Q&A: Bianca Viscomi, MD, Addresses the Dermatological Impact of Menopause at IMCAS

Menopause is increasingly recognized as a major health transition, yet its profound effects on skin quality remain under-discussed in both public discourse and clinical care. At Merz Aesthetics’ recent IMCAS symposium, “Ahead of the Curve,” Bianca Viscomi, MD, board-certified dermatologist at Bianca Viscomi Clínica Dermatológica in São Paulo, Brazil, and a Merz Aesthetics Global Speaker, spotlighted menopause as a pivotal, hormone-driven inflection point for skin biology. In this Q&A with Dermatology Times, Viscomi examines why menopausal skin changes are often overlooked, how rapid collagen loss and structural decline affect patients’ psychological well-being, and which evidence-based, multimodal strategies can help clinicians better address skin quality during this life stage.

Dermatology Times: From your clinical experience, why do you think only 25% of women speak to a dermatologist about their menopausal skin symptoms?

Viscomi: In clinical practice, most women do not initially interpret skin changes as menopause-related, but rather as normal aging, stress, or reduced skin care efficacy. This perception reflects limited public education about the skin as a hormone-responsive organ and the fact that menopause care pathways prioritize vasomotor and genitourinary symptoms. Cutaneous changes are frequently framed as cosmetic rather than health-related, making them a lower priority in time-limited consultations. This aligns with published data showing substantial knowledge gaps and under-recognition of menopause-related skin impacts.

Dermatology Times: How do these visible changes translate to psychological impacts for your patients? What patterns are you and your colleagues seeing in the clinic?

Viscomi: The most consistent pattern is a disconnect between internal well-being and the sudden changes women see in the mirror. Accelerated dryness, crepiness, texture changes, and laxity are often perceived as abrupt and disproportionate, disrupting identity and self-confidence. Many patients report frustration and a sense that previously effective routines “no longer work,” particularly during peri- and early postmenopause, when sleep disturbance and mood changes reduce emotional resilience. Social withdrawal, avoidance of photographs or intimacy, and heightened sensitivity to external comments are also frequently observed, reflecting the psychosocial burden described in the literature.

Dermatology Times: When a patient has already lost their initial one-third of collagen, what are the most effective clinical interventions currently available to help restore that elasticity?

Viscomi: I begin by aligning expectations: while we can meaningfully improve skin biomechanics, hydration, and dermal density, we are not reversing tissue to a premenopausal state. Optimal outcomes rely on a multimodal strategy combining systemic optimization, regenerative procedures, and long-term home care. Regenerative injectables such as calcium hydroxyapatite stimulate neocollagenesis and structural support, while intradermal hyaluronic acid improves hydration and elasticity without volumization. For firmness, microfocused ultrasound with visualization enables precise collagen remodeling at deeper tissue planes, delivering predictable and durable improvements.

Dermatology Times: How can clinicians stay ahead of the curve and bridge the gap between treating menopause as a hormonal event and treating it as a dermatological one?

Viscomi: Clinicians must move beyond viewing menopause solely as a hormonal event and address it as a systemic transition with direct dermatologic consequences. Routine screening for menopausal context in midlife consultations is essential, as skin response is closely linked to systemic changes. Explicitly explaining the biological effects of hypoestrogenism on collagen, extracellular matrix, hydration, and barrier function improves patient understanding and adherence. Collaborative care with gynecologists ensures cohesive management. Adopting a structured “menopausal skin visit” and intervening earlier, particularly during perimenopause, allows preservation of skin quality rather than delayed restoration.

Dermatology Times: What key themes did you emphasize during the IMCAS Symposium?

Viscomi: Two points consistently resonated at IMCAS. First, menopausal skin should be framed as a skin quality condition rather than a wrinkle-based problem, with outcomes assessed through parameters such as hydration, elasticity, dermal thickness, and functional integrity. Second, there is a critical need for higher-quality clinical studies that stratify patients by menopausal status and hormone therapy use. Estrogen deficiency and HRT exposure likely influence collagen-dependent outcomes and tissue remodeling.