Experiencing aging is a beautiful thing; it means more time spent with loved ones, more bucket list items checked off, and an overall fuller life. But with the beauty of a long life comes lots of changes, including within your own body. At a certain age—typically around the late 30s to early 40s—women start to enter perimenopause, which sees a fluctuation of hormones that can affect everything from mental and physical health to changes in the appearance and feel of the skin.
It should come as no surprise that aging makes you look, well, older. There are clear differences between someone in their 20s and someone in their 50s, with distinct markers such as volume loss in the face and more fine lines and wrinkles. And a lot of what we attribute to aging skin begins to take hold during perimenopause.
However, it’s important to note that perimenopause isn’t one-size-fits-all. In addition to some women starting perimenopause as early as mid-30s, others won’t reach this stage until much later. And even though it’s a universal experience for women, perimenopause can present differently from woman to woman. “Hormonal fluctuations affect every woman differently,” explains board-certified dermatologist Tiffany Libby, MD. “Some experience sagging and laxity first, others redness or adult acne, so treatment should be customized accordingly.”
Should you want to address these changes from an aesthetic standpoint, there are plenty of options, ranging from non-invasive at-home devices to more aggressive surgical options. “I find that each individual’s genetics, lifestyle, body weight, and hormones lead to a unique pattern of aging,” board-certified facial plastic surgeon Sean Alemi, MD, reiterates.
To break down the wide range of available treatment options, I spoke with Dr. Libby and Dr. Alemi, as well as board-certified plastic surgeon Goretti Ho Taghva, MD, and board-certified dermatologist Anetta Reszko, MD. “Instead of aggressive or one-dimensional procedures, this phase responds best to thoughtful, layered therapies that support true regeneration and help the skin function more youthfully from within,” says Dr. Taghva.
Read on for a comprehensive guide to the best cosmetic treatments for skin in perimenopause, and remember—most of what’s recommended here works best when mixed and matched into a regimen tailored to your specific concerns.
Level Up Your Skincare Routine
If you’re still not quite ready to pull the trigger on in-office treatments, or if you want to enhance the results of the treatments you are getting, be sure to use the right skincare products. Dr. Alemi says, “One of my first recommendations is to optimize the patient’s skincare regimen with appropriate, targeted medical-grade products.” Think brands like Alastin, Skinceuticals, SkinBetter Science, or Elta MD. Dr. Reszko agrees, saying that supporting the skin at home becomes just as important as what happens in the office.
She suggests using “a gentle retinol, vitamin C, ceramides, peptides, and moisturizer to keep the barrier strong.” And of course, sunscreen should still be part of your everyday routine. In fact, she says, “sunscreen becomes even more essential because reduced estrogen makes the skin more vulnerable to sun damage.” It might also be worth investing in an at-home LED device, too.
Incorporate Injectables or Fat Transfer for Volume Loss
One of the first lines of defense when it comes to treating perimenopausal skin is the use of injectables, particularly hyaluronic acid fillers. (Neuromodulators such as Botox may also be used in conjunction for an overall smoother appearance.) “While a small portion of women find facial weight gain, the majority complain about relative hollowing of areas such as the temples, under eyes, and cheeks,” explains Dr. Alemi. “This hollowing, paired with early soft tissue laxity, often creates what some women feel is an accelerated period of facial aging.”
Dr. Reszko says, “Injectables such as Botox and fillers address the volume loss, deflation, and deepening folds that occur as facial fat pads shift and bone density decreases, restoring structure in a natural way.” And the nice thing is that injectable fillers are generally a low-lift treatment, meaning you’re in and out of your appointment with instant results, requiring little to no downtime. Whether you are prone to bruising or swelling, as well as the area of the face you have injected, will inform your recovery, with some people seeing no side effects at all.
Should you be open to a more invasive approach, Dr. Alemi suggests a fat transfer. He says that this is “for those who have lost considerable facial volume with aging.” This requires harvesting someone’s own fat—so you’ll need to have enough fat for liposuction in one area—and then redistributing it using a fine needle to inject the area of fat loss. This tends to be the better choice for longer-lasting, more natural results, especially in larger areas.
Brighten Dark Spots and Dullness
Although perimenopause may call for adding new products and treatments, that doesn’t mean your routine needs a complete overhaul. “During perimenopause, the goal isn’t to stop treatments like chemical peels or ablative lasers, but to approach them more strategically,” explains Dr. Libby. To treat the pigmentation changes, such as dark spots or melasma, which tend to appear or become more pronounced during perimenopause, Dr. Reszko recommends gentle resurfacing treatments, whether with light lasers or mild chemical peels. These treatments “keep the skin smooth without overwhelming its now-slower healing abilities,” she explains. “Chemical peels enhance brightness and smoothness by promoting cell turnover and reducing pigmentation.”
Dr. Taghva, the founder of LEA Plastic Surgery & Aesthetic Lab, recommends BBL lasers, which leverage light energy to rejuvenate the skin, paired with Moxi lasers “for pigmentation, uneven tone, and early texture changes.” She points to studies showing that “consistent BBL treatments can actually shift gene expression in older skin to resemble that of younger skin, reactivating collagen pathways, reducing inflammation, and helping the skin function more youthfully at a cellular level.”
But because skin can become more sensitive and slower to recover during perimenopause, Dr. Reszko explains that certain treatments may need to be modified or paused, as hormonal changes can make the skin thinner, drier, and more sensitive, increasing the risk of irritation or delayed healing. This is why it’s important to find a trusted doctor because treating perimenopausal skin requires know-how and some finesse.
Opt for Skin Tightening Treatments to Address Laxity
Dr. Taghva likes to layer skin tightening treatments, saying she’ll use Ultherapy, Thermage and Scarlett RF Pro together as a nonsurgical approach, each targeting a different depth of the skin. Each of these uses a different modality to stimulate collagen production: ultrasound, radiofrequency/heat, and microneedling, respectively.
And you can get even more out of these in-office treatments by adding key ingredients that signal the cells to rejuvenate quicker and better. “In the office, many women choose to enhance their treatments with peptides, PRP or PRFM growth factors, or exosomes during microneedling or laser sessions to amplify collagen regeneration,” says Dr. Taghva. Most of these ingredients can be found in at-home products, too, but they work best when applied to freshly lasered or microneedled skin because they can penetrate deeper.
Plump the Skin by Boosting Collagen with Biostimulatory Injectables
Biostimulatory injectables like Radiesse or Sculptra are go-tos for treating perimenopausal skin, says Dr. Libby. These will “stimulate your own collagen rather than simply filling for the sake of filling and distorting your face,” says Dr. Taghva, candidly. The idea is that you’ll get longer-lasting, more natural results with biostimulatory injectables versus hyaluronic acid fillers. However, they are gradual, so it will take time to see results, whereas filler is instant.
For a Permanent Solution, Consider a Facelift
“For the more surgically minded patients who are seeking a more permanent solution, I will recommend a deep-plane facelift to reposition the falling tissue and tighten the underlying soft tissue laxity,” says Dr. Alemi. (And you don't have to be 70 to get a facelift, for what it's worth. According to the American Academy of Plastic Surgeons, 16,228 people aged 30-54 got facelifts in 2024.
Unlike most of the other options offered here, a facelift requires a longer recovery but yields longer-lasting results. And if you’re considering combining multiple treatments anyway, it might be the better choice. While traditional facelifts are more surface-level, a deep plane facelift goes deeper, lifting a layer of fat and muscle, and addressing areas like the neck and jaw for a more lifted, tightened effect rather than a pulled or stretched look.
How Does the Skin Change During Perimenopause?
“Perimenopausal skin tends to become thinner, drier, and more sensitive, with a duller tone and slower healing,” explains Dr. Libby. This all stems from hormonal changes that occur at this time. “Estrogen decline reduces collagen, sebum, and hyaluronic acid production, while barrier repair and antioxidant defenses weaken,” she adds.
Why Does the Skin Change During Perimenopause?
Dr. Taghva explains, “The changes we see in our skin come from fluctuating estrogen, progesterone, and testosterone.” Because hormones trigger a response in the skin, one person may experience more breakouts due to decreased estrogen, leading to the increased effects of testosterone, while another may only notice dryness and dullness. Or there could be a unique combination of these things.
At What Age Do Perimenopause Skin Changes Start to Happen?
Perimenopause-induced changes in the skin can start “as early as the late 30s to early 40s, when estrogen and progesterone start to fluctuate,” says Dr. Libby. However, Dr. Taghva says, “I focus less on age and more on patterns—irregular cycles, new dryness or sensitivity, stubborn pigmentation, or a softer jawline,” so rather than clocking birthdays, pay attention to what your skin may be telling you about what’s going on inside your body.
Are Breakouts Normal During Perimenopause?
“Because of the hormonal shifts, perimenopausal skin is more prone to breakouts,” says Dr. Alemi. Similarly to how skin shifts during puberty and pregnancy, when hormone levels fluctuate, perimenopausal skin can become drier, more sensitive, and/or more acne-prone.
Will Every Woman Experience Noticeable Changes in Their Skin During Menopause?
“No two women experience perimenopause the same way,” explains Dr. Reszko. “Some lose volume earlier, some see more sagging, others deal mainly with pigmentation.” There are many factors that contribute to why perimenopause varies so vastly from woman to woman: “Skin type, genetics, hormonal shifts, ethnicity, and lifestyle all shape what each woman needs,” she explains, which is why it’s so important to develop a personalized treatment plan that addresses each woman’s unique concerns.
As for the timing of these changes? “Some women see major shifts dramatically within a year or two; others barely notice gradual changes until their late 40s or early 50s,” adds Dr. Taghva.
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Meet The Experts
Tiffany J. Libby, MD, is a board-certified dermatologist and dual-fellowship trained Mohs surgeon and cosmetic surgeon. She is the Director of Mohs Micrographic and Dermatologic Surgery and an Assistant Professor of Dermatology at the Brown University Warren Alpert School of Medicine. Dr. Libby graduated from an accelerated 7-year B.S./M.D. program on a merit-based scholarship from Rutgers NJ Medical School and was inducted into the Alpha Omega Alpha Honor Society. After an Internal Medicine Internship at The Mount Sinai Hospital in New York, she served as Chief Resident during her Dermatology residency at Albert Einstein College of Medicine/Montefiore Medical Center. She then completed a dual fellowship program, receiving accreditation in both Mohs Surgery and Dermatologic Oncology as well as Cosmetic Dermatologic Surgery.
Dr. Sean Alemi, a double board-certified facial plastic and reconstructive surgeon, is certified by the American Board of Otolaryngology and the American Board of Facial Plastic & Reconstructive Surgery. Renowned for his precision and commitment to natural aesthetics, he enhances each patient’s unique beauty with surgical artistry.
With expertise in both surgical and non-surgical facial and body rejuvenation, Dr. Ho Taghva performs a diverse range of surgeries including blepharoplasty, fat transfer, rhinoplasty, breast augmentation, breast lift, facial rejuvenation, mommy makeovers, and minimally invasive endoscopic procedures.
As a busy working mom, Dr. Ho Taghva is especially sensitive when it comes to intimate issues; her vaginal rejuvenation procedures address both cosmetic issues and functional concerns.
