office too, as menopausal Gen Xers grapple with the loss of skin elasticity brought on by rapidly-dropping estrogen levels. “The women seeking what we’re calling ‘menopause makeovers’ are still relatively young—in their forties and fifties. This is not a 65-year-old, pull-it-tight facelift patient. This is a woman who is still working, at the top of her game, and feels some pressure to still look her best, but is seeing fairly dramatic changes in her skin because of estrogen loss and the subsequent decrease in collagen. Usually the first areas to grow slack are the eyes and the jawline.”
In addition to reduced elasticity, Dr. Liotta says menopausal hormone shifts can also cause the skin to thin, cartilage to soften and facial bones to deteriorate. “Collagen loss causes the brows to drop, and the upper and lower eyelids to become looser and more wrinkled. The decrease in elasticity can also enable fat beneath the eyes to puff forward, accentuating eye bags. And the loss of facial bone allows soft tissue to fall, leading to jowls, deepening of the nasolabial folds, and a less defined jawline,” she explains.
To address these changes, Dr. Liotta says women often opt for procedures like blepharoplasties to tighten loose lids, chin implants to address bone loss in the jaw and pull the skin there tauter, and even rhinoplasties (nose jobs) and earlobe lifts to combat the cartilage loss that can leave once-well-shaped noses or earlobes droopy.
“You’ve likely heard people say your nose and your ears continue to grow with age. But that’s not really true. What’s happening is a combination of the skin thinning and growing looser—and the cartilage that used to give your nose or ears angularity and refinement suddenly softening and spreading. The result is a droopy earlobe or a nose that flattens and widens when you smile,” says Dr. Liotta, who’s coined this procedure a “nose lift or a nasal rejuvenation rhinoplasty” and says it’s becoming one of her most popular surgeries. “I did this kind of rhinoplasty on three menopausal women this week and I have two more next week.”
In her Beverly Hills office, Kimberly Lee, MD, a board-certified facial plastic and reconstructive surgeon, says she’s also seeing a number of “women in their 40s and 50s seeking eyelid surgery…but these patients are seeking natural results, where others may not know that they’ve had something done. They aren’t looking for results that have no wrinkles, just fewer wrinkles.”
Dr. Liotta adds: “I like to refer to these menopause makeover procedures as ‘moving the furniture around, rather than knocking down the walls.’”
That’s not to say some women in their forties and fifties don’t ever get facelifts. But, generally, these younger patients are undergoing a (somewhat-euphemistically coined) ‘minilift,’ or ‘babylift.’ “These terms are a bit of a misnomer because a facelift is still a facelift, even if you’re not removing as much skin as you would on a 65-year-old, or you’re primarily pulling just the lower face taut. But on younger patients this does tend to be a smaller operation so, I guess, in that sense it is ‘mini,’” says Dr. Liotta.
Catherine Chang, MD, a board-certified facial plastic surgeon in Beverly Hills who specializes in these ‘younger facelifts,’ says she is seeing an increase in the number of 40- and 50-year-old women coming in for this procedure—in part because they recognize it may be ultimately more cost-effective and the results more natural than continuing to invest in noninvasive options, like hyaluronic acid fillers. “Fillers add volume to the face and can be great—and they typically look natural, initially. But, as you age, and your skin thins and stretches, you lose volume more quickly, and the soft tissue pulls the face down, so you now have to spend more money to put in even more filler to get that ‘lift’ you’re after,” she explains, adding this can lead to an unnatural “widening and squaring” of the face.
Dr. Liotta concurs, adding that another reason hyaluronic acid fillers, in particular, may not garner the same results once you’re menopausal is that these fillers are “hydrophilic, meaning they suck up all the fluid in the area. And during menopause the body already retains more fluid, so the result may end up puffier than intended.”
For Jean, a 59-year-old lawyer and single mom, getting a facelift at 56 was partially motivated by the fact that, while she had gotten fillers in the past and been pleased with them, she knew at this point in her life, surgery was going to get her the most natural, enduring lift. “My only child had just left for college, I wanted to get serious about dating again—and I wanted to feel more confident about the way I looked,” she recalls. “I wasn’t happy with the jowls and sagging I saw along my jawline and I knew surgery was the answer. But I was afraid of looking overdone so I went with a surgeon who understood my desire to have a very natural, what I called ‘mild’ lift. I was very, very pleased with the result; I felt like I looked refreshed, but still like myself.”
And that desire for a natural—and mostly undetectable—result is what Dr. Liotta hears repeatedly from her menopausal patients. “They say things like ‘I want a small change to feel better;’ they are not looking for The Swan–level makeover. These are women in serious jobs who are working, maybe dating, and just want to stay in the game and look as good as they feel. At 50-something, they have more in common with the women on Sex and the City than they do with the Golden Girls—who were both in their fifties, as crazy as that sounds. But the changes caused by menopause can make you look tired, and your face doesn’t reflect the way you feel inside. These smaller surgical procedures give women back their mojo. They’re not done yet,” says Dr. Liotta.
This article was originally published on Vogue.com.
