DR. JOHN BURNS JR., MD · PLASTIC SURGERY
What Happens to Your Skin in the First 5 Years After Menopause?
Hormones shift. Collagen can drop by up to 30% in the first five years. The right plan can preserve, restore and protect — at every stage.
Read the GuideOr explore skin & facial rejuvenation
THE BIOLOGY · MENOPAUSE & SKIN
Why Does Menopause Affect Your Skin?
Estrogen plays an important role in skin biology. It influences collagen production, hydration, elasticity, wound healing, pigmentation, oil production, blood vessels, hair follicles, and several types of cells within the skin.
AAD
Up to 30% collagen loss in the first 5 years
Increased dryness
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Thinner skin
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Decreased collagen
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Reduced elasticity
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More visible fine lines and wrinkles
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Crepey texture
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Increased sensitivity
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Facial volume changes
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Greater laxity around the face and neck
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Menopause is officially defined as 12 consecutive months without a menstrual period — but the hormonal transition begins earlier during perimenopause.
The ideal time to start thinking about menopausal skin health may actually be before menopause.
THE TIMELINE · FIRST 5 YEARS
What Happens to Your Skin During the First 5 Years After Menopause?
There is no universal timeline. Genetics, sun exposure, smoking, weight changes, skincare, medications, overall health, and hormonal status all influence how a woman's skin changes. However, the first five years can provide a useful framework for understanding what many women experience.
YEAR 1
YOUR SKIN MAY SUDDENLY FEEL DIFFERENT
One of the earliest changes is often dryness. Women frequently describe skin that simply does not behave the way it used to. Products they have used for years may suddenly feel irritating. Makeup may settle differently. The complexion may look duller, and fine lines can become more apparent as hydration decreases.
- Dry or dehydrated skin
- Increased sensitivity
- Reduced oil production
- Dullness
- Rougher texture
- More visible fine lines
- Slower recovery after irritation
What should you do?
This is an important time to protect the skin barrier. Rather than responding to aging with increasingly aggressive exfoliation, menopausal skin often benefits from a gentler approach built around hydration, moisturization, sun protection, and carefully selected active ingredients.
YEARS 1–2
COLLAGEN LOSS BECOMES MORE VISIBLE
Collagen provides much of the skin's structural framework. As collagen decreases, the skin gradually becomes thinner and less resilient. Fine lines may deepen, and areas that previously appeared smooth can begin to look more crepey.
Changes may become particularly noticeable around the:
- Eyes
- Crow's-feet
- Upper lip
- Cheeks
- Jawline
- Neck
- Décolletage
- Hands
- Upper arms
This is why Dr. Burns emphasizes the concept of collagen banking during perimenopause and early menopause. Instead of waiting for advanced laxity and then trying to reverse it, the goal is to preserve skin quality and support collagen earlier.
YEARS 2–3
SKIN FIRMNESS AND ELASTICITY DECLINE
Collagen provides strength. Elastin helps skin recoil.
As both change with menopause and chronological aging, women may begin describing their skin as:
Looser.
Crepey.
Thinner.
Less firm.
More tired-looking.
The jawline may become less defined. The neck may appear looser. Eyelid skin can become heavier or more crepey.
But there is an important distinction: facial aging is not only a skin problem. The face ages at multiple levels, including the skin, facial fat, supporting ligaments, muscle, and bone.
That is why selecting the right treatment matters.
A laser may improve pigmentation and texture, but it cannot replace significant lost facial volume. Filler can restore volume selectively, but it cannot remove substantial loose skin. Radiofrequency can support collagen remodeling and mild laxity, but it cannot reproduce what a facelift accomplishes when deeper tissues have descended.
The treatment should match the anatomy.
YEARS 3–4
FACIAL VOLUME LOSS MAY BECOME MORE APPARENT
Another change can become increasingly noticeable during this period: the face begins to look less full.
- Hollowing of the temples
- Flatter cheeks
- More visible under-eye hollows
- Deepening nasolabial folds
- Marionette lines
- Reduced jawline definition
- A more tired or drawn appearance
These changes are not necessarily caused by menopause alone. They occur as menopause overlaps with the normal age-related changes affecting facial fat and skeletal support.
This is also why simply 'filling wrinkles' can produce disappointing — or unnatural — results.
Dr. Burns approaches facial rejuvenation three-dimensionally. The goal is to determine why the face looks older before deciding how to treat it.
For small, targeted areas, conservative hyaluronic acid filler may be appropriate. For broader facial deflation, facial fat transfer may offer another option by restoring selected areas with the patient's own fat.
YEARS 4–5
THE CUMULATIVE CHANGES BECOME MORE NOTICEABLE
By approximately five years after menopause, several processes may be occurring simultaneously: Collagen loss + reduced elasticity + dryness + volume loss + gravity + cumulative sun exposure.
- More prominent wrinkles
- Crepey eyelid skin
- Jowling
- Lower-face laxity
- Neck laxity
- Increased pigmentation
- Uneven texture
- More visible pores
- Loss of facial fullness
- Changes around the mouth
- Reduced jawline definition
This does not mean every woman suddenly looks dramatically older five years after menopause. Instead, menopause can accelerate or amplify bio…
PROACTIVE CARE · BEFORE MENOPAUSE
The Best Menopause Skin Strategy May Start Before Menopause
One of the most common questions is: 'What should I be doing before menopause to protect my skin?'
The answer is not one expensive procedure or miracle product. It is consistency.
01
Get Serious About Sunscreen
If there is one anti-aging skincare product almost everyone should use, it is sunscreen. UV exposure contributes to collagen breakdown, pigmentation, wrinkles, and skin cancer risk. When menopausal changes are already affecting collagen, protecting the skin from unnecessary UV damage becomes even more important. Use a broad-spectrum SPF 30 or higher every day and remember areas beyond the face:
- Neck
- Décolletage
- Hands
- Forearms
02
Consider a Retinoid Before You Think You Need One
Retinoids are among the most extensively studied topical ingredients for photoaging. Depending on the formulation, they may help improve:
- Fine lines
- Texture
- Pigmentation
- Skin turnover
- Collagen production
The goal is not necessarily to use the strongest product possible. As menopausal skin becomes more sensitive, aggressive retinoid use can create unnecessary irritation. A customized regimen can help balance effectiveness with tolerability.
Medical-grade skincare can be customized around skin type, pigmentation, sensitivity, lifestyle, and treatment history at Jola Aesthetics.
03
Protect Your Skin Barrier
One common mistake is trying to exfoliate your way out of aging. More is not always better. As skin becomes drier and thinner, excessive acids, scrubs, peels, and retinoids may compromise the skin barrier and increase irritation. A menopausal skincare routine may incorporate ingredients such as:
- Ceramides
- Hyaluronic acid
- Glycerin
- Squalane
- Peptides
- Carefully selected growth-factor or regenerative products
Healthy skin is the foundation upon which almost every other aesthetic treatment is built.
04
Add Antioxidant Protection
Topical antioxidants can complement daily sunscreen. Vitamin C is frequently used to support a comprehensive skincare routine because of its role in antioxidant protection, collagen formation, and pigmentation management.
But an effective skincare routine does not need 15 products. A small number of scientifically sound products used consistently is often more useful than an elaborate routine a patient cannot maintain.
Consistency is the foundation of every effective skincare routine.
TREATMENT FOCUS · COLLAGEN & SKIN QUALITY
What About Collagen-Stimulating Treatments?
This is where Dr. Burns encourages patients to change the question. Instead of asking:
"How do I get rid of this wrinkle?"
Consider asking:
"How can I maintain the quality and structure of my skin over the next 10 years?"
That shift leads naturally to treatments designed to support collagen and overall skin quality.
TREATMENT 01 · NONSURGICAL TIGHTENING
XERF Radiofrequency Skin Tightening
At Dr. Burns' practice and Jola Aesthetics, XERF radiofrequency is one nonsurgical option for patients interested in collagen stimulation and skin tightening. Radiofrequency energy heats deeper tissues without removing the surface of the skin, encouraging collagen remodeling over time. Depending on the patient, treatment may be considered for areas including the:
- Face
- Jawline
- Neck
- Abdomen
- Arms
- Thighs
Because collagen remodeling develops gradually, treatments such as XERF are often better viewed as part of a long-term maintenance strategy rather than a replacement for surgery when substantial laxity is already present.
TREATMENT 02 · LASER SKIN QUALITY
Laser Treatments for Menopausal Skin
Lasers address another component of aging: skin quality. Depending on the technology and settings selected, laser treatments may improve:
- Sun damage
- Pigmentation
- Uneven tone
- Fine lines
- Texture
- Enlarged-looking pores
- Dullness
At Jola Aesthetics, Ultra by Cynosure Lutronic provides a relatively low-downtime option for patients seeking improvements in pigmentation, tone, texture, and overall radiance. More aggressive resurfacing may be appropriate for patients with more advanced photodamage or wrinkles.
REGENERATIVE CARE · THE TREATMENT STACK
Microneedling, Volume & Neuromodulators
MODALITY 01 · MICRONEEDLING
Microneedling and Regenerative Skin Treatments
Microneedling creates controlled micro-injury designed to stimulate the skin's natural repair response. Depending on the treatment plan, it may help address:
- Fine lines
- Uneven texture
- Acne scars
- Enlarged-looking pores
- Mild pigmentation
- Overall skin quality
Microneedling can also be incorporated into a broader regenerative skincare program when appropriate.
Not every regenerative product or treatment is equivalent. Product selection should be based on credible science, safety, and the individual patient's needs — not simply what is trending on social media.
Not every regenerative product or treatment is equivalent. Product selection should be based on credible science, safety, and the individual patient's needs — not simply what is trending on social media.
MODALITY 02 · FACIAL VOLUME
Don't Forget Facial Volume
One of the most common mistakes in treating the menopausal face is focusing exclusively on skin. Sometimes what looks like 'loose skin' is partly a loss of the volume underneath it. Treatment may involve several approaches.
Hyaluronic acid fillers — Provide precise volume or structural support in selected areas.
Biostimulatory injectables — Used when gradual collagen stimulation and selected volume improvement are desired.
Facial fat transfer — Appropriate when facial aging involves more significant deflation.
Dr. Burns may use fat transfer to address areas such as the temples, brows, cheeks, lower eyelid-cheek junction, nasolabial folds, marionette region, lips, chin, and jawline.
Fat transfer can be particularly useful when the goal is to restore broader facial architecture rather than chase individual wrinkles.
MODALITY 03 · NEUROMODULATORS
Where Does Botox Fit In?
Menopause itself does not directly cause dynamic wrinkles, but the transition often occurs at an age when expression lines are becoming increasingly visible. Neuromodulators such as Botox may soften:
- Forehead lines
- Frown lines
- Crow's-feet
- Bunny lines
- Chin dimpling
- Downturned corners of the mouth
- Selected platysmal neck bands
Botox does not replace collagen, restore substantial volume, or correct pigmentation.
This is why modern facial rejuvenation frequently involves treatment stacking — using different treatments for different components of aging rather than expecting one procedure to solve everything.
This is why modern facial rejuvenation frequently involves treatment stacking — using different treatments for different components of aging rather than expecting one procedure to solve everything.
THE NEXT CHAPTER · SURGICAL REFINEMENT
When Is It Time to Consider a Facelift or Neck Lift?
Eventually, there is a point where skincare, lasers, Botox, fillers, and energy-based devices reach their limitations. Significant jowling, neck laxity, platysmal banding, excess eyelid skin, brow descent, and deeper facial tissue descent cannot reliably be corrected by simply adding more nonsurgical treatment.
Surgical options may include:
- Deep plane facelift
- Neck lift
- Upper blepharoplasty
- Lower blepharoplasty
- Brow lift
- Facial fat transfer
The goal is not to recommend surgery prematurely.
It is also not to continue spending money on nonsurgical treatments when those treatments can no longer address the underlying anatomy.
Editorial portrait — a placeholder for Dr. Burns' own before-and-after gallery image.
DR. BURNS' APPROACH · LONG-TERM STRATEGY
Dr. Burns' Menopause Skin Strategy: Think in Decades, Not Appointments
The most effective approach to menopausal skin aging is rarely a single procedure. It is a long-term strategy.
01
During Perimenopause: Protect + Preserve
Focus on daily SPF, medical-grade skincare, retinoids when appropriate, antioxidants, moisturization, healthy lifestyle habits, and early collagen-stimulating treatments when indicated.
02
Years 1–5 After Menopause: Preserve + Stimulate + Restore
Continue excellent skincare while considering treatments such as XERF, laser resurfacing, Ultra, neuromodulators, conservative fillers, and facial fat transfer based on the specific changes occurring.
03
Beyond Five Years: Maintain + Reassess
Continue maintaining skin quality, but recognize when facial anatomy has changed beyond what nonsurgical treatment can reasonably correct. At some point, repositioning descended facial tissues may create a more natural result than repeatedly adding filler or escalating energy treatments.
The treatment should match the anatomy — at every stage.
THE WELL-AGING MINDSET
Aging Well Instead of Fighting Aging
Menopause is not something that needs to be 'fixed.' And healthy, beautiful skin at 55 does not need to look identical to skin at 25.
The goal is well-aging.
Hormonal changes are real. Collagen loss is real. Facial volume and structural support change over time. Understanding those changes allows women to approach aging strategically rather than suddenly trying to correct everything at once.
THE FOUR-ACTION PRESCRIPTION
Protect your skin early. — Daily SPF, barrier care, medical-grade skincare.
Stimulate collagen appropriately. — Retinoids, regenerative treatments, energy-based devices when indicated.
Restore volume conservatively when it is lost. — Selective filler or facial fat transfer based on anatomy.
When structural aging becomes significant, choose treatments that address the actual anatomy. — Surgical refinement where nonsurgical options have reached their limit.
With thoughtful planning, the years during and after menopause can still be a time when women look healthy, vibrant, natural, and completely like themselves.
Healthy skin at every age — on your own terms.
Dr. John Burns
SCHEDULE A CONSULTATION · DALLAS, TX
Menopause Skin & Facial Rejuvenation in Dallas
At John Burns, MD, PA and Jola Aesthetics, patients have access to both surgical and nonsurgical facial rejuvenation, allowing treatment to evolve as their skin and facial anatomy change.
SURGEON
John L. Burns Jr., MD, FACS
BOARD CERTIFICATION
Board-Certified Plastic Surgeon
SPECIALTY
Facial Rejuvenation & Aesthetic Surgery Specialist
LOCATION
Dallas, Texas
EXPERIENCE
25+ Years of Experience
Patients interested in developing a personalized plan for perimenopausal or postmenopausal skin can schedule a consultation with Dr. Burns and the Jola Aesthetics team.
Schedule a ConsultationVisit Dr. John Burns Plastic Surgery to learn more.
This article is intended for educational purposes and does not substitute for individualized medical advice. Patients considering menopausal hormone therapy should discuss its potential risks and benefits with an appropriate physician.