So you are now in your 40s. It is a great time to be alive, especially if you are a woman.

Your career may be on track, or you may be gaining momentum there. Your kids may be of school age, and life might be feeling a bit easier now. You may feel like the frantic rushing of the earlier decades may be settling, and you are ready to focus on you again after feeling second best (or last!) for the best part of many years. Many women find their 40s to also be the decade they start caring less about the unsolicited opinions of others and start being more vocal about what they will and will not accept in their lives and from others. What's not to love?

The good news is, if you've maintained some of the skincare basics in the earlier decades, you may hit your 40s in good stride, with not as much to do as someone who has kept putting it off.

What is irrefutable?

1. volume loss in the face due to ageing - none of us can avoid this
2. progressive collagen loss in skin, leading to deeper wrinkles and lines and loss of that plump, glowing texture young people have
3. pigmentation due to cumulative sun damage, pregnancy and more!
4. early sagging of skin which pools around the lower face - showing up as jowls, a double chin and neck folds
5. drooping upper eyelids and sometimes, onset of eyebags that are not amenable to dermal fillers due to the presence of fluid within them aka malar bags or festoons which need different treatment modalities.
6. in our mid 40s onwards, as oestrogen levels begin to decline, many women experience thinner skin, hair loss and more brittle nails. Even if they've been careful with sun protection of the face, neglect to the hands, neck and decollete may begin to show up here.

So here are some suggested options that may help. 

As may be apparent by the non-exhaustive list above, a personalised holistic full face approach to rejuvenation is needed here, not just some ad hoc anti wrinkle treatment here and there when time and budget allows for best results.

This is often the decade where sitting down with a doctor who does this day in and day out and takes a holistic, multi-modal approach and will guide you as to your options, timeframe and budget, so you can decide if you will commit, or age as nature intended, is key.

So what are some common procedures I recommend to my patients in their 40s, who've not had much, if anything, to date, and have another 20+ years of ageing as well as a career ahead of them, with young blood appearing daily?

1. Dermal fillers 

By the time we hit our 40s, if we have not had any injectables prior, most of us who are at a healthy weight will begin to see the signs of significant volume loss in our faces by way of hollowing temples; undereye shadows and hollows; loss of volume in the cheeks, leading to prominent folds around the nose and mouth, and if we are naturally very slim, a gaunt appearance. Additionally, most of us have underdeveloped chins, easily visible in our side profiles, but do not really realise it until we hit our 30s and up, when we begin to see early pooling of skin around the lower face. In this case, judicious use of chin and sometimes, jawline filler can help camouflage the appearance slightly and give a better looking profile.

Dermal fillers can be a great way to gradually add volume to these areas of deficit over time (3-9 months depending on the amount of volume needed - it may be as much as 15 mls over 2-3 sessions as your budget allows) and mask some of the signs of ageing.

It used to be thought that dermal fillers need to be replenished every 6-12 months but we know now that likely leads to the pillowface syndrome we see all around us now. In most of us, fillers will last around 12-18 months once we hit maintenance, and often for much longer such that after the initial upfront cost and volume, we may only need an extra 2-3 mls (if that) annually. At this point, less is definitely more and I begin to steer patients away from more filler to other treatments that will work on improving skin quality that will last them over the years to come.

2. Anti wrinkle treatments

If we have not begun anti wrinkle treatments in the earlier decades, this is often the decade where we may wish to consider adding them to our skincare staple. Due to a combination of thinning skin, repetitive facial movements over decades, most of us will reach our 40s with deep lines with movement and many of us will see these lines between our eyes, on our foreheads and around our eyes even at rest.

Anti wrinkle treatments, done well do not simply freeze the muscles, but rather soften the relevant muscles without freezing them so much that other nearby muscles begin to work overtime to allow some movement. Unless one has the budget to freeze almost all the face, I generally advise that freezing an area is unlikely to be of benefit to most of us, and may lead to discordance in the way we appear to others - stiff and emotionless.

3. Personalised, prescription skincare 

If you have not already, a personalised skincare routine, which may involve prescription products, is a great idea in this decade, when childbearing may be behind us and we worry less about side effects and effects of certain medications on pregnancy. I regularly see patients who have damaged their skin barrier by mixing and matching whatever happens to be the latest skincare trend, and who present with skin problems as a result of overuse.

Equally, hormonal changes related to pregnancy and adult female acne are common culprits we may meet in our 20s till our 40s, when a personalised skincare routine devised by a trusted doctor is worth the time and money rather than trial and error at the skincare counter to help you manage your skincare woes and help you age well in the years to come.

4. In-clinic skin therapies for collagen induction 

While not every treatment will suit every patient, nor their budget, based on your particular skincare concerns, including the most pressing one and your skin quality, we can advise on skincare therapies in clinic that will best help.

Keep in mind, that most skincare therapies require an initial series of treatments over a short interval for best results, followed by at-home care and repeat in-clinic treatments 1-2 times a year so you can budget appropriately and plan for best results.

5. Biostimulatory fillers 

In addition to in-clinic skincare therapies by our staff, we love biostimulatory fillers for some of our patients who may be suited for them, which involve injecting filler that induces your own collagen over time, and which lasts upto 2 years. Initial treatment involves 2-3 sessions a month apart, followed by annual maintenance for best results.

6. Permanent fat dissolving treatments 

To treat the dreaded early jowling as well as the double chin, you may be suited to permanent fat dissolving injections, depending on the size of the fat to be dissolved. Usually a minimum of 2 sessions are needed. Results are permanent.

7. Upper eyelid correction surgery 

Upper eyelid skin begins to droop and sag from as early as our 30s in some, but it may not be until our 40s that it begins to impact our day to day function. For some of us, it may be more apparent at the end of the day when we are tired. For others, we may begin to notice that makeup is harder to apply to the drooping eyelids, or mascara smudges due to the eyelid in the way. Yet others may find that they are developing deep forehead lines due to chronically lifting their eyebrows to see better, and may not realise just how much they are doing this until they have their first anti wrinkle treatment to the forehead muscle.

The good news is, upper eyelid correction surgery is usually a straightforward procedure that can be conducted under local anaesthetic and takes around an hour. You will be able to drive yourself home, and will usually need 1-2 weeks of downtime. A consultation to plan your suitability and to plan the procedure is required prior to any surgery.

8. Hand, neck and decollete rejuvenation 

Often forgotten in the process of facial rejuvenation, these are important areas to treat so the face matches the other parts of the skin on regular display - our hands, necks and decolletes. Rejuvenation processes are usually similar to those used to treat the face and can be added on to a given skin therapy for a smaller additonal cost at the time of treating the face than on its own.

Fillers including biostimulatory fillers and PDO threads may also help. If there is too much sag, volume loss or skin quality deterioration, a face and/or necklift may be suggested instead if you have the budget for it.

9. PRP for hair loss 

Hair loss, while more common in men from a younger age, is nonetheless an issue that can affect upto 49% of women during their lifetimes. Hormonal fluctuations including perimenopause and menopause itself, can contribute significantly to hair loss as well as other medical problems such as anemia, thyroid issues, stress, large weight fluctuations and more so it is best to see a doctor to address this concern, and to help you determine if you may be suited to treatment (not all types of hair loss will be) and what that entails. PRP, derived from your own blood is a safe and effective way to reverse hair loss and activate new hair growth. The rate of hair regrowth is individual but on average, regrowth may be noticed around the 4th month after initial injection, and patients may notice they are not losing as much hair as previously. As with most concerns related to hair, skin and nails, an initial course of treatment is required, after which maintenance is needed 1-2 times a year to maintain results.