You're not ugly, you're just stressed! Bizarre effect of cortisol on facial structure

Influencers have come up with a new thing that you can blame all of your problems on: cortisol. 

In over 140,000 posts on the topic, TikTok users are blaming the stress hormone for a range of ills - from a puffy face to bloating to adult acne. 

Doctors say in rare cases this natural hormone can cause facial swelling, such as in the case of comedian Amy Schumer, who has a rare disorder that causes cortisol to go into overdrive, called Cushing's disease. 

But for the average person, a puffy face might be a natural occurrence, and not sign of some underlying hormonal imbalance. 

'I think the ‘cortisol face’ trend is trying to explain a perceived cosmetic issue, like a round face, and trying to medicalize it, in order to be able to take control of fixing it,'  dermatologist Dr Cristina Psomadakis told The New York Times. 

It seems many people are concerned about facial puffiness. Google searches for 'cortisol face' have increased steadily since March of 2024, peaking earlier this month. 

This could be in part due to how popular the topic seems to be on social media.  

Liz Tenuto, known by her 2million TikTok followers as The Workout Witch, has released many videos about the topic. 

In a video posted in January of 2024, Ms Tenuto said that high cortisol 'changes the way you look' by giving you adult acne, puffy face, neck hump, puffiness around the eyes,  bloating and more. 

To solve this problem, Ms Tenuto recommended to commenters: 'I suggest the release stress & trauma somatic exercises at the [link emoji][heart emoji]'. 

Following that link, Ms Tenuto has a variety of different personal exercise regimens, journals and training routines beginning at $19. 

Other influencers use this to promote their individual supplement lines or apple cider vinegar. Others yet recommend using Gua Sha, a traditional Chinese medical practice, which involves dragging a tool over the face to promote de-bloating. 

However, doctors  like Dr. Rajita Sinha, a licensed clinical psychologist and director of the Yale Interdisciplinary Stress Center, told The NYT, say these symptoms like a puffy faces aren't signs that anything is wrong. 

For the average person, 'it would have to be very, very high levels of stress for it to have a more visible, non-transient effect,' Dr. Sinha said. 

Ms Schumer announced that she was dealing with Cushing's syndrome in February 2024 in a newsletter

Instead, the facial differences are probably due to natural changing related to aging or weight fluctuation. 

Cortisol is sometimes known as the stress hormone, but it plays a much more complex role in the body. 

There are receptors for the hormone on almost every part of your body, according to the Cleveland Clinic. So when it gets released into your blood stream, it can latch onto and affect everything from your immune system to your muscles to your hair, skin and nails. 

It helps control how your body uses its energy, regulates blood pressure and tells you when to be alert and when to be asleep. 

It also can play a role in inflammation, which is where people have come up with the idea of cortisol face. 

When your body is responding to an injury, cortisol gets released. This makes your body inflamed in order to stamp out invading bacteria or other external forces that can make you sick. 

Sometimes, chronic stress can have a similar affect on the body - sending large amounts of cortisol into the blood stream regularly, leading to inflammation which might make you appear puffy. 

But this condition is actually quite rare, and is usually only seen in people recovering from surgery, using steroids or dealing with an underlying health condition

For example, Cushings syndrome is a condition that causes your glands to overproduce cortisol, leading to chronic swelling, weight gain and facial rounding. 

It can be fatal or go away on its own, and it's relatively rare, affecting between 40 to 70 people out of every million, according to the NIH. 

Comedian Amy Schumer,43, is currently living with Cushing's syndrome , and pushed back against the public attention she received from her plump face while raising awareness for the condition. 

'It has been a crazy couple [of] weeks for me and my family. Aside from fears about my health, I also had to be on camera having the internet chime in. But thank God for that. Because that's how I realized something was wrong ' Ms Schumer said.