When is puffiness of the face a result of too much cortisol?

The first time I heard about cortisol face wasn’t from that Mandana Zarghami TikTok video. It was from a PR rep who compassionately told me so during lunch (she got her coverage, and I was left confused), a fellow beauty editor who is never seen without a Oura Ring…and, unfortunately, a Gen-Zer who destroyed all my aura points by adding that I needed to “chill out because aren’t you old?”. 

But before I go on to describe what cortisol face is or even how to self-diagnose it, I have to first explain what cortisol is.

According to Dr Fathiyah Diyana, a Hybrid Care Doctor at Doctor Anywhere, cortisol is often called the “stress hormone”, something our body betrays us by producing when we’re under stress. Playing an essential role in regulating processes like metabolism, blood sugar levels, and immune response, Diyana adds that “while it’s normal and necessary in short bursts, consistently high levels over time can disrupt these functions and lead to health problems.”

In short, you aren’t just what you eat. You are also what you do. 

Likewise, Dr Goh Chye Tee, who is a physician at Hanmin TCM Clinic, explains that high levels of cortisol can be caused by anything from emotional upset to dampness and heat of the body or by other external pathogens. Both doctors agree, however, that it’s often our lifestyles that we can hold accountable for this ailment. It ranges from how we put our bodies under immense stress from excessive caffeine intake, doom-scrolling on our phones till late, or doing the bare of most when it comes to exercising. 

Want to hear something else that’s fun? According to a Cigna Healthcare Vitality Study in 2023, nine in 10 Singaporeans (87 per cent) reported feeling stressed in 2023 – that’s a lot of people who might be sporting cortisol faces. But having one’s face puff up isn’t the first sign of extreme stress. Dr Diyana states that it’s often mood-related, “such as increased anxiety, irritability, or feeling constantly on edge” before it starts showing up as physical signs. Dr Goh adds that cortisol-related swelling may also appear on the abdomen area, upper back, neck, legs, and ankles.

“While it may not always be immediately serious, it’s a warning sign that your body is under prolonged stress, and it’s wise to address it early. I advise patients not to ignore these signs and to seek medical advice if they notice persistent changes,” says Dr Diyana, who connects these changes to severe problems like high blood pressure, sleep disturbances, a weakened immune system, increased skin conditions like acne, and an increased risk of developing chronic conditions like heart disease or type 2 diabetes. Aka, a GOOP fanatic’s worst nightmare. 

According to celebrity makeup artist Larry Yeo, however, what one might perceive as cortisol face is more likely a cause of them falling prey to clickbait.

“I think there can be many factors for puffiness. Some people are just genetically puffy in the morning, or some could face such an issue due to medication or their dietary habits that might include heavy dinners and/or high-sodium food that causes water retention instead. Some could be triggered by allergies, and some might not even be hydrating enough in the day and drink too much water at night.”

The best way to debloat one’s face, according to him, doesn’t sound particularly fun as he advises people to go for an early morning workout to sweat excess fluid out or, in the case of an industry urban legend, to “go up and down the stairs four to fives times and at a minimum of five stories like what an ex-fashion stylist used to make models do during morning shoots”. But if you possess the physical strength of a toddler, Yeo also says that consuming a banana might help as the potassium in it can reduce sodium retention.

Cycling back to cortisol, both Dr Goh and Dr Diyana offer advice on living life fancy-free. First, Dr Goh advises one to look at one’s diet and reduce sugar and salt intake (TLDR: eat like a Mediterranean person). Food therapy with items such as poria (茯苓) and Chinese barley (薏苡仁) can be used to reduce water retention and puffiness. He also recommends acupuncture on selected acupoints to improve water metabolism, reduce swelling and/or destress. From there, Dr Diyana preaches the positivity of relaxation techniques like deep breathing, mindfulness, yoga, or even just finding time for hobbies or activities that bring joy and reduce stress. Others can include setting a regular sleep schedule (if you have the rigid sleep habits of an Amish person, you’re doing it right).

“Lymphatic drainage can temporarily reduce facial puffiness by promoting the removal of excess fluid, which may give some relief for “cortisol face.” However, this is only a short-term solution”, adds Dr Diyana, because after all, there is only so much a tool can do. But suppose one is looking for more firepower. In that case, Yeo prescribes the use of products ranging from the M.A.C Cosmetics Fast Response Eye Cream, $44.95, a liberal application of The Ordinary’s Caffeine 5% + EGCG Depuffing Eye Serum, $19 on damp skin, or Peter Thomas Roth Instant Firmx® No Filter Primer, $76 in emergency cases. However, it’s not recommended for use on dry skin types or with foundations that aren’t silicone-based based as it breaks up the primer’s three film-forming layers. 

M.A.C Cosmetics Fast Response Eye Cream, $68

The Ordinary Caffeine 5% + EGCG Depuffing Eye Serum

Peter Thomas Roth Instant Firmx® No Filter Primer, $76

Lastly, Dr Diyana believes that prevention is always better than cure. “The real focus should be on reducing cortisol through proper sleep, balanced exercise, and relaxation techniques”, and of course, for those struggling with persistent puffiness, seeing a doctor or TCM physician can provide an in-depth approach to one’s problems.