Is Cortisol Face Really Why Your Face Is Puffy?

A puffy face isn’t exactly a beauty goal for most people. Instead, there are de-puffing face masks, eye creams and other skin care routines, all with the goal of making your face look contoured, smooth and less bloated.

Many things can cause facial puffiness, such as allergies, eczema, high-salt diets and even the simple act of lying flat as you sleep. But now people on TikTok say there’s another reason for puffy, round faces: high cortisol, aka the stress hormone.

Social media users are calling it “cortisol face” and claim that too much of this hormone causes a round face, puffy skin, under-eye circles and acne. But is that true? Yes and no, experts say. Here’s why:

“Cortisol is what we call a glucocorticoid hormone, and it actually helps regulate your body’s response to stress,” said Dr. Divya Yogi-Morren, the medical director of the Pituitary Center at Cleveland Clinic.

Cortisol is mainly produced in the adrenal glands (which are on top of the kidneys), said Dr. Mehboob Hussain, an endocrinologist at University of California at Irvine Health. And cortisol is essential for day-to-day life.

“Without cortisol, many functions of the body would not be able to occur properly, and essentially no cortisol means you would die if there’s no treatment or remediation of that,” Hussain said.

Cortisol also helps “control the body’s use of fat, protein, carbohydrates and your metabolism,” added Yogi-Morren.

“If your body has too much cortisol, it can just be because of daily stress in life, or it can actually be because of a disease called Cushing syndrome,” Yogi-Morren said.

“The most frequent cause of situations where there’s too much cortisol in the body is when people are taking cortisol for medical reasons for prolonged periods of time at high doses,” added Hussain. (This can lead to Cushing syndrome.)

Cushing syndrome is not something that can be treated at home or diagnosed via a video on TikTok. Instead, you need to see a doctor for testing and treatment, Yogi-Morren noted.

Additionally, there are times when your body makes extra cortisol, like when you break a bone, said Hussain, but levels even out after a short period of time.

When it comes to a rounding of the face because of high cortisol, stressful moments in life are likely not what is causing that. It’s likely Cushing or another health condition, such as polycystic ovary syndrome (PCOS), which causes weight gain among things, including irregular periods and excess hair growth.

“Most of the time it’s not going to be Cushing syndrome… it’s most likely going to be something else that is something more frequent, you know, PCOS, obesity, diabetes, metabolic syndrome. Those are associated with these changes,” Hussain said.

TikTok users also say so-called cortisol face causes under-eye circles and acne. According to both experts, this can be Cushing syndrome, too.

Acne can develop if you have Cushing syndrome, said Hussain, and it can also develop as a symptom of some of the other conditions he mentioned above, such as PCOS.

But even if you don’t have one of these conditions, you may still deal with high-cortisol-related acne, said Yogi-Morren.

“Elevated cortisol, which is associated with high stress, can lead to increase in androgens. Androgens are basically male hormones, both men and women have them, but if you have excess androgens, you can… produce more oil, and then if you have more oil, you have excess bacteria and dead skin cells, which clog the pores and result in acne,” Yogi-Morren explained. “And there are studies that [say] stress-induced cortisol elevation has been linked to exacerbation of acne symptoms.”

On TikTok, under-eye circles are also said to be a sign of high cortisol. And thinning skin is another symptom of Cushing syndrome, Yogi-Morren said, as are things such as fatigue, muscle weakness and slow healing.

“The thinnest skin in your body might be under your eyes, so that’s why we’re getting some under-eye symptoms,” she said.

“The best thing for everyone to do is to talk to their providers about their cortisol levels, and if you’re concerned, your primary care doctor will usually order some preliminary tests,” Yogi-Morren said. “And then if the tests are abnormal, you may get referred to an endocrinologist who specializes in high cortisol, like myself, to further evaluate and decide what needs to be done.”

Cushing syndrome is not something that can be managed through lifestyle changes, but if you have a high-stress life or other underlying issues that are the reason behind a puffier-than-usual face, your primary care doctor may prescribe other at-home treatments, Yogi-Morren said.

“They might talk to you about stress management levels, sometimes they might put you on a healthy diet or a weight management program,” she explained.

Again, though, if your face shape changes or you notice under-eye circles or acne, it’s less likely to be Cushing syndrome, Hussain said.

“When I was going to medical school and was getting early clinical training… one of my professors would say what’s frequent is frequent, what’s rare is rare, and that’s just going to stay,” Hussain said. “Cushing is rare. Acne is frequent. PCOS is more frequent. Obesity is an epidemic, right? And so the frequent things you’re going to encounter much more, and what’s rare is going to stay rare.”