People look at me funny when I talk about prevention.

I am a primary care doctor, ie a specialist GP, aka Primary Care Physician and our focus and training tends to be holistic, cradle to grave care and a big part of that, is preventing problems before they occur.

As someone who has a special interest in Primary Care Dermatology including Aesthetics, a conversation that comes up regularly is “HOW do I age well?”

On the one hand, I am stoked that people are taking an interest in ageing well because in many ways, the ageing process begins as early as our twenties.

On the other hand, I am less pleased about the fact that most young people seek their skincare and ageing advice from unreliable sources, usually on social media, that can cause more harm than good.

So if I was to summarise suggested care by decade, here it is, with the following caveat:

-generalised advice. If you have specific concerns, make an appointment with a trusted doctor that you can have a therapeutic relationship with.

- advice is mostly based on what is most commonly seen by decade; fairer skin types begin to show age on average a decade earlier than ethnic skin ie late 20s vs late 30s or even older. This seems to even out around 60 for everyone.

Your Teenage Years

-young bodies may be thin but young faces are full of fat. Youth is beauty personified.

-attention span is short, acne is almost a given, since upto 80% of teens will have acne to some degree.

- keep skincare routine simple –I tend to personalise it to 3 steps including prescription Vit A if needed.

- establish a daily SPF30+ habit now

- avoid taking up bad habits- don’t do drugs; get enough sleep; exercise; eat mostly well.

Your Twenties

-if you have no skin concerns, focus should still be mainly on prevention as during your teenage years.

-consider adding in a Vit A; talk to your doctor about options

-you may begin to notice hollowing under the eyes in this decade, and especially if fair skinned, fine lines and wrinkles during movement ie frown/forehead lines and crows feet, but also in some, at rest.

- if this is you and it bothers you, consider a consultation to address these with skin therapies that stimulate collagen, and judicious use of injectables- a little can go a long way without freezing movement.

Your Thirties

-many of us, if we choose to have children, will spend some of our 20s and/or 30s unable to use many prescription skincare products, as well as in-clinic treatments.

-These usually include Vit A derivatives as well as pigment fading medications. Use them when able, under the guidance of your doctor, who may also be able to suggest alternatives to use while pregnant/ breastfeeding

-additionally, hormonal changes in pregnancy can wreak havoc on skin in the form of pigment and late nights and disrupted sleep with young kids can  seem to exacerbate the ageing process.

- if this is you, when able, talk to your doctor about a personalised skincare regimen that is pregnancy/ breastfeeding safe.

-if able and willing, this is the perfect time to begin to get serious about ageing well as prevention is no longer enough.

-you may benefit from in-clinic treatments when able and this will almost certainly involve a multi-modality approach as the concerns are beginning to add up-  large pores; adult acne in some; fine lines and wrinkles; sun damage in the form of age spots, pigmentation and melasma; volume loss typically under the eyes and around the mouth leading to a tired/ sad look.

-What you invest in now will stand you in good stead for years to come, if you take a holistic approach

Your Forties

-this is the decade in which,  without an effective plan in place, you will begin to see the ageing process really take hold.

- in addition to all the excellent habits from your youth,  this may be the time to consider if you are planning to age the way nature intended, or to age gracefully. The two are not interchangeable.

-this is the age when skin begins to thin and feel dry from declining oestrogen, peri menopause is a thing from your mid forties and bony loss in your face- around your eyes, your mouth and your jawline leads to deepening skin folds -drooping eyelids,  sunken eyes,  eyebags, deep smile lines, “smoker’s lines”, receded chin, jowls and “double chins”.

- lines also become more prominent and may be present even at rest on the face and around the neck

-this decade is THE time to begin planning the years ahead, caring for skin and minimising the negative effects of ageing: thinning skin with poorer resilience; global volume loss in the face with uneven fat distribution to the lower face; bony loss in the face,  leading to sagging overlying skin around these areas.

-if you have been getting regular tweakments until now, there should not be any major surprises.

- if you have not, this may be the decade you really begin to notice all the ways in which there is now a mismatch between how you see yourself and what you see in the mirror

-with a curated treatment plan over some months and budgeting,  it may still be possible to slow the process and manage the negative effects of ageing.

Your Fifties and beyond

I often see the sixth decade of life as being the opportunity that is “do or do nothing” and I often say this to patients who want to look younger but lack the budget, the willingness to show up or do not want injectables, much less surgery.

In this decade and beyond, it becomes harder and harder to undo decades of neglect and damage with only non surgical options and it may be cheaper to encourage them to spend on a face and neck lift for significant loose skin. After this, if they can budget for it, they would benefit from volume replacement and improvement of skin quality for ongoing rejuvenation.

Menopause in women additionally accelerates skin ageing as well as bone loss such that women age twice to thrice as fast as men from middle age, so there may be limits on how much can be done, even if budget was no limit, because now biology is. Often at this point, especially if money is an issue, I tend to encourage patients to continue to care for their skin to the best of their ability as having beautiful healthy skin that regularly attracts compliments is a beautiful boost to self esteem, often well into their 70s and beyond.

The takeaway message from all this?

-Begin early

-Stick to simple, effective skincare

- Make choices that will serve you for life together with a trusted provider whose focus is on prevention and holistic care,  over fads and trends

Having said that, it is NEVER too late to begin, but your options will become more limited or unaffordable beyond a certain point. Lastly, ageing well can be a form of self care and investment in yourself.

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