Sleeping poorly, living under pressure, or going through a prolonged period of stress not only can affect our mood: the skin can also reflect it. Alterations of the skin barrier, inflammation, dehydration, loss of radiance or a reduced recovery capacity are some of the manifestations that can appear when the body remains too long in a state of alert.
But if stress can modify the skin’s condition, can it also influence how it responds to an aesthetic treatment? The question is not to claim that cortisol can “nullify” the effect of a procedure, but to understand that the overall state of the body and, especially, the skin can influence recovery and the tissue’s response. Because after all, how we feel greatly influences how cosmetic medicine acts on us.
Stress on the Skin
Stress affects our skin more than we imagine, as well as the barrier function. If this persists, it can be very harmful, as explained by Dr. Ana Revuelta, aesthetic doctor, nutritionist, and pharmacist and medical director of Renare Farma Clinic. “Chronic stress can alter barrier function, increase water loss and promote a more dehydrated, dull, and reactive skin. It also stimulates inflammatory processes, so it can aggravate conditions such as acne, rosacea, atopic dermatitis, or psoriasis.” This also causes that “the skin can recover worse from minor injuries or procedures.”
This idea is also shared by Dr. Carlos Gómez, aesthetic physician and founder of Clínicas Carlos Gómez, who brings his experience from the consulting room. “We see it daily in consultations. When a person goes through a prolonged period of stress, the skin tends to lose luminosity, becomes more sensitive and may present outbreaks or inflammation. The skin speaks a lot about how we are inside.” For Dr. Marjorie Garcerant Tafur of Bexclinic, the impact goes even beyond what we can observe at first sight. “Chronic stress leaves a measurable biological footprint. It increases low-grade inflammation, alters barrier function, favors collagen loss and modifies cutaneous microcirculation.” The professional notes that it can be diagnosed through skin ultrasounds that “allow us to objectify those changes and tailor the treatment. Today, precision aesthetic medicine should not be limited to correcting the visible but must understand what is happening in the tissue beyond what we see on the surface.”
Cortisol, the Buzzword
If there is a term we cannot stop seeing on social networks and articles, it is cortisol. Closely linked to stress, it is a hormone essential for responding to stressful situations, but the problem arises when that activation lasts over time. “Cortisol is necessary to respond to stress, but when it remains elevated for a long time it can interfere with the activity of fibroblasts, with collagen synthesis and repair mechanisms,” considers Dr. Revuelta. The professional adds that “it can also increase oxidative stress and weaken the skin barrier. It is not the only cause of aging, but it is another factor within the exposome, together with sun, pollution, tobacco, diet, or lack of sleep.”
For Dr. Carlos Gómez it is “a hormone necessary, but when it remains elevated for a long time it can accelerate certain processes related to aging. The skin loses quality, firmness, and regenerative capacity. That is why I always say that taking care of yourself goes far beyond a cream or a treatment.” For her part, Dr. Marjorie Garcerant Tafur notes that “cortisol is essential for adapting to stress, but when it remains elevated it favors collagen catabolism, alters tissue repair and contributes to the inflammaging phenomenon.” This skin inflammation and the scientific evidence highlight the professional, “showing that aging does not depend solely on the passage of time, but also on the biological environment in which the skin lives and maintaining a permanent state of alarm with elevated cortisol is pro-aging in all tissues.”
Aesthetic Medicine and Stress
That our skin is stressed does not mean that an aesthetic treatment will not work, but it can change its effectiveness. Dr. Garcerant believes that a prior diagnosis is a key reference and states that the tissue response depends on the patient’s biological state. A skin with persistent inflammation, vascular alteration, or compromised barrier function may respond less predictably. The professional believes that “when we know the tissue, we can choose the technology and the most appropriate strategy, using treatments that yield good results one after another instead of accumulating missteps.”
If we focus on treatments, Dr. Gómez considers that “treatments work best when the body is in balance. When there is a high level of stress, the skin’s repair capacity can be affected and results may take longer to become apparent.” This is in line with Dr. Revuelta who adds that elevated cortisol “can indirectly influence the outcome”: an inflamed, dehydrated skin or one with reduced repair capacity may recover worse from lasers, peels, microneedling radiofrequency, or surgical procedures. This stress, furthermore, “worsens sleep, promotes bruxism and alters some habits, aspects that can condition both the outcome and the patient’s perception of it,” explains Dr. Ana Revuelta.
And the thing is that with aesthetic medicine we are not going to reduce the stress of our skin. “There is no aesthetic treatment that lowers cortisol.” The first step is to recover the skin barrier and control any active inflammation, emphasizes Dr. Revuelta. The professional recommends, subsequently, “addressing hydration, radiance, spots, redness or collagen loss through personalized protocols: hydrating treatments, intense pulsed light, non-ablative lasers, radiofrequency, ultrasounds, or bio-stimulation.”
“I tend to opt for treatments that restore hydration, luminosity and quality to the skin, in addition to stimulating collagen production. But as important as the treatment is understanding what that patient is experiencing and accompanying them in an integral way,” says Dr. Gómez. This is echoed by Dr. Marjorie Garcerant Tafur. The professional mentions that “there is no universal treatment. The key is to combine an objective diagnosis with procedures that stimulate regeneration while respecting the tissue’s biology. Energy-based technologies, personalized cosmetics and protocols adapted to the skin’s state allow restoring homeostasis without transforming the face.”
Care Beyond the Consultation
Trying to avoid stress is key, but it is not always in our hands. Therefore, professionals recommend guidelines to follow in our daily routine. Dr. Ana Revuelta recommends “sleep properly, exercise regularly, use daily sun protection, avoid tobacco, moderate alcohol and maintain a balanced diet. It is also important to learn to manage stress through breathing, meditation, therapy, or any activity that is sustainable for that person.” Dr. Gómez adds to these points “finding moments to disconnect. Rested skin tends to respond much better to any treatment.”
On the other hand, Dr. Marjorie Garcerant Tafur considers that “the treatment begins outside the clinic. Good sleep, strength training, nutrition rich in proteins and antioxidants, photoprotection, stress control and cosmetic adherence multiply the results.” The professional concludes that “skin longevity is the sum of technology, science and habits.”
