The Art of Aging Well: Menopause & Regenerative Aesthetics

How hormonal changes affect the skin, fat, and structural support of the face and why regenerative aesthetics may offer a more thoughtful approach to aging.

Did you know that the decade between approximately 44-54 years old can be one of the most accelerated periods of visible aging for women? Not coincidentally, this is also the period in which many women will enter perimenopause or menopause.

This information is not meant to scare you!

My name is Nicole Talacha, and I am an aesthetic and facial plastic surgery nurse who helps women navigate this period of change. From an aesthetics perspective, the menopausal transition can accelerate several changes that my patients often describe to me as “I feel like I aged overnight”, or “I just don’t feel like myself.” It helps when I explain that there is actually a biological reason for this.

One of the biggest components of this change is declining estradiol. Estrogen receptors are present throughout the skin and supporting tissues including fibroblasts, keratinocytes, sebaceous glands, hair follicles, blood vessels, adipose tissue, and bone. Therefore, as estrogen declines, fibroblast activity changes and our production and maintenance of collagen, elastin, and intrinsic hyaluronic acid are affected.

The result? Skin becomes thinner, drier, and less resilient. We notice more laxity, fine lines that remain even when the face is at rest, changes in texture, and general loss of that plump, hydrated quality we associate with youthful skin. The change can happen surprisingly quickly. Research suggests that women may lose nearly 30% of their dermal collagen during the first five years following menopause. During this stage of life, age-related changes in both the superficial and deep facial fat compartments also become increasingly apparent, contributing to the heaviness, laxity, and ‘sagging’ that many of my patients begin to notice.

This leads me to one of the most important concepts I discuss with my patients: aging does not occur only at the level of the skin. The face is an interconnected structure made up of skin, fat, muscle, ligaments, and bone. All these structures change as we age, and hormonal changes during the menopausal transition can influence several of them. This is why simply “filling a line” does not always create a beautiful or natural result. We must understand why that line appeared in the first place. This understanding has fundamentally changed my approach to aesthetics.

Enter Regenerative Medicine.

To practice regenerative medicine is to understand the aging process. Regenerative medicine in aesthetics is not meant to change your face. It is aimed at supporting and restoring youthful structure and function by working with the biological systems already present within your body. When I am with patients, I ask myself: How can I improve the quality of this tissue? What can I do to improve the extracellular environment for cells to thrive in? Where have we lost structural support?

Depending on the patient, this may mean incorporating treatments to stimulate collagen and elastin, improve skin hydration and quality, or address age-related changes in volume and structural support. Radiesse, Sculptra, PDGF-BB, PDRN, and Renuva are some of the products used within this approach, each working through a different mechanism to address specific components of the aging process. There is no single treatment that can address every component of facial aging. By thoughtfully combining multiple modalities, we can target the different tissues and processes involved and create a more comprehensive approach to rejuvenation.

Neuromodulators and dermal fillers still absolutely play an important role in the overall treatment plan. I use them frequently, but I do not believe they should be the entire conversation surrounding facial rejuvenation. Instead, I view them as part of a larger, individualized approach. When used alongside regenerative and biostimulatory treatments when appropriate, we can create results that are natural, balanced, and designed around the individual patient.

There’s a Polish proverb, Każdy wiek ma swoje prawa.

It directly translates to “every age has its own rights.” I find this saying incredibly beautiful because each stage in life comes with its own experiences, expectations, freedoms, and challenges. The menopausal transition is no different. It should be celebrated. It should be a period of metamorphosis, but it should never leave a woman feeling disconnected from herself.

In my role as an aesthetic provider, I believe every age has its own beauty. It is a privilege to be trusted by my patients to help them navigate these changes while always keeping their best interests in mind. My goal is to preserve, restore, and enhance what makes each woman uniquely herself.

References

Aguilera, S. B., Branch, S., & Soro, L. (2016). Optimizing injections of poly-L-lactic acid: The 6-step technique. Journal of Drugs in Dermatology, 15(12), 1550–1556.

Franco, J., Aguilera, S. B., Le, J. H. T. D., Brasater, D., Nicodeme, E., & Meckfessel, M. H. (2026). Poly-L-lactic acid as a regenerative treatment for the glucagon-like peptide-1 receptor agonist user population. Dermatologic Surgery, 52(6S), S10–S15. https://doi.org/10.1097/DSS.0000000000005171

Lephart, E. D., & Naftolin, F. (2021). Menopause and the skin: Old favorites and new innovations in cosmeceuticals for estrogen-deficient skin. Dermatology and Therapy, 11(1), 53–69. https://doi.org/10.1007/s13555-020-00468-7

Lephart, E. D. (2022). Factors influencing skin aging and the important role of estrogens and selective estrogen receptor modulators (SERMs). Clinical, Cosmetic and Investigational Dermatology, 15, 1695–1709.

Wilkinson, H. N., & Hardman, M. J. (2021). A role for estrogen in skin ageing and dermal biomechanics. Mechanisms of Ageing and Development, 197, 111513. https://doi.org/10.1016/j.mad.2021.111513