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In my work as a cosmetic physician (and even in my work as a skincancer doctor) I regularly have the discussion with patients who are beginning to see signs of ageing they dislike as early as their 20s, about options.
I have come to realise that for women at least, as the vast majority who have these discussions, are women (thank you patriarchy!),there are definite lines drawn by some when it comes to anti-ageing options.
There is the “skincare only” cohort, who cite a variety of reasons for being anti-injectables and other enhancements and it is these I want to focus on today, because it is an entirely valid choice, as long as women understand what they are actually saying when they say they are "not afraid of ageing” and “want to age gracefully” and “role model to my daughters that you don’t need to be afraid to age” and similar concepts.
So what DO I say to women I meet and consult with, who are hesitant about, or afraid of, considering in-clinic treatments, especially injectables such as anti-wrinkle treatments and fillers as we begin our therapeutic relationship?
1. Most skincare is surface deep.
Our skin is the largest organ we have, whose sole function, is to keep “us” separate from the world.
Formulations and skincare designed to be used topically, are typically very hard to formulate as most ingredients do not penetrate this barrier very well, unless it is damaged, and even when well formulated (eg hormone patches and gels, nicotine replacement patches), only a percentage of the active ingredient has the ability to penetrate.
So as much as the hype may say so, there is a limit on how much change most skincare can effect, over time, with some exceptions- Vit A derivatives are a great example of this.
As a guiding principle, over-the-counter formulations, which are not regulated as they are classed as cosmeceuticals, may vary widely in their formulations and strength as well as efficacy of their ingredients.
Prescription topical products on the other hand, are classified as medicines and heavily regulated – these are usually formulated not for feel and elegance and fragrance, but for efficacy, so these miss the lush/ pampering element, but usually do the job much better for skin problems than OTC stuff, provided they are formulated well and packaged to last, since many of them are also sensitive to air and light.
Apart from that, in-clinic treatments ie skin therapies such as chemical peels and medical grade skin needling are other examples of ways to improve surface skin texture, even out skin tone, improve fine lines and wrinkles and boost collagen production, with ongoing repeat sessions.
Discontinued, skin will gradually return to its normal state pre treatments so maintenance is an important part of treatment plans with all skincare and skin therapies.
2. There is no skincare that will replace injectables
There is a lot of fear among women I see about injectables, often with the explainers such as “I don’t want to look like so many women out there” “I don’t want people to know I’ve had WORK done” and “I’d be horrified if I got duck lips”
Others are adamant that it is not in line with their ethos on ageing well, which is fair and reasonable if that is their stance. What I usually say to these women, who also usually want to look “younger” and “fresher/ less tired” and “have less wrinkles” is that there is no skincare or skin therapy that will replace injectables. Why? Ageing is a genetically programmed process that is individual to each person, influenced by their genetics including ethnicity and overall health and many of the changes we see over time are ONLY amenable to in-clinic interventions or, left too late, surgery.
I was recently asked if face yoga will erase the wrinkles – short answer? Nope.
I understand the fear around looking fake, looking stupid and as one woman said, looking like “mutton dressed as lamb” as well as being judged.
At the same time, I like to offer my opinion:
- We only notice the BAD injectables jobs walking in our midst. The ones who have had it done well, are imperceptible.
I had a woman in her 40s recently, who saw me for her first injectables treatment, and was very worried about looking fake/ done as she has teenage girls “and they will notice if I look odd!”. When she returned for her review appointment and was ready for more, she advised me that her teenagers HAD noticed she looked better, fresher, but could not put their fingers on the WHY. Done well, this is exactly the goal of injectables, or as one of my patients said to me early on in our therapeutic relationship, “I want to spend a lot of money to look like I wake up like this everyday”
- Injectables (anti wrinkle injections as well as dermal fillers) once we begin to notice the things in our faces that we dislike, take time. It is unlikely to be a “one and done” treatment and like any worthy goal, usually involves many elements of treatment and modalities, of which injectables form just one, and usually the most costly aspect initially. Maintenance is usually more manageable. With my patients I often begin with injectables if they need it, as it will give the most immediate results, and in the background, we keep working on the longterm goal – which may involve more injectables, skin therapies, at home skincare and more. In saying all that, if someone is adamant they do not wish to have injectables, then that is completely ok too, as long as they understand the limitations of skincare only.
3. Most skincare involves lifelong changes and commitment
Just as we would not expect to be able to run 5km the first week we begin an exercise program, so it is with skin.
Years of neglect cannot be magically undone by a single session (or 3) in clinic or by using skincare, no matter how good, for a month. Skin takes time and “good skin does not happen by chance, it happens by appointment.”, usually at the intervals recommended for best results.
I believe in this so much, that now, if someone cannot commit to their suggested treatment plan, I tend to advise I am not suitable for them because failure to follow through is a waste of (our) time and (their) money and will not get them the results they say they want.
So what basics can you begin with even on a budget?
- wear SPF 30+ daily;
-eat mostly healthy;
-watch alcohol intake;
- get enough sleep most nights;
- get a personalised skincare suited to your age, skin type and skin concerns if any and that may include some initial in-clinic sessions to jumpstart the process, followed by maintenance treatments less often but it is about small changes that will lead to big results over time.
4. Skincare will not mask signs of ageing
These signs can become increasingly distressing as early as our 30s and if left too late, well into our 50s, it may almost certainly be too late to do much non-surgically.
This is THE biggest message I want to send to people who don’t want to consider injectables but are bothered by the signs of ageing on their faces.
- Skincare alone will not get rid of wrinkles especially deeply etched lines. You need anti wrinkle injections for those.
- Skincare alone will not replace hollows and dark circles under the eyes no matter what anyone tells you. You need assessment if you are a candidate for filler, but it is a tricky area to treat with age.
- Skincare alone will not mask other signs of ageing that are frequently distressing :
-deeply etched lines;
-hollows and dark circles under eyes;
-sagging around the lower face ie jowls and double chins;
- ageing around the mouth including disappearing lips
-sundamaged and aged décolleté
Many of these CAN be rejuvenated so they are more in line with how you see yourself. Equally, they can be improved so you look fresh, rejuvenated, and like you’ve just had a holiday without looking “overdone”, and together with effective, personalised skincare, is one of several methods to get to this point, over time and with budgeting.
All that said, if it is not what a patient wants, then we can absolutely focus on skincare only, and personalise that as long as its limitations are understood.
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