What to expect from a menopause makeover
The customizable combination of procedures often includes blepharoplasty, neck lifts and liposuction to reverse changes to the face and body that may be brought about by menopause

Menopause is just another word until you've opened the freezer to get some relief from a hot flash, stockpiled books for sleepless nights and Googled "should I buy a weight vest?" Then you know how unpredictable, uncontrollable and unrelenting menopause can be. The decrease in estrogen levels and metabolism can mean that "patients, sometimes, have no control over what is happening from head to toe and how they are aging," said Michele Shermak, MD.

When patients come into her office during menopause – usually in their 50s, sometimes 40s – "a lot of women come in feeling very meh. They're going through this change where they're just not feeling as attractive anymore; they're not feeling energetic or confident. It's all these issues related to the beginnings of hormone deficiency," said Dr. Shermak. "I like that menopause is being acknowledged more, and that people are trying to come up with ways to proactively address it – and certainly, plastic surgery is one thing that really does create a very impactful change."

There is no one "menopause makeover" blueprint, just like there is no one way that menopause affects everyone – entering menopause can feel like stepping into a "big unknown," said Dr. Shermak. Rather, menopause makeovers are customizable suites of surgeries for addressing menopause-related changes to the face and body so that a patient can "finally look in the mirror and see themselves – the person who they expect to see."

It might include a neck lift, blepharoplasty, facial fat grafting, breast lift, liposuction or tummy tuck. And while reclaiming your jawline can't necessarily lull you back to sleep at 2 a.m. (if only!), plastic surgery is often the only way to address some of the changes that menopause brings, and it can do it in a way that's "super impactful and age-reversing," said Dr. Shermak.

For patients, deciding to do something about physical changes – such as a softening of the jawline, sagging of the upper lids and difficulty keeping off weight – that they've noticed with menopause often "comes with a recognition that one stage of life is over and another is about to begin. It is usually a better stage of life for most people, because now they are established in their careers, their kids are not in diapers anymore, it's different," said Mark Mofid, MD. "There's more of a focus on you, as opposed to being the provider for your children – the focus stops being on what they need to do for other people, and it can start being on what they can do for themselves."

If you are a member of the MTV generation, we don't need to tell you that Gen Xers "know what they want, they are mature and they're not impulsive," said Dr. Shermak. After weighing their options, patients may decide to "seize the day and get it done so they can enjoy it. And every time, the changes are immediate – it's night and day, it's incredible."

Here are the procedures patients are most commonly discussing with their plastic surgeons when it comes to menopause makeovers.

Blepharoplasty and neck lifts

"We are definitely getting into the face at this stage, and eyes and neck are the two biggies," said Dr. Shermak. Upper and lower blepharoplasty can really "refresh and wake up the eyes," she explained, by addressing sagging on the upper lids and prominent fat pockets (more commonly called bags) under the eyes. "A lot of people will say that when their mother, father or aunt had surgery, it was covered under insurance – meaning that they had so much skin on their upper lids, it [was causing] a visual defect." Her patients want to "get ahead of that, because they've seen it and they don't want to make it to that point."

Blepharoplasty has a pretty short downtime: "By a week, when the sutures come out, they're fine to go back to work and cover up bruises with makeup," said Dr. Mofid.

In their 50s, many women also start to notice changes to their necks. "It's bands, excess skin – that little waddle – or lack of a crisp jawline," said Dr. Shermak. "Many of these women lose their lower facial proportion with lack of good angulation between the chin and neck." Neck lifts can restore definition and smooth the look of bands, in a discreet way that appeals to many Gen Xers. "They've seen some celebrity work which seems 'overdone' – but it's crazy how much impact we can get with a neck lift, and people won't even notice." The downtime for a neck lift is typically two weeks.

Gen Xers may be more cautious about a facelift, having grown up during a time when people were less accepting of them, but for the right patient, "it's a more comprehensive approach," said Dr. Shermak, who seeks to "educate patients in a respectful way" about the potential benefits of a facelift and whether they are a candidate.

Oftentimes, menopause makeover patients "tend to want to have the adjunctive procedures [first] – it might be facial fat grafting, it might be a blepharoplasty – and not the full facelift yet," said Dr. Mofid. "They're reserving that for five to seven years from now. They just want to tide themselves over." He often performs nano fat grafting under the eyes to smooth tear troughs and wrinkles and nano or macro fat grafting elsewhere on the face. "I do nasal labial folds, cheeks, temporal hollows, the area around the lips and the mouth, especially if they've had fillers removed. There are real skin changes that occur at this point in time. The skin tends to become a little drier and not quite as shiny or hydrated." And with fat grafting, he explained, "wrinkling tends to get a lot better and the quality of the skin is improved."

Breast lifts and augmentation (or fat grafting)

Breasts can change in different ways during menopause. Declining estrogen levels can lead to breasts becoming less dense, which can result in sagging, so "we'll talk about a breast lift. Or some ladies have had prior breast surgery when they were younger that could be zhuzhed up, because the body is so dynamic over time and they're looking to get revision work," said Dr. Shermak. Some patients, who either already have implants or are getting them for the first time, "are happy to go a little bigger. They want a little more oomph."

Others may want to ditch their implants altogether. "A lot of women get more fat in their breast area as they get older, some more than others, so they feel like they have enough volume to do without the implant," said Dr. Shermak. In those cases, she may remove the implants and use fat transfer to add half a cup size "to get a softer, fresh look."

Dr. Mofid said that more of his patients are opting to remove implants for a more natural look.

Liposuction or tummy tuck

As metabolism slows, "often there's a discussion as to what would be a better procedure for a patient – liposuction or tummy tuck," said Dr. Shermak. Liposuction may be done on "the back, the abdomen, the arms, the outer thighs, inner thighs, knees, neck – everywhere." The shoulders down to the buttocks or hips is especially common. "We'll take care of everything from the top of the bra roll and work our way down to the waist and then get into the hip area. It's the back, from top to bottom." With a tummy tuck, which removes excess fat and skin, "I tell my patients, if they can focus for two weeks on their recovery, they'll set themselves up for a really good post-recovery period and can definitely get back to things after two weeks in a girdle or [an elastic compression wrap called] a binder."

While a patient and their plastic surgeon work together to choose which procedures are right, they'll also discuss timing of the operations. Unless there are preexisting medical conditions in the picture, "I like to do multiple regions at one time," said Dr. Shermak. "I always talk to patients about being efficient with their money, with their recovery time and with feeling like they're done – so they're not getting their abdomen done and then still doing a breast lift later. It's nice to treat people comprehensively, if they safely can."

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.