Banish Your Moon Face: Tips for a Slimmer Look

Do you notice that your face appears swollen or puffy after starting a new medication for a chronic health problem? Are you experiencing weight gain around your torso and have developed a new 'hump' at the back of your neck? If so, you may have a 'moon face.' This article examines what moon face is, its causes, how it can affect you, and strategies you may take to support this symptom.

What is moon face?

Moon face, also known as 'moon facies,' refers to a round, puffy appearance of the face resembling a full moon. Its characteristic appearance arises from the symmetric accumulation of fat or fluid around the sides of the face. This sometimes makes it difficult to see the ears when viewing the face from the front.

Moon face is not a disease itself but rather a potential symptom of a disease or a side effect of medications. It should not be confused with other conditions that cause facial swelling, like injury, infection, or allergies.

How moon face can affect you

Moon face itself is not dangerous. However, it may cause issues with self-esteem, potentially leading to feelings of embarrassment around others. Research showed that patients with Cushing's disease reported a lower quality of life if they had a moon face. These issues with body image may lead people with moon face to avoid social settings. Continuously, social isolation might lead to further health problems and decreased well-being.

So, while moon face does not directly pose a danger to your health, it can lead to social, mental, and emotional consequences that, in turn, can make daily life a struggle.

Causes of moon face

By identifying the causes of moon face, treatments can be targeted to the underlying condition. The following are the most common reasons why someone may develop moon face:

Steroid medications

Steroid medications such as prednisone, dexamethasone, or methylprednisolone are prescribed for a variety of health conditions. Their main function is to reduce inflammation and suppress the immune system. This makes them potentially beneficial for inflammatory and autoimmune conditions. Some common conditions treated with steroids include:

• Rheumatoid arthritis
• Lupus
• Inflammatory bowel disease
• Psoriasis
• Asthma
• Chronic obstructive pulmonary disease
• Adrenal insufficiency

Oral steroids are most likely to cause moon face, although in rare cases, topical steroids can also do so. One study showed the development of lipodystrophy (fat gain in some parts of the body, including the face) in 69% of participants after 12 months of treatment with 20 mg of oral prednisone daily.

Steroid dose also appears to make a difference. One study showed that 25% of patients taking more than 7.5 mg of oral prednisone per day developed 'cushingoid' features, which can include a moon face, compared to only 4.3% of patients taking under 5 mg per day.

Why does moon face commonly occur with prolonged steroid use? First, steroids cause redistribution of fat to certain areas of the body, including the face. Second, steroids contribute to increased appetite, leading to increased fat mass overall. Third, steroids can cause sodium and water retention in tissues of the body, including the face.

Cushing's syndrome

Cushing’s syndrome refers to a condition in which there is an excess amount of a hormone called cortisol in the body. Cortisol is a naturally occurring steroid hormone that has many roles, including helping the body respond to stress, regulate blood pressure and blood sugar, and control the sleep-wake cycle.

The most common cause of Cushing’s syndrome is excessive or prolonged use of steroid medications (corticosteroids). In Cushing’s syndrome, moon face usually accompanies other features of a 'cushingoid' appearance — this includes fat pads at the back of the neck, also known as a buffalo hump, and fat accumulation around the abdomen, among others.

Hypothyroidism

Hypothyroidism is a condition in which your thyroid gland does not produce enough of the thyroxine hormone. As thyroid hormones are involved in many physiological processes, a person with hypothyroidism may experience many different symptoms, such as weight gain, increased sensitivity to cold, and depression.

Moon face may also occur in individuals with hypothyroidism, especially when the condition is not being treated with an adequate dosage of thyroid hormone replacement medications or when medications are discontinued.

People with severe or untreated hypothyroidism might develop myxedema, a skin condition where complex sugar molecules called glycosaminoglycans collect underneath the skin, including the face, potentially leading to swelling.

Diabetes, insulin therapy, and weight gain

Type 2 diabetes is strongly associated with obesity, which may cause excess fat involving the face. Insulin therapy can also cause weight gain. This can be due to several factors, one of which is its effect on appetite stimulation. Increased hunger can lead to excess consumption of calories, contributing to weight gain.

Polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is a complex medical condition affecting females. In this disorder, the ovaries produce a high number of androgens, causing symptoms such as irregular periods, acne, and excess body hair. Hormonal imbalances, obesity, insulin resistance, and symptoms potentially leading to diabetes might be the reasons why women with PCOS sometimes have moon face, although the exact mechanisms are unclear.

Who is at risk for developing moon face?

It is relatively unclear who will develop moon face with the before-mentioned conditions and who will not.

In a study of 88 patients on prolonged prednisone therapy, the following risk factors predisposed certain patients to the development of moon face: female sex, age < 50 years, high initial body mass index, and high caloric intake. However, because this was a small study, definitive conclusions cannot be drawn.

Misdiagnosis of moon face

Several other conditions can be mistaken for moon face. These include, but are not limited to:

• Infections. Infections of the eye (conjunctivitis), sinuses (sinusitis), skin (cellulitis), or teeth can cause facial swelling. Usually, these will be accompanied by other features such as redness, pain, or fever.
• Allergic reactions. Allergies to particular foods, substances, or medications can lead to rapid swelling of the face. However, swelling typically also involves the eyes and lips, distinguishing its appearance from moon face.
• Superior vena cava syndrome. This is a rare condition in which a vein called the superior vena cava is blocked, preventing blood from exiting the head and neck. Usually, the face is discolored, and other symptoms are present, including enlarged neck veins, cough, and arm swelling.
• Polycythemia vera. This is a rare blood disorder in which too many red blood cells are present, causing the blood to thicken and flow slowly. This leads to facial flushing.

It is vital to distinguish moon face from similar-appearing conditions because treatment differs. Moon face is not dangerous, but other conditions, such as infections or allergic reactions, can be life-threatening if not treated promptly.

How to get rid of moon face?

Treatment of moon face involves resolving the underlying condition. Because moon face is only a symptom of another condition, the goal is to address whatever is causing it.

Medical treatment for moon face

Moon face associated with prolonged use of steroid medications can be addressed by slowly discontinuing the steroids or attempting a lower dosage. This should be supervised closely by your physician, and steroids should never be discontinued abruptly, as this can cause life-threatening complications. Moon face can take weeks to months to resolve after steroids are discontinued.

The treatment for hypothyroidism as a cause of moon face usually involves taking a medication called levothyroxine that acts as a synthetic version of naturally occurring thyroid hormone.

No specific medical treatment exists for the management of moon face associated with diabetes, insulin therapy, or PCOS. Typically, these are addressed using lifestyle modifications.

Lifestyle changes for moon face

Exercising regularly is an important way to limit weight gain, including in the face. Although it is not possible to spot-reduce facial fat, losing weight throughout the body will also reduce moon face. Try to aim for 150 minutes of moderate-intensity aerobic exercise and two days of resistance training per week.

Maintaining a healthy diet is another way to support the weight loss journey. Consume a diet rich in fruits, vegetables, and lean meats and limit highly processed foods, sugars, and alcohol. Curbing your salt intake to under 2,300 mg per day can also reduce moon face because salt causes your body to hang onto water, which may accumulate in the face.

Staying hydrated is another strategy for reducing moon face. When you are dehydrated, your body retains excess fluid, similar to when you consume too much salt.

Home remedies for moon face

There is no substantive research on natural remedies for reducing moon face since treatment includes targeting the underlying cause to reduce the amount of fat or fluid buildup in the face.

Some research shows that the herb ashwagandha or the vitamin A derivative retinoic acid can decrease the levels of cortisol in the body. However, it is unclear whether this is a significant factor in improving moon face in people with high cortisol levels in their bodies.

How to prevent moon face

Lifestyle strategies such as maintaining a healthy weight through diet and exercise may reduce the chance of developing moon face from steroid medications. In consultation with your doctor, using the lowest possible dose of steroids — if you must take them — decreases the likelihood that you will develop moon face. Let your doctor know as soon as possible when you begin to notice facial swelling, as they may be able to recommend alternative treatments. If you are hypothyroid, taking your thyroid medications as prescribed is also an important step in preventing moon face.

When to seek professional help

Fortunately, moon face is not a life-threatening condition. However, you should seek immediate medical attention if you experience the following symptoms, which may indicate that you have a more serious condition imitating moon face:

• Facial or arm swelling that appears suddenly, causes pain, or is severe
• Difficulty or decreased breathing
• Chest pain
• Confusion or weakness
• Signs of infection, such as fever, redness, or tenderness

Depending on the situation, your doctor may need to give you medications immediately to resolve the underlying problem, whether it is an infection, allergic reaction, a blood vessel problem such as superior vena cava syndrome, or dangerously low thyroid hormone levels.

To prepare for your appointment, take note of when your moon face began and whether it coincides with any medications you recently started. Besides a thorough medication history, your doctor may also ask you about other symptoms you are experiencing and evaluate you for the presence of health conditions that may be at the root of your moon face.

If you are concerned you may have moon face, know that you are not alone. Over half of people who take steroids long-term can develop swelling and puffiness of the face, and it can affect people who have Cushing’s syndrome, diabetes, obesity, hypothyroidism, and PCOS. You can be empowered to address your moon face by managing your weight and talking to your doctor about your concerns.