This episode features Dr. Diana Ponsky, a renowned facial plastic surgeon in Cleveland, Ohio, who leads Ponsky Facial Plastic Surgery. Double board-certified in Facial Plastic Surgery and ENT, Dr. Ponsky specializes in natural facial rejuvenation. She discusses how hormonal shifts impact the face and what women can do about it.

Dr. Ponsky notes that a sharp drop in hormones around menopause can feel like an "acute switch" in aging.

• Collagen Loss: Women can lose up to 30% of their collagen within five years around menopause, followed by a 2% loss each year.
• Structural Changes: Low estrogen affects receptors throughout the skin and bone. This causes skin to become coarser, fat to descend, and even facial bones (like the jaw and areas around the nose) to atrophy, which can flatten the brow arch.

Aging gracefully is about slowing down the process, which Dr. Ponsky compares to constant maintenance on a car.

• Proactive Care: Genetic predispositions mean some women benefit from early surgical prevention (like brow lifts or fat transfer).
• Lifestyle: Rigorous skincare, sun protection, and avoiding repetitive motions (like drinking through straws) are crucial for maintenance.
• The Role of HRT: Dr. Ponsky is a firm believer in Hormone Replacement Therapy (HRT), even starting in perimenopause, to slow the loss of muscle mass and bone density (including in the face).

• Fillers: These are volumizing agents (like hyaluronic acid) that replace lost volume; they do not lift. Dr. Ponsky cautions against overuse, as too much filler can distort muscle movement.
• Never Too Late: For those who missed the prevention window, aggressive treatments like deeper lasers and fat transfer can still yield great results, combined with a commitment to nutrition and a long-term care program.

Dr. Ponsky reminds women that given we are living longer, tending to our bodies is necessary. It's not vanity; it's ensuring a high quality of life long after menopause.