The Rise Of The Menopause Makeover

It seems like all anyone can talk about these days — both on social media and IRL — is plastic surgery. And while we can thank Gen Z and millennials for their candid approach to aesthetic procedures, Gen X and baby boomers are getting the most work done, accounting for 45% and 30% of total cosmetic procedures in 2022, respectively, according to the American Society of Plastic Surgeons. With the 45-plus set leading the charge, get ready to see doctors catering to this cohort with 2024’s unofficial plastic surgery top trend: the Menopause Makeover.

Similar to the mid-aughts mommy makeover for postpartum women, the Menopause Makeover is a clever phrase coined not for one specific procedure but a tailored array of surgical and noninvasive procedures aimed at counteracting the effects of menopause on the body and face. And while the Menopause Makeover isn’t yet appearing on plastic surgeons’ treatment options like the mommy makeover, many think it’s only a matter of time based on the demand for surgical intervention. “We don’t call it the Menopause Makeover, but all the women who are postmenopausal are asking for the same thing — they’re asking to have their tummy taken care of, their breasts taken care of, their butt, and their face,” says Dr. Norman Rowe, M.D., a board-certified plastic surgeon in New York City.

TZR asked top plastic surgeons and dermatologists across the country to weigh in on this burgeoning trend and share what happens to the body and skin during menopause, what procedures are most effective to counteract those changes, and why they think the Menopause Makeover is just now catching on as the next big thing in aesthetics.

Goodbye Estrogen, Hello Thin Skin

Menopause typically affects those with uteruses and ovaries starting around age 51 or 52, although some people can experience early menopause in their early to mid 40s. Menopause itself simply means that your ovaries no longer produce eggs or hormones, eventually leading to the end of your menstrual cycle and childbearing years. However, the changes to your body extend much further than just your reproductive organs.

“Estrogen is like a fertilizer for your plants — it stimulates collagen and bone,” explains Dr. Sabrina Fabi, M.D., FAAD, a board-certified dermatologist in San Diego. “Our fibroblasts in our skin no longer have that fertilizer effect to lay down new collagen and elastin or hyaluronic acid. So, as a result, within the first three years of menopause, you lose 30% of your intrinsic ability to create new collagen. And that translates not just into a thinning of the skin but the little septa that connects the skin to the underlying muscles.”

According to Dr. Melissa Doft, M.D., FACS, a double board-certified plastic surgeon and clinical assistant professor at Weill Cornell Medical School, the skin also stops producing as much oil and gland formation changes, resulting in drier, crepey skin. That decrease in collagen and elastin also translates into more hanging skin, she says.

All that estrogen loss can also have an impact on your bones and cartilage, notes Dr. Dara Liotta, M.D., a facial and plastic reconstructive surgeon on Park Avenue and the so-called Nose Job Queen of NYC. “Bone reabsorbs all over our bodies when the estrogen decreases, including areas that are skeletal in the face, like the cheekbone and the chin, which contributes to people feeling like their neck is aging,” she explains. “Because all those skeletal bony structures need their rigidity and to be the shape they are to hold the rest of the soft tissue up in the face. And that little bit of reabsorption also contributes to the feeling of descent of all those tissues.”

She notes that estrogen loss also softens the cartilage structure of the nose, something that many people are blissfully unaware of. “Nobody thinks about estrogen and progesterone affecting the way the nose looks, but the two times I hear people talk a lot about feeling like their nose changed drastically is after pregnancy and then menopause. As estrogen goes down during menopause, cartilage relaxes and it tends to lose the stiffness that gives your nose angularity and makes it look more narrow. As the cartilage relaxes, people feel like their nose gets wider.”

The eyes also see some major changes, says Liotta, with both the upper and lower lids experiencing very different issues related to a loss of elasticity and muscle. “Estrogen withdrawal accelerates the eye puff, where the fat underneath the eye comes forward and makes a bag that can’t be camouflaged with filler like an eye hollow can,” says Liotta. “That fat around the eye is usually kept back by the elasticity of both the skin itself as well as a muscle called the orbicularis muscle. When estrogen decreases, those tissues relax and that lets the eye fat poof forward more. With the upper eyelid, the skin actually ends up hooding over the eyelid a little bit because all that tissue that used to be held up by youth and estrogen starts to relax and descend a little bit, so the position of the eyebrow itself, as well as the upper eyelid starts to hood down.”

But your face isn’t the only area that sees some major changes, notes Doft. “We’re seeing a lot of redistribution of fat, a lot of times targeted towards the midsection around the stomach,” she explains. “So for people who have never had fat in that area before, all of a sudden they’re starting to get this new fat. Because of the hormonal changes, a lot of people also find that their breasts get a little larger, so some people who have had a breast reduction want a secondary reduction because they’ve gone up a size. People who had implants put in, now the implants feel too big and the skin has sort of sagged around the implants. Or they put in a bigger implant because they wanted to fill the volume that was lost after pregnancy, and now they’re like, ‘Wow, this implant is too big for my body.’ A lot of patients are getting rid of their implants and opting for a lift or downsizing their implants.” Adds Rowe, “When we go through menopause, we have an increased amount of fat predominantly in the buttocks or thighs. And we have a skin quality that is becoming thinner, more wrinkled, and less tight. So now we have more fat and loose skin, so all the treatments in a Menopause Makeover in one form or another are about trying to combat those two things.”

Introducing The Menopause Makeover

To help counteract these issues, plastic surgeons and dermatologists offer an array of treatments that help keep the face and body looking more youthful for longer. Dubbed the Menopause Makeover, it’s a specialized array of treatments tailored to the specific patient and their unique needs, meaning no Menopause Makeover looks the same. “The Menopause Makeover is in your late 40s to mid 50s to potentially even early 60s, and things they want to address are the body but also they notice their faces getting a little saggy, they’re getting nasolabial lines, they’re getting jowls, so it’s a combination of face, body, and breast,” says Dr. Philipp Franck, M.D., a board-certified plastic surgeon specializing in facial surgery, breast surgery, body contouring, and nonsurgical rejuvenation at Kassir Plastic Surgery in NYC.

Compare that to the mommy makeover, he notes, which is typically targeted toward women in their late 20s to 40s and focuses on the changes people see during pregnancy. “You have an expansion in your abdomen, your separation of your abdominal muscles [from pregnancy], and the breasts — those are the big two areas of concern,” he says. Adds Rowe, “The real difference that I see as far as Menopause Makeover opposed to the mommy makeover is that Menopause Makeovers don’t stop at the neck. Other than women coming in postpartum and saying they want some Botox or lip filler, I’m not doing facelifts on a 35-year-old postpartum woman.”

While each treatment is different, typically doctors say that Menopause Makeovers usually consist of some combination of breast reductions or breast lifts; liposuction or lipo sculpting in the abdomen, butt, and/or thighs; tummy tucks for excess skin; facelifts; brow lifts; lower and upper eyelid blepharoplasty; brachioplasty (aka arm lifts); and thigh lifts.

Less talked about but no less popular is the rise in rhinoplasty for the postmenopausal crowd. According to Liotta, the aforementioned cartilage loss, coupled with thinning skin, causes the nose to not only lose its angularity and sharpness but to also exacerbate any perceived irregularities. “Estrogen loss thins the skin and makes it a little more crepey, and what that does over the nose is if you have a little bit of a dorsal hump to begin with, it will exaggerate the look of that hump because you lose the fat and the thickness of the skin surrounding,” she says. “Also, as the skin thins, you see irregularities that may have been there before but were camouflaged by the padding of the skin and subcutaneous fat. As the structure is relaxed, the nose gets wider, flatter, longer. All those things are from the softening of the cartilage, and so it’s a really common time for people to come to me for a rhinoplasty. I have a huge percentage of patients I call a nose lift or a rejuvenation rhinoplasty, where I just bring them back to where they were premenopausal.”

Non-Invasive Maneuvers

But that’s not to say every option is surgical. According to Dr. David Shafer, M.D., FACS, a board-certified plastic surgeon in NYC, the hallmarks of a well executed Menopause Makeover are a combination of surgical and non-invasive procedures, as surgery can only address the tightness of the skin — it can’t impact the quality of it. “When you’re evaluating a patient, you want to look at several different factors like skin laxity and skin quality,” he says. “Skin laxity we can address with surgery. If you have to take your fingers and push your face back, that’s a surgical kind of thing, but when you’re looking at your face and you say ‘I don’t like how this skin looks here or there,’ then you’re looking at nonsurgical treatments. We have all these great energy-based devices like laser, radio frequency, plasma, and ultrasound that we can use. What they are doing is hitting the cells and the collagen at different levels to help tighten and to help improve the elasticity and collagen content, help with the texture of the skin, and the color of the skin. So there’s not one magic wand that does everything, but different energy based devices that we use in combination with surgery to get the best effect.”

One such device that he says is running all day, every day at his NYC practice is the Genius RF by Lutronic, a radiofrequency microneedling machine that he calls a game-changer for menopausal patients. “It’s not a substitute for surgery, but it’s an addition. A lot of times, we will do a facelift and then [my business partner] Dr. Dendy Engelman will come in and treat their under eyes or part of their face with the Genius. For the body, we have another device called the NuEra Tight by Lumenis, which is another radiofrequency treatment, but that’s more for body tightening, and it’s like you’re ironing out the skin. It takes multiple treatments, but we see positive results from patients.”

Injectables are another category that continue to be beneficial to this age group, although the focus and how they are used tend to look a bit different. Fabi, for instance, uses dilute Radiesse injections off-label frequently in this age group for areas like the neck and inner arm. While Radiesse is typically used for volumizing, when diluted with saline, it removes the volumizing effects while still giving patients the collagen biostimulatory benefits to thicken the thin skin. “I like to do a dilute Radiesse wash of thin skin on the neck,” she says. “Sometimes I layer it with a non-ablative fractionated laser to thicken skin and also address sun damage. The inner arm is also an excellent place for dilute Radiesse, because you can have a very toned arm, but the skin cannot keep up.” As Fabi notes, there is no surgical fix for chest wrinkles; however, she has seen success in her patients with off-label Sculptra injections combined with IPL to counteract discoloration.

Up until a few months ago, those looking to counteract the decrease in hydration in their skin were limited to topical moisturizers. However, thanks to the introduction of Skinvive, an injectable hyaluronic acid moisturizer, postmenopausal patients now have a longer-lasting solution to their hydration woes. “Skinvive is a nonviscous hyaluronic acid, so it comes out almost like water, but it’s crosslinked, so it takes a long time to metabolize it,” explains Shafer. “You get about six months of superhydration under the skin, and hydration is good for appearance, but also the health of the skin. After treatment, our patients describe increased brightness, improved texture, and improved appearance of the skin, so it’s changing the underlying skin.”

The Changing Face Of Aging

While doctors note that there has always been an interest in these procedures from this cohort, many have noticed a definite increase in the numbers as well as patients’ knowledge of the procedures available to them, something they attribute to the shifting attitudes toward age in society. “Fifty nowadays is not what 50 used to be,” says Franck. “You don’t think of a 50-year-old man or woman anymore the way you would think of them maybe 20 or 30 years ago.” Adds Rowe, “We’re living longer; women are staying in the workplace longer; they want to appear vital and maintain relevance. Social media is obviously playing a role — Kris Jenner is out there, and she looks great, so social media is a huge driver in plastic surgery.”

Not to mention the conversation about menopause itself has gone from a taboo topic to a booming category in the beauty aisle, making people with uteruses much more comfortable talking about this completely natural stage of life and showing them they no longer need to suffer in silence — both medically and aesthetically. “There’s more awareness around biological age,” says Fabi. “That’s ultimately what menopause is — the biological age of your ovaries. There’s more awareness about hormone replacement, and that’s lended to people talking and speaking more about it. That you can actually do something about it. It’s acceptable to speak about the changes that you still may see and what you can do about it.”

Another contributing factor is that financially, unlike postpartum patients, who now have the ever-increasing cost of raising a child to contend with, the postmenopausal set tends to be one of the most financially secure and willing to spend on aesthetic treatments. “Your economy robust patient population is 40 to 50-plus,” says Franck. “We see a lot of dynamics and volatility depending on the economical market, but that segment is pretty much always willing to pay.” Shafer agrees, explaining, “These are empty-nesters that have more disposable income now. A lot of them are before retirement and at the peak of their earning capacity, but they’re really looking to have that final last push for these improvements, so they have the money, they don’t mind spending, and they’re comfortable doing so.”

Proceed With Caution

That’s not to say everything is sunshine and rainbows once the hot flashes end and the Menopause Makeover is scheduled. While postmenopausal patients may be more comfortable with plastic surgery these days, there is still an inherent risk with any surgical procedure as you get older, says Shafer, much more so than that of a younger patient. That means medical clearance is doubly important to ensure patients can tolerate surgery and anesthesia — making sure they don’t have a heart condition, high blood pressure, lung conditions, or any systemic conditions that would cause problems during or after their procedure.

Recovery is also a major concern, as the body’s ability to heal slows down with age, notes Shafer. “As we get older, recovery is a little bit more involved, so sometimes with older patients, instead of doing a lot of procedures at one time, we might split it into a series of procedures, just to give their body a little bit more time to recover,” he says. “The body only has a certain capacity for healing, so if you’re doing multiple areas, then it has to spread apart that energy for other healing instead of focusing on one area and then a couple of months later focusing on another area, so the body can go full steam ahead for healing each area.”

Swelling is also a major concern, notes Liotta, so be prepared for more intense recovery and to add a laser or radiofrequency microneedling into the mix to help speed up the healing process. “It takes longer to recover from these surgeries because the skin is more lax in general — that means that swelling sticks around for longer, and then when the swelling resolves, the skin never quite shrinks down as much as it would in an 18-year-old,” says Liotta. “A lot of patients will have laser resurfacing done at the same time as surgery as well as radiofrequency microneedling. You can combine the two during surgery to help stimulate the skin and resurface the skin to help regain a bit of that youthfulness, but there are obviously some things that you just can’t completely change, and that is one of the struggles.”

While it should go without saying at this point, we’ll repeat it because it’s absolutely crucial: Make sure you are only going to a board-certified surgeon for your Menopause Makeover. And, as Liotta notes, if you are having a facial procedure done, the doctor should be showing you before and after photos of someone in your age range. “If you are going to see a surgeon about facial procedures that you want postmenopausally, you should be able to see pictures of other postmenopausal patients,” she notes. “It’s not going to help you if you’re going for a rejuvenation rhinoplasty and you’re looking at a picture of an 18-year-old. You’re different people.”

Perhaps the most important thing to keep in mind is that while menopause is a great equalizer in terms of skin aging, taking good care of your whole self in your 30s and 40s can help set you up for the best results down the line. “I love operating on people who have been doing really good skin maintenance because they have really good skin quality, they heal better, and they get a better result,” says Shafer. “You’re investing in your skin for the future — whether it’s fillers or lasers — all these things are stimulating collagen and helping your cellular metabolism.”

Experts:

Dr. Melissa Doft, M.D., FACS, a double board-certified plastic surgeon and clinical assistant professor at Weill Cornell Medical School

Dr. Sabrina Fabi, M.D., FAAD, a board-certified dermatologist in San Diego

Dr. Philipp Franck, M.D., a board-certified plastic surgeon at Kassir Plastic Surgery in NYC

Dr. Dara Liotta, M.D., a facial and plastic reconstructive surgeon on Park Avenue

Dr. Norman Rowe, M.D., a board-certified plastic surgeon in New York City

Dr. David Shafer, M.D., FACS, a board-certified plastic surgeon in NYC