In the last few years, menopause, which was once a never-to-be-talked-about side effect of female aging, has gotten a new publicist and a new lease on life. The natural phenomenon causes a decline in the production of female sex hormones, affecting some women as early as their mid-40s but most later in life. Like any change to the female body—pregnancy included—there’s a lot that transpires, but with menopause, there are permanent hormonal changes that equate to shifts in how the body stores fat, skin quality, and more.
As Michael Polakov, a global consultant in medical aesthetics, shares, the field of treatments for menopause is growing as the medical community realizes the importance of advancement in this area. “Research shows that women experience the earliest stages of peri-menopause earlier and earlier, possibly for reasons similar to why young girls experience puberty prematurely,” he says. “Women of every age are looking for solutions that go beyond hormone replacement therapies already available.” For these reasons and more, the number of female patients visiting their plastic surgeons and dermatologists for help balancing their hormones and correcting what menopause has changed is on the rise, hence the birth of the menopause makeover.
Featured Experts
- Elie Levine, MD is a board-certified plastic surgeon in New York
- Aviva Preminger, MD is a board-certified plastic surgeon in New York
- Mariam Awada, MD is a board-certified plastic surgeon in Southfield, MI
- Michael Polakov is a global consultant in medical aesthetics
- Dr. Angela DeRosa is the medical director at Belmar Pharma Solutions
The Changes Menopause Brings
The female body goes through many shifts throughout one’s life, which continue long after pregnancy. One of the more trying hormonal changes that the body experiences is menopause, a time when the ovaries produce far less estrogen and progesterone, leading to various physical and emotional symptoms. According to Belmar Pharma Solutions medical director Dr. Angela DeRosa, hormonal changes from menopause usually consist of low libido, hair loss, skin changes, weight gain, irritability, night sweats, hot flashes, vaginal dryness, changes to bone health, and overall just not feeling like yourself. “So many women complain of feeling blah,” she adds. With reduced estrogen in the body, the skin’s ability to produce new, healthy bundles of collagen, elastin and hyaluronic acid decreases, leading to paper-thin, dry, wrinkled, and pigmented skin that cannot snap back into place.
Fluctuations in normal estrogen production slow the metabolism, which also causes stubborn fat to accumulate on the hips and belly. Once-firm skin becomes slack and droopy, particularly in the breasts, and losing and maintaining a healthy weight becomes challenging for many women.
In addition to changes in the body and its overall look, facial changes also occur from both the effects of menopause and the natural progression of aging. Although board-certified New York plastic surgeon Elie Levine, MD says every woman experiences aging differently, changes to the brow, droopiness of the upper and lower eyelids, puffiness, a sagging jaw, lines, necklines, and volume loss in the face are also critical age-related factors.
According to board-certified New York plastic surgeon B. Aviva Preminger, MD, there’s a newfound interest in helping women through this transition period, allowing them to feel more comfortable being open about their symptoms and needs.
What Is a Menopause Makeover?
Dr. Preminger likens the menopause makeover to the popular mommy makeover, which may involve breast and body procedures. However, the main point of differentiation between these buzzy multi-prong procedures is that a mommy makeover focuses on reconstructing the effects of pregnancy in postpartum women, whereas the menopause makeover addresses the impact of dipping hormones that affect the face and body. Dr. Levine adds that several elements of a menopause makeover overlap with a mommy makeover. “Ultimately, both are done on women who are done having kids and have the time to take care of themselves.”
There’s no hard and fast rule about what a menopause makeover must include. Typically, as board-certified Southfield, MI plastic surgeon Mariam Awada, MD explains, a menopause makeover will address both the physical and emotional changes women experience. Most menopause makeovers consist of a breast procedure, body sculpting or fat removal, like liposuction, skin excision (when necessary), and a facelift with some eye or brow procedure and usually, but not always, some form of hormone therapy. It can also include surgical and minimally or noninvasive procedures and treatments. “The makeover also goes beyond cosmetic enhancements aiming to improve health, well-being and self-confidence overall as women transition into this new phase of life,” she adds. “The concept encompasses a range of tailored treatments and lifestyle adjustments.”
Women who seek out a menopause makeover typically, but not always, have not had a mommy makeover. “Often, these patients notice changes in their body, chest, abdomen, waistline, and overall body contour,” Dr. Levine says. “Specifically, many women who are perimenopausal experience truncal weight, which is weight gain in the abdomen and flanks that have redistributed from other areas. They point out that they weigh the same amount as in their 20s, yet their body fat distribution differs. Correcting this is one of the key elements of a menopause makeover.”
One thing Dr. DeRosa shares that often goes untapped is the role of testosterone in healthy healing. “When I look at a patient, I look at the whole person and not assume that a deficiency is only related to hormones. It’s important to recognize testosterone deficiencies when assessing women, too,” she says. “A lack of testosterone can lead to a host of potential issues, one being insulin resistance, which can cause poor wound healing and have an effect on surgery patients, so it’s important always to get that under control first.”
The Surgeries and Treatments
As Dr. Preminger shares, age-related changes due to hormonal fluctuations are a global change that requires several procedures to address it effectively. “I do a lot of facial rejuvenation, breast reductions and lifts, tummy tucks, and liposuction to reduce stubborn fat,” she says. “The loss of skin elasticity affects multiple areas, particularly the face, neck and breasts.”
Hormone management via bioidentical hormone therapy (BHRT) and hormone replacement therapy (HRT), which Polakov says relies on updated approaches with newer methods with fewer side effects, is also an essential component to integrate into a treatment plan. “The goal is to create hormone harmony using a delicate balance of different hormones to help alleviate the typical menopausal symptoms while also restoring (or even enhancing) libido and desirable sensitivity.”
For the eyes and brows
Unfortunately, the upper and lower lids suffer from a decline in estrogen, leading to a loss of elasticity and lax muscle, puffy-looking eyes, and protruding bags. “We commonly treat the upper and lower eyelids with surgery to remove excess, thin, and wrinkled skin,” Dr. Adawa says. Depending on a combination of factors, Dr. Levine shares that some patients may also benefit from an endoscopic brow lift.
For the hair
Estrogen and thyroid hormones are, as Dr. DeRosa says, drivers of changes to the hair, leading to thinness. While topical treatments and supplements are a good place to jumpstart hair growth and add density to the hair itself, consider hormone therapy treatments and microneedling with platelet-rich plasma (PRP) and platelet-rich fibrin (PRF).
For the breasts
The breasts naturally hold fat, yet when the skin quality changes, they are likely to sag and lose their perky shape. Once the hormonal changes settle in, some women notice that their breasts droop more, while others find they become larger as a result of menopause. “Many women who get breast implants when they are younger decide that they no longer want them or that changes in their breast elasticity require a lift or replacement,” Dr. Preminger explains. “I’m also seeing a lot of menopausal women opting to downsize or take out their implants and replace them with fat and a minor lift,” she adds. Breastwork during a menopausal makeover can also include, as Dr. Levine shares, breast lifts, reductions, augmentations, or a combination of these procedures.
For the stomach
Liposuction is the go-to solution to address hard-to-get-rid-of fat from the lower abdomen and hips. With menopause, there’s a redistribution of fat, so some areas where fat wasn’t a problem become an issue suddenly. The abdomen and waistline often become weight loss resistant despite your best efforts in the diet and exercise departments. Depending on a woman’s specific concerns, Dr. Levine says combining liposuction with abdominoplasty and radiofrequency skin-tightening can control the abdominal area and the back and waist. “We can also use liposuction to treat the inner and outer thighs and radiofrequency skin-tightening to help improve cellulite.” Dr. Adawa adds that CoolSculpting is another option to free the body of unwanted hormone-dependent fat deposits on the stomach and the love handles, arms, and even neck.
For the face
Full face rejuvenation, consisting of a facelift with a neck lift, is on the priority list for many menopausal women. While fillers have their place, menopausal women mustn’t become too reliant on them. In some patients, the degree of sagging due to hormonal level shifts and a loss of elastin and collagen causes the skin to lose its ability to snap back, so using too much filler can give way to an overfilled, puffy appearance and make things worse.
For the nose
Rhinoplasties are rising in menopausal patients due to bone reabsorption caused by estrogen decline. A lack of estrogen can cause the skin on the nose to become thin and crepey and the cartilage in the nose to become soft and relaxed, which is why an aging nose often loses its sharp definition and starts becoming wider-looking and the tip more round-looking and even limp. Some women opt for preservation rhinoplasty, a resurrected technique that prevents over-manipulation of the nose and nasal tissues during surgery. Dr. Preminger says it always surprises her when she sees patients get a rhinoplasty later in life, “but some women experience increased drooping of the tip with age and want it corrected.”
For the skin
A drop in collagen and elastin leads to thinner, drier, more wrinkled skin and changes to the skin’s appearance. While a facelift is the procedure for getting rid of lax skin once and for all, other options to help firm it include ultrasound- and energy-based RF microneedling skin-tightening treatments.
To tackle menopause-related dryness, loss of elasticity, and wrinkles head-on, Dr. Awada adds that skin care plus professional procedures such as lasers, microneedling and platelet-rich plasma, are all essential to rejuvenate and improve the skin’s health, especially when there’s a loss of collagen and facial fat accompanied by weak and thinning skin. “Other treatments like Intense pulsed light (IPL), Diamond Glow, and HydraFacials followed by hyaluronic acid facial fillers such as Juvéderm and Restylane or biostimulators like Bellafill can help to improve the skin.”
For the vagina
The face, breasts and stomach aren’t the only parts of the body that menopause can get the best of. Some women experience excess tissue on the labia that they wish to correct. Dr. Preminger says many of her patients come in looking to remove the excess tissue of the labia minora, which can be caused by aging and a loss of hormonal support, with a labiaplasty.
Vaginal dryness is also a byproduct of menopause, often affecting intimacy and causing discomfort. To address a lack of vaginal lubrication and decline of elasticity in the area, which can be bothersome for postmenopausal women, Dr. Preminger uses devices like Votiva to help.
