MENOPAUSE CHANGES

Perimenopause and Menopause are a big change in a woman’s life. Not just because of the end of menstruation, but because your body changes all over. You will feel like your body is not your own, that what has been constant and worked for you for thirty years suddenly does not anymore.

Why am I, a plastic surgeon, writing about this? Because I see many women who come in around this time, almost bewildered, at how things have changed. It feels like walking off a cliff. In the span of what seems like a month or two, your skin on your eyelids, breast, or abdomen droop. Your cellulite increases. Your abdomen widens and fat and weight accumulates. What are the changes you will see? And what can you do?

Skin quality changes. Thinner, drier. Loss of elasticity.
Eyelid changes.
Breasts droop, widen, and commonly get larger
Abdomen loosens. Urinary incontinence and bowel habits change. Skin may hang.
Weight gain, particularly around the abdomen
Bone density changes
Sleep issues
Hot flashes (aka “heat blooms,” “hot flushes”)
Brain fog

I have many blogs on the subject, as menopause affects me, my patients, and surgical healing, and menopause is of interest. I am NOT a gynecologist. You should discuss these health changes with your doctor. For the plastic surgical issues, I can help you after consultation.

Hair & skin

With changes in your hormone levels, your hair, skin, and nails change. Estrogen slows the loss of collagen in your skin. It maintains moisture by increasing sebum, the mucopolysaccharides, and hyaluronic acid levels in the skin. It prevents wrinkling. Your hair thins, your nails become more brittle.

What can you do?

HAIR

Supplements (Huge range of options from Vitamins A & B, biotin, collagen)
Shampoos (usually niacin or DHT blocker based)
Minoxidil (Usually a topical foam)
PRP (This is costly and not great for overall loss, but may work well for an area of thinning)

EYELASHES & EYEBROWS

Latisse. It is the only eyelash growth serum which holds the patent. It works. You can go on maintenance after your build up your lashes.

SKIN

Hormone replacement. Read my many blogs on the subject.
Antioxidants. Most commonly seen are Vitamin C and Vitamin E
Retin A or Retinols. These are also antioxidants. It is old school medicine, but effective and still the gold standard.
Sunscreen
No smoking anything. (includes vaping, pot, etc)
Chemical Peels, like TCA. This is a whole subject unto itself. Read more HERE. It is best for fine wrinkles and light pigment.
Fat grafting and stem cells. This is my favorite treatment to enter the arena. Nothing makes skin look pink and dewy like fat grafting. Read more HERE.

Eyes & face

You may notice rapid aging of the face as you hit perimenopause and menopause. Your skin becomes more lax, you form jowls, your nasolabial folds deepen. Your eyelids may hang over your lids or they may look deep and sunken. You look tired. Lines form around the eyes and lips.

Not fun.

Up until age 55-60, you can improve most changes in the face without doing a facelift.

Skin quality– see skin box. But if the sheet on the bed looks wrinkled, the bed looks bad.
Facial volume. As you age, you lose fat all over your face: the temple, cheek, brow, chin, and around the mouth. In the office you can fix this with fillers: Juvederm, Restylane, etc. In the operating room, I like to fix this with fat grafting. Fat is preferable to me for many reasons: it is using your own tissue, it is what you actually lost, I can do it all over the face which gives a natural balanced reversal, and it has stem cells which improve the quality of the skin.
Blepharoplasty. Everyone needs their excess eyelid skin removed at some point. Eventually insurance may cover it when you start to hood too much, as it impairs peripheral vision. If you are looking “tired all the time” that is a lower eyelid/cheek issue. Lower eyelid surgery is always cosmetic, but I think for a natural balanced look, addressing the unit of the eye together is important, which includes adding fat to the eye – cheek junction.
Facelift. Many refer to this as a “lower facelift” “necklift” “minifacelift.” This is to address skin laxity along the jowls, jawline, and neck. It involves a scar around the ear into the hairline. To have a longer lasting effect, you need to address the deeper tissue (“SMAS”) in addition to the skin. It should be coupled with fat grafting.

Be wary of threadlifts, coolsculpt to the face, or ulthera. Things with no downtime give temporary relief and may cause permanent issues down the road. I do not support any tech which obliterates subcutaneous fat in the face. Fat nourishes the skin. It is important to help skin quality, and the most important fat is that fat directly underneath the skin which is unfortunately affected by noninvasive “tightening” machines.

Breast changes with aging

As you age, the most common things you see in your breast is they get larger, wider, and droopy. I call this a “mature” or matronly breast. When your breast is large, droopy, and wide, it makes you look heavier. It puts more strain on your shoulders and neck. It is harder to exercise.

What are the common surgeries I do?

Breast lift. I do a lollipop short scar lift. It allows me to reshape the breast tissue. YOU DO NOT NEED AN IMPLANT. Many surgeons still do the anchor style lift. Not only is does the anchor scar have a long scar along the underwire area, it does not allow for good reshaping, so many surgeons will say you “need” to use an implant. Please do not do it.
Breast reduction. As you age, your breast becomes fattier. That coupled with common weight gain around menopause may cause your breasts to get larger. Breast reductions are one of the happiest surgeries I perform. Again, I do the lollipop short scar technique. I lift, reduce, and narrow the breast. Fat in the bra strap area is liposuctioned. Any tissue removed is analyzed for cancer. Your cancer risk is reduced as you have less breast tissue.
Implant removal. Many women had breast implants placed when they were younger. Now, entering their 50s, they may find their breasts are larger than they want, they don’t want to have to deal with future surgeries when they are older, or they may concerns they have breast implant illness. This can be done with or without a breast lift as needed.

Menopause Belly

Women gain weight during menopause and skin quality loosens. Weight gain happens because your metabolism slows, and your desire to work out wanes as your estrogen levels are lower. The pattern of where the fat goes also can change with more fat going internally, what we call “intraabdominal” or “visceral” fat. This can increase your risk of diabetes and metabolic syndrome. And your skin loosens because your skin quality deteriorates: loss of elastin & collagen, thinning, less moisture.

What to do?

For external fat, liposuction is an option. Liposuction is great for the back, arms, love handles, abdomen, and thighs. One issue as you hit your 50s is your skin tone. The more aggressively you remove the fat, the higher the risk for laxity, wrinkling, and cellulite. Liposuction is not a weight loss technique. It is to reshape and change the body’s fat pattern.
For hanging skin, muscle separation, lower back pain, urinary incontinence, and bowel issues, abdominoplasty is a good option. People erroneously think tummy tucks are cosmetic. There is a real functional benefit. Studies show (and my patients corroborate) improvement in low back pain, urinary leaking (many patients say “I can sleep through the night again without having to pee”), and bowel habits (many state they are now off fiber, stool softeners, etc and are regular without trying).
For internal fat, the only way to get to this is with weight loss. I strongly recommend intermittent fasting and the Obesity Code book. Focusing on insulin resistance is not only good for weight loss, it helps improve HbA1C.

is surgery safe?

As you get older, one question I commonly get is “Am I too old?”

There is no concrete age at which you cannot do surgery. And the adage “50 is the new 40” is real. We are active and healthier longer. But any surgery has risks, and as you get older, you need to take your risk into account.

In my practice, I always use Board Certified Anesthesia MDs for anesthesia. I operate at an accredited center. If you have any abnormalities during your workup, we will have you evaluate those prior to surgery. This is elective surgery. We need to optimize safety.

Do you have any medical problems? Diabetes, heart issues, blood pressure issues? Have you seen your general medical doctor and had a good physical? This is a good reason to do so. Get labwork. Get an EKG if over the age of 60. Get a recent mammogram. See my page on preoperative advice. As you enter the age over 65, risks may go up. There is a good index called the Frailty Index which helps stratify risk. See the link HERE. There are some 60 year olds with higher risk than an 80 year old. The frailty index looks at gender, do you live alone, have you had cancer, unintended weight loss, shortness of breath. Take the quiz via the link. I have heard people worry about anesthesia as they age, that the anesthesia may cause delirium or cognitive changes. There is no evidence of this. A recent Anesthesia study published looking at 40-80 yo patients, and they concluded “Recovery of cognitive function to baseline was rapid and did not differ between age decades of participants.”

Menopause