Round Table Discussion: Aesthetic Treatment Considerations for the Perimenopausal & Menopausal Patient

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BACKGROUND: Menopause is a normal feature of the female aging process that commonly occurs during the 6th decade of life. During perimenopause, many negative effects begin to occur affecting the skin that are associated with decreasing production of estrogen, progesterone, and testosterone. Estrogen supports the extracellular matrix, collagen production, and dermal blood supply, while progesterone promotes extracellular matrix formation, dermal blood supply, and dermal water retention. Decreased testosterone impacts cutaneous blood supply and sebum production, causing skin dryness. AIMS: The primary objective of the following consensus roundtable was to discuss best practices for aesthetic providers when treating patients with perimenopausal and menopause-related skin conditions. PATIENTS/METHODS: A roundtable discussion was held by several notable experts in their field during a special edition of the Thriving in Diversity webinar series on Friday, June 13, 2025. The discussion included a gynecologist, a plastic surgeon, and two dermatologists who provided their clinical experience and consensus recommendations for treating perimenopausal and menopausal patients. RESULTS: Numerous therapies are available to treat patients with perimenopausal and menopause-related skin conditions. These include hormone replacement therapy (HRT), topical estrogen therapy, topical retinoids, topical cosmeceuticals (moisturizers, signal peptides, growth factors, exosomes), dermal injectables and biostimulators, and energy-based treatments, each with varying beneficial effects. The experts in this panel find that hormone replacement therapy, topical estrogen, injectable poly-L-lactic acid, injectable hyaluronic acid, and carbon dioxide laser resurfacing are the most effective interventions for treating hormone-related skin changes. CONCLUSIONS: Although menopause ultimately affects all women and is likely to produce unwanted effects including undesirable aesthetic changes, numerous treatments are available to treat or mitigate these effects.

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