What a Doctor Prefers Over Botox: Root Cause Skincare for Perimenopause and Beyond
Written and edited by Sarah Bonza MD, MPH, MSCP, FAAFP, DipABLM, NBC-HWC
Topical estrogen and niacinamide can help support your natural beauty.
As a physician dedicated to helping women thrive through perimenopause and menopause, I’m often asked about the best ways to maintain youthful, vibrant skin—especially when wrinkles, fine lines, and dark circles start to appear. Many of my patients are curious about Botox, but I prefer to take a different approach: one that addresses the root causes of skin aging rather than simply paralyzing facial muscles.
Here’s what I tell my patients, and what I personally recommend for radiant, resilient skin in perimenopause and beyond.
Why Perimenopausal Skin Changes
During perimenopause, declining estrogen levels lead to a cascade of changes in the skin: reduced collagen production, diminished elasticity, increased dryness, and a thinner, more fragile skin barrier. This is why wrinkles, fine lines, and dark circles become more prominent. Instead of masking these signs, I focus on restoring the skin’s natural vitality by supporting its structure and function from within.
Niacinamide (vitamin B3) is one of my favorite ingredients for perimenopausal skin.
My Top Root Cause Skincare Strategies
1. Niacinamide: The Multitasking Powerhouse
Niacinamide (vitamin B3) is one of my favorite ingredients for perimenopausal skin. It’s gentle, well-tolerated, and does it all: strengthens the skin barrier, boosts collagen and elastin production, brightens dull complexions, improves texture, soothes inflammation, and even helps with hormonal breakouts and hyperpigmentation.[1] Unlike vitamin C, it rarely causes irritation, making it ideal for sensitive, changing skin.
2. Topical Estrogen: Replenishing What’s Lost
For women experiencing significant skin thinning, dryness, and loss of elasticity, topical estrogen (such as estradiol or estriol creams, available by prescription) can be transformative. Clinical studies show that after six months of use, women saw marked improvements in skin firmness, hydration, and a reduction in wrinkle depth, sometimes up to 100% improvement.[2,3]
Topical estrogen directly addresses the hormone deficiency at the root of perimenopausal skin aging, boosting collagen and restoring a youthful glow without systemic hormonal side effects.
3. Microinfusion of Collagen, Growth Factors, and Hyaluronic Acid
Rather than Botox, I recommend microinfusion (also called microneedling or microchanneling) with serums containing collagen, growth factors, and hyaluronic acid. This technique uses ultra-fine needles to create microchannels in the skin, dramatically increasing absorption of active ingredients and stimulating the body’s own collagen and elastin production.[4] Growth factors accelerate skin repair and regeneration, while hyaluronic acid deeply hydrates and plumps the skin.
Botox does not address the underlying causes of skin aging. I prefer to focus on restoring the skin’s natural vitality by supporting its structure and function from within.
Why Not Botox?
While Botox can smooth wrinkles by weakening facial muscles, it doesn’t address the underlying causes of skin aging. I prefer to support healthy muscle tone and skin structure, preserving natural expression and vitality.
My Top 5 Home-Based Microinfusion Kits
For women who want professional-grade results without the cost or downtime of in-office treatments, these at-home microinfusion kits are safe, effective, and easy to use.
This is not a promotional post. These are the devices I recommend to my patients based on safety, efficacy, and user reviews.
These 5 at-home microinfusion kits are safe, effective, and easy to use.
What to Look For:
Single-use or easily sanitized needle heads (to reduce infection risk)
Serums with proven actives: hyaluronic acid, peptides, growth factors, niacinamide
Needle length of 0.2–0.5mm for safety and efficacy at home
The Bottom Line
If you’re navigating perimenopause and want to maintain a youthful appearance, focus on root cause solutions: replenish lost nutrients and hormones, stimulate your skin’s own repair mechanisms, and choose treatments that support, not suppress, your natural beauty. Niacinamide, topical estrogen (when appropriate), and microinfusion with collagen, growth factors, and hyaluronic acid are my top recommendations for radiant, resilient skin.
Remember: This is not a promotional blog. These are the real strategies and products I use and recommend to my own patients, based on science and personal preference. If you’re interested in exploring these options, consult with a healthcare provider who understands the unique needs of perimenopausal women.
Your skin deserves care that goes beyond quick fixes. Let’s nurture it from the inside out.
References
[1] D. L. Bissett, J. E. Oblong, and C. A. Berge, “Niacinamide: A B Vitamin that Improves Aging Facial Skin.” Jun. 2025. Accessed: Jun. 29, 2025. https://journals.lww.com/dermatologicsurgery/citation/2005/07001/niacinamide__a_b_vitamin_that_improves_aging.12.aspx
[2] M. J. Thornton, “Estrogens and aging skin,” Dermato-Endocrinology, vol. 5, no. 2. Taylor & Francis, p. 264, Apr. 01, 2013. https://doi.org/10.4161/derm.23872
[3] A. K. Rzepecki, J. E. Murase, R. Juran, S. G. Fabi, and B. N. McLellan, “Estrogen-deficient skin: The role of topical therapy,” International Journal of Women’s Dermatology, vol. 5, no. 2. Lippincott Williams & Wilkins, p. 85, Mar. 15, 2019. https://doi.org/10.1016/j.ijwd.2019.01.001
[4] E. B. Houshmand, “Introduction to Microneedling.” p. 1, Mar. 19, 2021. https://doi.org/10.1002/9781119431817.ch1