How serious is ‘moon face’? Here’s when to worry about cortisol levels, according to doctors

It’s not amore hitting your eye.

The beauty buffs of TikTok have a new common enemy in cortisol. A condition dubbed “moon face” has struck fear in the faces of stressed-out young adults who now believe their overblown visage can be blamed on their cortisol levels.

Also known as “cortisol face,” the term refers to a perceived side effect of having too-high cortisol — the stress hormone — levels in the body.

However, doctors warn worry warts not to conflate the conditions that lead to bona fide “moon face” with other more common causes of facial puffiness, such as sleep deprivation or sugar consumption.

“While chronic high cortisol levels can lead to facial swelling, this is usually seen in more severe endocrine disorders rather than in the everyday stress most people experience,” Dr. Vijay Murthy, a functional medicine doctor and co-founder of Murthy Health, told Healthline in a recent report.

“Chronic high cortisol levels can lead to facial changes, but such pronounced effects are not commonly seen outside of significant medical conditions. In most cases, everyday stress does not elevate cortisol to the levels needed to produce such a dramatic physical change,” Murthy added.

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More accurately, “moon face” is a symptom with well-defined causes, such as taking steroids or having Cushing’s syndrome, in which the body regularly produces too much cortisol — hence the alternative moniker, “cortisol face.”

Other lifestyle factors and conditions could cause facial swelling. High salt intake, some medications and lack of sleep can cause water retention, leading to bloating; allergies may prompt inflammation; and certain medical conditions, such as kidney disease, are marked by edema, a swelling caused by too much fluid trapped in the body’s tissues as the organs are struggling to remove excess salt and water.

While the potential for chronic disease sounds scary, Dr. Gowri Reddy Rocco, a double board-certified specialist in regenerative health and hormones, reassured in Well+Good that recent beauty trends emphasizing a thin, chiseled mug — think: “Ozempic face” and mewing exercises — are skewing peoples’ expectations of what a healthy face can look like, and that not every puffy face is a sign of underlying illness.

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Is it possible that many of the round-faced TikTokkers complaining of “moon face” are indeed struggling with a chronic stress hormone imbalance? Not likely, doctors say.

Indeed, too-high levels of cortisol can lead to weight gain, depression and inflammation. However, rather than cortisol alone being the cause of a ballooning face, it’s more likely that feeling overwhelmed encourages bad habits that also cause puffiness, such as drinking booze and snacking too hard on junk food.

True “moon face” is brought on by a “buildup of fat deposits throughout the face and it’s usually due to excessive cortisol production,” said Rocco. Among the multitudes of complaining social media users, however, the swelling effect may more likely be attributed to “water retention, weight gain, drinking too much alcohol, dehydration, and a poor diet high in fats, sugars, and ultra-processed foods.”

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Cortisol is an essential hormone in the body and key to activating stress responses — a biological survival mechanism to kickstart us into fight, flight or freeze. Produced by the adrenal glands the hormone also helps regulate blood sure and pressure and contributes to immune system function. On a typical day, healthy cortisol levels peak early in the morning and wane throughout the day.

While stress is not likely the primary factor behind facial puffiness, there may be a link. One side effect of a cortisol spike is lipogenesis, a metabolic process by which excess fatty acids are created and deposited around the face, neck and midsection.

High cortisol can also contribute to water retention, causing puffiness, but the effects would be subtle, according to doctors who spoke to Healthline. Pronounced cases of facial swelling will likely have more significant underlying causes that may be related to cortisol but not caused by it.

True “moon face” can only be treated by removing the factors that cause the buildup of cortisol — for example, the cessation of steroid use or, in the case of Cushing’s syndrome, surgery may be required to remove the overactive, cortisol-producing glands.

For those with garden-variety facial puffiness, however, experts recommend taking better care of yourself with more sleep, exercise, healthy meals and, the best medicine of all, love and laughter — all of which reduce cortisol and promote the production of happy hormones including endorphins and oxytocin.

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