Perimenopause brings more than just hot flashes—it can quietly change the structure of your skin from the inside out. That transition into menopause “lasts for about 10 years and can be quite debilitating, especially early on when estrogen levels are dropping,” says Duxbury, MA plastic surgeon Christine Hamori, MD. The good news: there are meaningful ways to ease those changes.
“Thoughtfully timed interventions during perimenopause are not about looking younger, but about maintaining structural support and helping patients continue to look like themselves as their skin adapts to a natural biologic transition,” adds New York plastic surgeon B. Aviva Preminger, MD.
“Perimenopause brings hormonal fluctuations—especially declining estrogen—that directly affect the skin’s structure,” Dr. Preminger continues. “Collagen production drops, skin thins and dries, elasticity decreases and facial fat and bone support subtly shift. These changes are biological and structural, which is why over-the-counter skin care is often insufficient.”
However, the approach to treatment is not one-size-fits-all. Fresno, CA dermatologist Kathleen Behr, MD, notes that it’s important to individualize treatments based on each patient’s needs and concerns. Ahead, here’s a look at some of the options your provider might recommend.
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Skin-Tightening Treatments
With age, skin tends to become more lax, and perimenopause is an ideal time to address it with in-office treatments. “Lasers, energy-based devices, peels and biostimulatory injectables help stimulate collagen, improve skin thickness and hydration and preserve skin quality during this transitional phase,” says Dr. Preminger.
New York facial plastic surgeon Lee Ann Klausner, MD and Dr. Behr both recommend Ultherapy PRIME, a type of skin-tightening treatment that uses ultrasound energy to boost collagen and tighten skin without surgery. Dr. Behr also recommends Fraxel, Morpheus or UltraClear—energy-based resurfacing treatments that trigger collagen renewal—to help improve skin texture and fade pigment irregularities.
In addition to facial laxity, similar changes can occur below the belt. Vaginal dryness and painful intercourse can begin as early as age 35, says Dr. Hamori. But there are skin-tightening options for this area, too. “Radiofrequency intravaginal treatments such as Morpheus8V or Votiva are helpful for dryness and genitourinary syndrome of menopause.”
Hormone Therapy
“Treatment during perimenopause often starts with hormone balance. Symptoms such as hot flashes, brain fog and sleep disturbances can be quite distressing,” says Dr. Hamori. “We treat perimenopausal patients based on their symptoms. This can include oral progesterone for sleep and transdermal estrogen—delivered via patch or cream—for hot flashes.”
When it comes to sexual symptoms, she adds, “The most effective and safe treatment is intravaginal estrogen or DHEA.”
Dr. Behr often combines bioidentical hormone pellet therapy with skin treatments. “This can be started in perimenopause, often with testosterone therapy alone. By optimizing hormones, we get better results from our minimally invasive skin treatments to help stimulate fibroblasts that are slowing down with age,” says Dr. Behr, who notes the therapy also helps increase collagen production.
Surgical Interventions
“When hormonal changes lead to true laxity or volume descent, surgical interventions can be particularly beneficial. Procedures such as a facelift, necklift and fat transfer restore underlying anatomy rather than masking aging, often producing more natural and longer-lasting results when done earlier rather than later,” says Dr. Preminger.
Dr. Klausner and Dr. Preminger also note that eyelid surgery is especially popular among perimenopausal women. “When eyelids become droopy, blepharoplasty is the most effective way to remove excess skin from the upper lids,” explains Dr. Klausner. She adds that many patients also consider submental liposuction and mini-lifts to refine the jawline.
TED Treatments
Hair loss and shedding are common during perimenopause. Dr. Klausner recommends noninvasive TED (TransEpidermal Delivery) treatments for anyone struggling with thinning hair. The technology uses low-level electrical currents to push peptides and growth factors deeper into the scalp, thereby increasing their effectiveness in reaching hair follicles. It’s a “painless way to drive peptides and growth factors into the hair follicles of the scalp to reduce shedding and increase hair growth,” she explains.
