Can stress really give you a round, puffy ‘cortisol face’ like online influencers claim?

“You’re not ugly. You just have cortisol face,” Mandana Zarghami told viewers at the start of a recent TikTok video, one of many on the social platform blaming a rounded, puffy face on high levels of the hormone.
Hundreds of lifestyle and beauty influencers have claimed online that they’ve transformed their appearance by tackling stress. Many are sharing before and after photos that contrast their once fuller faces with new, lean jawlines, attributing the difference to lower levels of cortisol, the hormone produced in response to physical and mental stress. Some are even selling products and programmes they claim will reduce cortisol and lead to a slimmed-down appearance.
Zarghami, 28, said in an interview that her aim on TikTok was to educate people about the effects of high cortisol, though she does have a wellness business, through which she sells a “hormone-balance tea”.
When she began experiencing visible swelling of her face and abdomen in 2020, Zarghami consulted a doctor, who suggested stress might be to blame. She felt frustrated by the response: “How can I control my stress if you’re not giving me tools?” she wondered.
Zarghami made lifestyle changes that she believed had reduced both her cortisol level and her persistent facial swelling. These included drinking diluted apple cider vinegar after waking, and then green tea throughout the day. She also stopped weight lifting and instead started doing low-impact exercise and walking.
Zarghami later shared those tips online, claiming that “cortisol face” could be tackled without drugs or expensive products. “I did a lot of research on how to fix this naturally,” she said.
Experts, however, are sceptical that there is anything to be fixed. It’s true that chronically high levels of cortisol can affect your appearance – but only in rare cases. The idea of “cortisol face” is based in a misconception about how the hormone most often affects the body, and, experts said, is most likely a reflection of society’s growing preoccupation with how we look and how stressed we feel.
“I think the ‘cortisol face’ trend is trying to explain a perceived cosmetic issue, like a round face, and trying to medicalise it, in order to be able to take control of fixing it,” said Dr Cristina Psomadakis, a dermatologist based in London.
THE ROLE OF CORTISOL
Cortisol is known as the “stress hormone” because it regulates the body’s response to perceived threats, whether that’s physical danger or pressures at work. It’s vital for regulating blood pressure, glucose and metabolism, and for many other crucial bodily processes. But its association with chronic stress has earned the hormone a bad reputation. Online, people have singled out high cortisol as the cause of their fatigue, stomach bloating, dull skin and more.
Your cortisol levels might be higher when you are stressed, “but that doesn’t necessarily amount to a disease or a disease process”, Dr Psomadakis said.
Cortisol levels naturally fluctuate throughout the day, temporarily spiking in response to stress and other triggers, like lack of sleep, alcohol, and too much salty or sugary food. That means you might wake up with a subtly puffy face the morning after an intense day or a big night out. But your body has ways of keeping cortisol in check, and most often, the effect will pass with a return to healthy routines.
“It would have to be very, very high levels of stress for it to have a more visible, non-transient effect,” said Dr Rajita Sinha, a licensed clinical psychologist and director of the Yale Interdisciplinary Stress Center.
Many of the transformations shared in “cortisol face” posts seemed to reflect weight loss or gain, or the fat pads of the face migrating with age, Dr Psomadakis said.
Facial swelling can also be caused by a variety of other issues. It can be tied to the lymphatic or circulatory systems, an allergic reaction or sinus infection, or simply sleeping or lying flat for a prolonged period, which can cause fluid to pool around the face, Dr Psomadakis said. “All the symptoms that people are describing, I can medically explain through a constellation of factors – as opposed to just one.”
Medically high levels of cortisol are distinct from cortisol that’s simply elevated, and must be diagnosed through blood tests. In one rare but serious condition, known as Cushing’s syndrome, the body overproduces cortisol, which can lead to a swollen, rounded face, in addition to other symptoms.
Cushing’s is usually caused by taking steroid medication for another condition – or, less often, a tumour – not unhealthy lifestyles or day-to-day stress, said Dr Roberto Salvatori, an endocrinologist and medical director at the Johns Hopkins Pituitary Center. “I suspect most people who have a round face don’t have Cushing’s syndrome,” he added.
Nonetheless, Dr Psomadakis said she was increasingly seeing patients come in with concerns about their stress levels and cortisol.
“They’ll never come to me and say, ‘I’m doing this because I saw a TikTok video.’ They’ll say ‘Could it be Cushing’s?’”
‘HYPER-AWARE’ OF OUR FACES
Dr Psomadakis said “cortisol face” was only the latest in a line of social media-driven concerns she has seen as a dermatologist. Often, people over-attribute an apparent symptom – or perceived physical flaw – to a single cause, she said.
Dr Psomadakis said she routinely sees patients “obsessing over the smallest details” of their appearance, reflecting ever more precise beauty standards. But the picture presented on social media can be distorted, not just through lighting and filters but also a aesthetic interventions such as lip fillers and buccal fat removal. Between social media and Zoom meetings, “we’re living in an age where we’re hyper-aware of changes in our face”, Dr Psomadakis said.
On TikTok, however, influencers simplify the many factors at play to dangle a quick fix, promising perfectly balanced hormones and a lean jawline to boot. “They’re taking advantage of the trend to show a before-and-after, go viral and bring people in,” said Vanessa Oly, a certified nutritionist and founder of the Toronto-based Root & Remedy Wellness.
Orly said she had also heard from clients focused on their cortisol levels and not necessarily their overall health. “It’s very common practise right now to say, ‘My hormones are the problem, can you solve this for me?’” she said.
But she and other experts said that staying alert to how stressed you feel is sensible. For Zarghami, having long felt uncomfortable in her skin, the effectiveness of the changes she’d made was self-evident. “If I can motivate another person to take these small steps to better themselves, and they are happy with what they see and how they feel, then my work here is done,” she said.
By Elle Hunt © The New York Times Company
The article originally appeared in The New York Times.