.png&w=3840&q=75)
"Director, I suddenly aged." This is the most common phrase people over forty utter in the consultation room. The moment comes when someone who was praised for their youthful appearance until yesterday gasps in surprise in front of the mirror. But most of them look at the same thing: collagen. They think that their nasolabial folds have deepened because collagen has decreased and immediately think of fillers, but in fact, something else moved first: the hormone rhythm. Today, I will explain why nasolabial folds deepen when estrogen decreases, and in what order we explain things to patients in the consultation room and what we recommend.
It's not sudden aging, but crossing a certain threshold
Many people use the word "suddenly." However, in the consultation room, it's rarely sudden. From the mid-30s, ovulation gradually becomes irregular, and progesterone starts to fluctuate first. Estrogen is then affected as well. This hormonal rhythm slowly goes out of sync, and then, at a certain critical point, noticeable changes become apparent.
This was also the case for a 41-year-old patient who was known for her youthful appearance until last year but whose impression changed within a year. The changes had been progressing even before that, but she only noticed them one morning in front of the mirror.
Facial changes are often not primarily due to a decrease in collagen, but rather a result of hormonal changes occurring first.
It's easier to understand if you remember the sequence. Hormones fluctuate first, and then collagen follows. Therefore, if you only look at the skin, it's easy to miss the true starting point.
Estrogen is the spring that holds your skin up
"Why have my nasolabial folds deepened so much?" I answer this question in one sentence: Estrogen is like a spring that supports the skin from within.
When female hormones are sufficient, this spring is firm and holds the cheeks up well. However, when estrogen decreases, the spring loses its strength, and the cheeks and surrounding tissues sag downwards, making the nasolabial lines more prominent. The lines that appeared with every expression gradually become fixed. These changes are also a common pattern for those who visit the consultation room with concerns about expression wrinkles.
A study published in the UK in 2023 also discussed how skin collagen and elasticity indicators significantly change before and after the menopausal transition. Therefore, the approach of "my nasolabial folds have sunken, so I'll just fill them with fillers" might only address the symptom. Fillers fill the sunken areas, but examining the cause together involves checking hormones. This means looking at both the result and the cause.
Estrogen runs the collagen factory
Let's delve a little deeper. Estrogen can be compared to a factory that produces collagen. When estrogen is sufficient, the following processes occur:
- Collagen synthesis is promoted
- Skin thickness is maintained or increases
- Skin blood flow increases, supporting a healthy complexion
- It also helps with the ability to retain moisture
Conversely, when estrogen decreases, the operation of this factory slows down. Collagen production decreases, the skin thins, elasticity diminishes, and facial sagging occurs. Ultimately, this leads to deepening nasolabial folds. This connection is explained in more detail in Why skin and body change together after your 40s, which you may find helpful to read.
If hormone therapy is a suitable option, there are reports of skin indicators recovering during the treatment process. However, the indications for hormone therapy vary depending on an individual's medical history and test results, so the decision to start must be made through a medical consultation. If you are interested in approaches that directly address collagen itself, you can also refer to The principle of restoring skin elasticity through collagen regeneration.
If you find it difficult to assess whether the changes started in your face or with your hormones, rather than repeatedly searching on your own, we recommend having it checked. Ask if my symptoms are due to hormonal changes
It's not just your face, eight signs in your late 40s
In the consultation room, it's rare to find patients complaining only about nasolabial folds. Usually, the entire body changes together. Here are common signs that often appear in the late 40s:
| Category | Common Changes |
|---|---|
| Morning State | Wake up swollen and recovery is slow |
| Body Shape | Weight gain primarily around the abdomen and muscle loss |
| Circulation | Increased coldness and tingling sensation in hands and feet |
| Head | Brain fog, a hazy or foggy feeling |
| Sleep | Wake up in the early morning and find it difficult to fall back asleep |
| Emotions | Mood swings are greater than usual |
| Energy | Unexplained fatigue and slow recovery |
These changes are not due to a lack of willpower. They are closer to signals sent by your hormone rhythm as it transitions to the next stage. If you want to know more about similar patterns, we recommend looking at Symptoms, causes, and mechanisms of menopausal body changes.
Five routines to start at home
So, what should you start with? Here are five lifestyle routines I recommend to patients in their 40s. They are not grand, but consistency is key.
- Sleep Consider 10 PM to 2 AM as the time when hormones recharge, and prioritize falling asleep during this period.
- Sunlight Spending about 10 minutes in the morning sun helps reset the hormonal clock along with serotonin secretion.
- Strength Training I recommend strength training about three times a week. The more muscle mass you have, the easier it is to maintain estrogen levels.
- Nutrition Magnesium and Vitamin D are raw materials for hormone synthesis, so I recommend taking them with your meals.
- Stress Management Relieve stress through meditation, yoga, or your favorite activities. Accumulated stress can raise cortisol, which can affect estrogen.
Among those who consistently followed these five routines, some reported changes in their skin texture after about three months. The extent of change may vary individually.
Key Takeaways Today
To summarize, a significant portion of facial changes after forty are linked to changes in female hormones, including estrogen. If your nasolabial folds have deepened, rather than just looking at the skin, examining the underlying fluctuating hormone rhythm is a more fundamental approach. Your body is not broken; it is sending signals that it has changed and that your management methods need to adapt. If you are curious about hormonal changes themselves or are considering when to get a check-up, please check how we approach this in Menopause Hormone Consultation.
If you find it difficult to determine where your symptoms originated, please feel free to inquire. Apply for Menopause Hormone Consultation
Written by: Lee Dong-hee Representative Director · Obstetrician and Gynecologist · View Medical Staff Profile
This article is based on content from a YouTube video · First published December 10, 2025 · Last reviewed May 30, 2026
This article provides general health information and is not a substitute for individual diagnosis or treatment. If you have symptoms, please consult a doctor for advice.