• On 60Minutes recently, there was a feature showcasing the decisions of women in their 50s such as Justine Bateman of Family Ties fame and 80s supermodel Paulina Porizkova, and their decision to not have injectables and to age the way nature intends.
  
  I’ve yet to watch the whole feature, but it continues to bring up important key points, which I’ll reflect on here.
  
  When I meet women of a certain age, they usually tend to fall into one of two main camps:

Young at Any Cost 

• This is the camp that has been having “tweakments” since a youngish age in an effort to stay ahead of the ageing curve, with enhancement as needed.
• Think, preventive anti wrinkle treatment because “the best wrinkle is the one you’ll never have” and lip, cheek and tear trough filler to address volume issues.
• Over the decades, they’ve ended up having most things, and in their 5th or 6th decade, are seriously considering surgery;
• “anything to stop ageing” is a comment I sometimes hear, which worries me in clinic.
• Social media is rife with accounts by injectors who share these ideas, showcasing examples in young faces, of “temple fillers to balance out this beautiful face due to hollowing created by cheek fillers” 
• 

Ageing as a privilege

• the other camp, is women who are older, and for any number of reasons, have decided that injectables are not for them for a variety of reasons
• they’re constantly exposed to bad work everywhere
• they see it as a sign of bad feminism
• they have daughters they want to set a good example for, by abstainin
• a combination of the above.

What’s striking to me as an observer, is the very marked black and white thinking prevalent in these two groups, with little to no nuance to consider a middle ground.

The first camp, as one may surmise, who begin at a young age, normalises the use of preventative anti ageing procedures, and over time, risk becoming overfilled or having filler migration because it becomes a habit and a means to feel good, as a pick me up, and as preparation prior to special events. Perception drift is so slow they may forget, over time, what they used to look like. 

Given how heavily advertised medical aesthetics is to the public at large, who remains largely unaware of the rare but real risks, it’s easy to see how packages, specials and 0.5ml here and a few top-up units there can add up over time- to a lot of money, and possibly an overfilled, frozen or unattractive look which is often when I first meet them.

The second camp, is one I rarely meet, but occasionally they see me for help with ageing  limited to a very narrow range of skincare options they may be open to - they may wish to minimise signs of ageing by focusing on beautiful skin, help with their adult onset acne, or be open to skin therapies without injectables. 

They, or their spouses are bombarded daily, with overdone faces and in their minds, this is what ALL medical aesthetics looks like - bad - so they don’t want anything to do with it. Alternatively, they may have seen on social media frequent posts about “botched treatments” and even rare but real complications and decided the risk is not worth it.

In these cases, I help with their concerns, without trying to influence their aversion to injectables unless asked for my opinion. Sometimes, over months of working together and with trust, they may reopen the door and ask again, but often they won’t. 

So who chooses the middle ground and what does that look like? 

The middle ground group is my ideal patient. 

I came to medical aesthetics reluctantly in 2015/2016, largely due to my background in surgical work and procedural work which I didn’t get enough of as a Specialist GP. I had, and continue to have, reservations around the unregulated industry, the lack of ethics and the lure of easy money by untrained injectors who work unsupervised after a 2-day or 2-week boot camp with minimal procedural skills. 

Equally, I identify with the desire to not look “done”, “fake” and more. It’s a topic that I continue to grapple with and for many years I struggled with the ethical issues I saw lacking in this industry. 

As to my own aesthetic journey, all I did was practice rigorous sun avoidance until  my early 40s, when I noticed that despite my best effort, Oil of Olay SPF and Dove soap were no longer cutting it. 

At the age of 42 I added active skincare to the mix. 

The year I turned 45, I added a sprinkle of anti wrinkle, initially to avoid wasting a vial that needed to be discarded and loved the subtle but effective results. 

Since then, I’ve had judicious use of non surgical and minimally invasive treatments to help me continue to like what i see in the mirror. My face is my brand, and many patients who choose to see me tell me my face, the fact that it moves, isn’t frozen and looks natural, is among the reasons they chose to see me despite their fears. 

For these patients, when it comes time to meeting me, usually after a period of anywhere from 6-18 months of lurking and following my posts on Instagram, their motivation for doing so is different from the two camps above - they’ve seen firsthand evidence of the middle ground that I refer to as “ageing well” with a heavy focus on caring for the skin first and foremost, with judicious use of injectables - anti wrinkle treatment AND fillers - and then maintained by collagen stimulating therapies.

The results for those who stay the course, have been nothing short of stupendous and life affirming, which is ultimately what matters especially as most of them, like me, aren’t open to surgery (yet). 

So where do I stand on this issue? 

I respect every woman’s right to do as she pleases with her face and her body and I’d rather people be upfront and honest about the work they’re having done, than lie about it because it’s a different problem to contend with then. Beyond an age, there is a certain amount of time, energy and money that goes into looking good and feeling well - I take the same approach to ageing well in our skin as we do to the impact of regular exercise for our bodies and muscle mass; the impact of brain stimulation to keep dementia at bay etc. 

At the same time, what I wish I could say to the likes of Paulina and Justine is that it is possible there is a happy middle ground between looking fake, done and odd and looking the way nature intended, with all its negative signs of ageing.

My goal, in medical aesthetics is not to chase every line, or to freeze every movement, or even to aim for the unattainable - complete symmetry, but to aim for fresh, rested, rejuvenated, which is an entirely different goal and far more difficult to achieve than the alternative. The way I do this, is by focusing on reducing or eliminating the negative signs of ageing that become more apparent over time. 

What do I mean by negative signs of ageing?

In my clinic these are the commonest reasons I see patients looking for change:

• they repeatedly get told they look angry due to the predominant lines between their eyebrows from concentration, as though they’re frowning all the time
• the lines in their forehead along with hooded eyelids give them a perpetually tired or surprised look
• volume loss around the eyes results in eyebags that can contribute to a sad look
• volume loss around the eyes results in their looking sad, tired and even “hollow”
• volume loss around the temples leads to a gaunt, unhealthy appearance and may contribute to worsening of under-eye hollows
• volume loss in the upper and mid face results in some mild pooling of skin around the mouth, causing disproportionate change in the facial shape and accentuate the hangdog face 

There are other examples, but you get the idea.

For someone whose main concern is SAG, who wants significant lifting, the only and best option remains surgery. There is quite simply, no way around this if you are in a position to afford this in terms of risk, downtime and cost. 

For everyone and everything else, my focus is not on lines and wrinkles, which are a normal part of life, and which are necessary to some degree to allow us to communicate non verbally, but on an overall restoration of the ageing face to a more rested and fresher appearance.

How do I do this?

• By taking a holistic whole face approach at the initial consultation to ensure we are on the same page. 
• we don’t take orders for “just some anti wrinkle” or “some lip filler” or anything else - all medical procedures require an adequate assessment first. 
• we take a medical whole person, full face approach and we take the time to do this well.
• based on our assessment together, we come up with a suggested treatment plan that addresses the key components of ageing as they apply to you:
  • skin and textural issues
  • lines and wrinkles
  • volume loss
  • maintenance 

Then, we discuss expectations, your willingness to commit to the timeframe, the appointments, the cost.

Then we begin, knowing it will take us 3-9 months to get to final results before we are at maintenance.

At the end of the process, patients usually tell me, though that is never the goal or the aim, “I look younger” because they look fresher, more rested and their skin is glowing.

For those who end stay the course, 80% of the work is done by them:

• they show up to appointments as advised and planned
• they book in advance and don’t cancel/ reschedule
• they do the work at home around the basics
• they attend clinic appointments and trust the process.
• they are willing to be held accountable 

So for those on the fence, who are either frightened by the faces we see all around us and who are ready to be guided & have the means to invest in themselves, I’d consider finding a physician who works in a similar way to consider your options and what is possible.

The ageing process stops for no one and beyond a point, surgery may be your best/ only option.