Ageing Naturally vs Ageing Well - are we lacking in nuance?

• On 60 Minutes 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 young age (early 20s) in an effort to stay ahead of the ageing curve, with enhancement as needed.
• Think, preventive injectable treatment because “the best wrinkle is the one you’ll never have”.
• Over the decades, they’ve ended up having most things, and as early as their 5th or 6th decades, 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 “ways to optimise” already young and beautiful faces. 
   

Ageing as a privilege

The other camp, is women who are older, and who, for any number of reasons, have decided that injectables and surgery are not for them. Why?  For a variety of reasons including: 

• they’re constantly exposed to “bad work”everywhere that is worse than simply ageing. 
• they see it as a sign of bad feminism
• they see it as a way of fighting against the patriarchy. 
• they have daughters they want to set a good example for, by normalising ageing. 
• they prefer to spend their money on other pursuits
• they’re already naturally beautiful eg ex supermodels, actresses and models, who are blessed genetically. 

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 guess, who begins at a young age, normalises the use of preventative “anti ageing”procedures, and over time, risk becoming overfilled or looking distorted because it becomes a habit and a means for a quick  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 remain largely unaware of the rare but real risks, it’s easy to see how packages, specials and DIY medical procedures can add up over time- to not only a lot of money, but an overfilled, frozen or unattractive look which is often when I first meet them.

The second camp, is one I rarely meet.

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, most of whom are new graduates 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 in clinic treatments 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 – using my signature trifecta, aka Proactive Ageing – 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 and so on. 

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 especially if one is not genetically blessed. 

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.

My goal is 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 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 prescription medications based on your internet search.
• all medical procedures require an adequate assessment first via our comprehensive medical consultations. 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 investment.

If you are ready, we begin. If you are not, I send you home to think about it until that changes or you go elsewhere. 

If we begin, it is with the knowledge it will take us 3-4 months to get to final results that we then maintain to peak around 9-12 months and beyond. 

There is no quick fix, no magic bullet to undo decades of genetics, neglect and choices. 

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

Other people notice they look “better” but can’t say why. 

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

• they show up to appointments as advised and planned
• they book in advance and don’t cancel/ reschedule/delay
• they do the work at home around the basics
• they attend clinic appointments and trust the process.
• they work through the anxiety and discomfort of not knowing. 
• they communicate concerns and discontent. 
• they are willing to be held accountable even if it hurts in the moment. 

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 left too late,  surgery or acceptance may be your best/ only option. 

Ready to begin your own FFA journey? Request a consultation here.