A cosmetologist in her late 50s in the USA posted recently about her skin transformation over 7 years and the true cost of it and it got me thinking.

Much of the beauty and aesthetic industry is on an race to the bottom:

1. they hire junior doctors and nurses to perform injectables purchased wholesale at bargain basement prices, with minimal training and minimal followup.
2. consultations are cursory and complimentary and designed to convert on the day to people walking in expecting to pay hundreds to order a treatment off a menu irrespective of whether they’d be suited to that treatment. 

In many cases, this is fine, there is definitely a market for this, and for those who don’t need much done, and want a quick pick-me-up, this is an absolutely ok model with lower risk treatments and no real problems to address. 

This, however, is not the case for many as early as our late 20s and more typically our 30s and beyond.

By the time we get to our late 40s and early 50s, many, if not most women, if they’ve not had anything done till then, will begin to be reasonably bothered by what they see in the mirror, prompting online searches, a foray into online groups for advice, following influencers to see what their skincare routine is and even seeking a complimentary opinion from one of the clinics mentioned above, for guidance on how to fix what bothers them.

Many may decide not to pursue anything, and we have women who talk about this such as Mia Freedman on her notox stance . 

On the opposite end we have beauty influencers such as Caroline Hirons known for speaking out against clean beauty and who is also a lot more open about spending on skincare as well as toxin and fillers. And who has drawn the line at plastic surgery for herself. 

In your 20s, as a general rule, much of skincare, including injectables and skin therapies, tends to be relaxation and enhancement if there are no skin disorders such as acne. You may have lips that are thinner than you’d like, and 1-2 mls of filler is a quick and simple fix to address this.

In your 30s, these changes begin to become more pronounced:

• sun damage adds up
• lines and wrinkles become more apparent, especially if skincare has been minimal to date
• volume loss in the face leads to hollows, shadows and even sagging which can be distressing and invite unsolicited comments from others.

These changes, once present, will only worsen in our 40s, 50s and beyond as the perimenopausal and menopausal years set in alongside the relentless ageing process which is inevitable irrespective of what we undergo by way of skincare, in-clinic procedures and even surgery. 

Depending on when you choose to begin your journey to ageing well, IF you choose to do so, the costs will begin to add up quite quickly at least initially, especially if there is a significant degree of effort needed to first halt or even reverse some processes eg

• acne with scarring;
• pigmentation including sungamage;
• etched in lines and wrinkles at rest;
• volume loss;
• loss of skin plumpness. 

These concerns all require an approach that I call a Full Face Rejuvenation or an FFR and can be initially costly in terms of both your time commitment and money. There is quite simply, no easy or cheap way around this if you want to do it well.

Would you expect to straighten your teeth for less than $7000-10000 and expect a good job for less than 12 months’ commitment?

 Would you expect to pay less than say, $15000 for breast implants or a rhinoplasty and expect it all to settle within weeks rather than months?

Would you expect to pay less than $30000 for a tummy tuck or a facelift and be driving the next week?

The more work there is to be done, the more time, effort, consistency and money it will take and anyone who tells you otherwise is, quite simply, lying to you and selling you marketing Koolaid. It’s dishonest and it is taking advantage of vulnerable people.

Sometimes I hear of people being told “You need 6-8mls of filler but if you can only budget for 1ml, let’s start with that and add to it over time.”

My concern that I take issue with this is:

• 1 ml will almost always do nothing to show you any significant progress that will motivate you to save for more and to come back if you need 6-8 times that amount
• someone who has a budget for only 1ml is unlikely to be able to find the money for 6-8 times that amount in quick supply and may experience distress or financial angst as a result 
• there is a high chance of dissatisfaction and loss to followup and in the process, they’ve spent hundreds of dollars to achieve nothing, which could have been spent elsewhere on something else that might have brought joy
• FFR takes a degree of accountability - it is you that needs to decide if you will show up and commit and be consistent. The work in clinic is 20% of the entire process, if that. The remaining 80% is dependent on you and if you cannot or will not commit, then it is often easier and kinder for me to say no. 

The woman who posted her own progress over 7 years in the USA, spent USD44,000 over the 7 years to achieve her results and for her, it has been totally worth it. This is what my own patients who have similarly spent significant sums of money, often in their 30s and 40s and hit maintenance which is far more manageable, tell me.

As with all discretionary spending, it is entirely up to each individual what they wish to prioritise that makes them happy. No judgement here either way. 

For some of us, it is travel. For others, home renovations or designer clothes and for yet others, aesthetic procedures. For many who live paycheck to paycheck, it may be none of these, which is another ethical issue entirely, but despite what your personal circumstances are, I’d like us all to stop pretending that medical aesthetics is, or should be, easy and affordable for everyone, if done well. All medical aesthetics is a want, not a need. 

• a highly qualified and skilled provider (a doctor in my case) with decades of experience won’t be cheap
• their insurance will be very high
• their overheads will likewise be significant
• if they believe in paying their staff well, these will add to the cost if they are ethical employers 

I personally do not support fast fashion or any other forms of exploitative practices in order to make something cheap at point of service and it is important to me to work in a way that aligns with this ethos. If someone cannot afford to have in-clinic treatments right now, there are still things you can do at home until circumstances change and it is a big part of why I post free educational content on my Instagram page to help those who cannot or will not choose more expensive treatments while remaining safe. 

Irrespective of what you choose, transparency and honesty is key and that includes financial consent so you know what you are looking at spending to begin and to continue the journey.

While it is not possible to say without a face to face assessment, I always say to people, the initial outlay is similar to orthodontics if you have several concerns bothering you that need to be addressed and improved, so please choose wisely. It’s your face, money should be a much lower priority than realistic expectations coupled with patience, budgeting and consistency.