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? volume loss in the face due to ageing - none of us can avoid this progressive collagen loss in skin, leading to deeper wrinkles and lines and loss of that plump, glowing texture young people have pigmentation due to cumulative sun damage, pregnancy and more! early sagging of skin which pools around the lower face - showing up as jowls, a double chin and neck folds 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. 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? 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

For many of us, our 30s can be a time of much change. Many of us may have children, with pregnancy and associated changes, breastfeeding, chronic sleep deprivation and wrangling little children. Additionally many of us may be dealing with work outside the home at the same time, and making progression on the career ladder, with the requisite sacrifices of time and some quality of life in the process. These combinations of sleep deprivation, late nights and long hours, plus physiologic changes such as pregnancy, birth and raising babies, can all wreak havoc on our wellbeing, and our skin. 1. Hormone related changes may result in pigmentation that becomes very hard to get rid of and is mostly an ongoing lifelong management issue. 2. Fine lines and wrinkles may begin to make themselves known on our faces from decades of frowning, squinting and even smiling. 3. Skin begins to thin, and superficial blood vessels may become more apparent, with easier bruising. With the decreasing collagen that began in our 20s, skin begins to lose its plumpness and glow and for some, adult acne may make itself known. Chronic sleep deprivation and stress may contribute to overall slight decline in skin health and our general sense of feeling blah. It is never too late to begin however your 30s heralds a shift in focus from prevention to more correction and if you've done the minimum to date, you may find initially there will be significant upfront costs before maintenance. So here are some tips to halting the ravages of time and beginning to reverse some before the process worsens. As always, the foundation of great skin in your 30s remains the same: - daily sun protection - getting as much sleep as is feasible - limiting poor food choices - processed foods, alcohol- avoid or quit smoking as it's among the worst choices you can make for your overall health and shows on your skin, teeth and nails. - get regular exercise. - consistency with all of the above. 1. Personalised skincare including prescription skincare If you are noticing problems on your skin that you dislike, over the counter skincare may no longer cut it, and may even make matters worse.  Consider a trusted doctor who can help assess and treat your skin concerns including with bespoke prescription ingredients. Common skin concerns in our 30s and older include pigmentation, rosacea as well as acne. These are all skin diseases, and once present, may be tricky if not impossible to cure, so do yourself a favour and spend on a personalised assessment, diagnosis and treatment plan to manage these conditions instead of experimenting and risking making matters worse.   Skincare favourites in this decade of life, provided there are no pregnancy related concerns, are Vit A derivatives and Vit C alongside any others your doctor may prescribe. 2. Anti wrinkle treatments Unlike anti wrinkle treatments in our 20s, when some use them in baby doses for prophylaxis, by now, you may noticed the faint beginning of lines even at rest aka static lines- a combination of declining skin quality and receptive muscle movements. These are much harder to soften and take time, and regular anti wrinkle treatments are a great way to do this. The drug works by softening/ paralysing the muscles used in forming the lines such that over time, the lines are softened. Using smaller doses as preventatives in other areas of the face remains a viable option to prevent deep etched in lines a few years later. Additionally, anti wrinkle treatments help smooth out skin and pores, giving skin an added luminosity that is hard to beat when done well. 3. Dermal Fillers This is often the decade when we begin to notice a definite loss of volume in the face as the combination of chronological ageing, cumulative sun damage and lifestyle choices begin to take effect. Depending on our genetics we may notice the changes under our eyes, or our cheeks, with dark circles, or deepening lines around the mouth. In some of us, we may even begin to notice hollowing of the temples.  We may get unsolicited comments about how tired or sad we look. Dermal fillers work to replace some of the lost volume in our faces that give a hollow, gaunt and tired appearance. While they don't lift, they do replace some of the lost volume, creating the illusion of lifting and refreshing the face, in small amounts. Too much filler, however is a bad thing and risks venturing into the territory of the faces we see all around us - duck lips, Simpson lips, chipmunk cheeks and more so stick to the one injector who knows what they are doing and who takes a holistic approach to the ageing process. Importantly, ensure they know when to say no. 4. Laser neocollagenesis Laser toning or neocollagenesis is a great way to gently induce collagen production with little to no downtime. On the surface, it's simply a laser session that seems quite relaxing, and doesn't seem to do much immediately.  A series of sessions are needed for best results, as with all skin therapies, but the laser heats skin layers under the surface, stimulating your own collagen in the process. In the process and depending on the type of laser, it may also help with pigmentation and mild redness.  5. Collagen Induction Treatments Treatments such as skin needling, Radiofrequency micro needling as well as Aquagold, PDO threads and PRP treatments are among some of the options available to help induce your own collagen over multiple sessions to induce your own collagen that will last you upto 2 years at a time.  While the exact method may differ, and different options may be recommended to you based on your skin, your concerns and your budget, they all work by inducing your own collagen production where applied leading over 3-6 months to smoother, firmer skin that has that glow we all seek.  6. Radiofrequency treatments Radiofrequency treatments

To those of us in our 30s and beyond, it can often feel like the aging process begins literally, overnight. One day, you're young and carefree and waking up with flawless skin (ifyou're lucky) despite late nights, poor dietary and lifestyle choices. It feels like no matter how poor the choices, our body and skin will keep up. Then suddenly, one day, whether that is in our late 20s, or our 30s, the signs of ageing seem to magically appear: pigmentation in patches on our faces early lines and wrinkles when we smile, frown and laugh if stress is a constant, skin issues including acne signs of sun damage, including less commonly, skin cancer dark circles under the eyes due to a combination genetics and choices leading to volume loss under the eyes and pigmentation that gives us a chronically tired look We could go on and on and on but let's not dwell... As a primary care doctor ie a GP, my passion is preventive care. I feel SO HAPPY when people see me for preventive care BEFORE (any) disease begins to take hold, when it often becomes a case trying to minimise ongoing damage, often incompletely. The solution, as always, is to begin before you think you need it, to maintain what you have and to capitalise on building what you do not have to see you through your 20s, 30s and well beyond with judicious tweakments. The benefit of this of course, is also some other key factors: by starting young you need less so can afford to budget for it. you learn how to budget effectively for self care and for the things that make you happy you learn to get comfortable with being held accountable to someone who will hold you to your goals and nudge you along through accountability you build consistency, a lifelong habit that often means the difference between those who see success and those who don't After all, any treatment you begin with that is tailored for and personalised to you, is going to stimulate your own collagen that will last you for years to come. So what are the best treatments that you should be focusing on in your 20s? So first the basics that you must get right or work on while planning your in-clinic treatments: daily SPF, regardless of the weather, especially in sunny cities like Sydney and really, most of Australia barring Tasmania. Even on cloudy days, the UV index is usually well above 3, leading to inadvertant sun exposure and damage. If you smoke, let's start working on quitting. Smoking depletes your own collagen and stains teeth and gives skin a sallow appearance. eat well, most of the time watch the alcohol consumption exercise is not only good for your heart, it's also great for your skin That being said, what are the best 5 in-clinic treatments in your 20s? 1. Small doses of anti wrinkle treatments - if you're open to it No two faces are the same nor are two skin types. If you have a very mobile face, you may find that you form deep wrinkles when animating that begin to set grooves in your skin over time. This is the perfect time to consider small doses of anti wrinkle treatments to limit the degree of animation without freezing movement completely. By the time most people present for anti wrinkle treatment, it's due to lines that are deep, etched into the face even at rest, and which bother them; at this stage, it usually takes a year of regular treatments to soften these etched-in lines. Starting younger keeps the worst of these at bay. 2. Laser genesis/ toning Also known as a laser peel, this is a gentle laser treatment that will help improve pore size by inducing collagen, improve fine lines and skin texture. There is no downtime unlike more intense lasers, so this is perfect for maintaining and improving skin quality and inducing your own collagen over the years. If wanted, you can also combine it with an LED treatment to add to the benefits and make it the ultimate relaxing treatment that will continue to reap benefits long after the appointment itself. 3. Chemical peels Not just for acne prone skin, light chemical peels are great when beginning to work on acne prone skin for adolescents and for adults alike. While a bespoke skincare plan, which may include prescription medication is important, a series of chemical peels will begin to work on the acne already present and lighten existing hyperpigmentation on the surface of the skin, reducing ongoing damage to the skin surface while the skincare and medication takes its time to work from below (typically 6-12 weeks to begin to show effects). Equally, depending on the formulation used, there are other chemical peels that work well for other skincare concerns in tandem with personalised skincare including pigmentation as well as early signs of ageing such as lines and wrinkles and smoothing overall skin appearance. 4. Bespoke skincare tailored to your skin concerns Given that our skin makes up 90% of our faces it is entirely appropriate that we feel self conscious when our skin doesn't feel at its best. Contact dermatitis due to excessive use of cosmeceuticals, or mixing the wrong products is common and something I see more often than I'd like to and most of this is because the skin is a living breathing organism, that is not just an inert blank canvas for the products we slather on it. The best way to invest in your skin now and well into the decades to come is through a personalised skincare regimen, especially if you have skin issues already, be it sensitivity, acne, or other concerns. Let a professional assess your skin and suggest a bespoke treatment plan. Once you find what works, it becomes a simple enough matter to stick to it for best results, until circumstances change eg pregnancy, ageing or any new concern.