Dr Joshi’s "Proactive Ageing Triad"

Dr Joshi’s  “Proactive Ageing Triad“ visually summarises a comprehensive, balanced approach to treating the ageing face.

It is mainly aimed at women ages 35- 55 who are not yet surgical candidates or do not plan on having surgery who have all of the other components of ageing that surgery alone cannot address. 

What is the core concept of Dr Joshi’s Proactive Ageing Triad, aka her FFA? 

The triangle at the center — Proactive Ageing Triad — highlights three foundational pillars in aesthetic medicine that must be addressed together for effective and seamless facial rejuvenation:

1. Muscle Tension and its impact on the face as we age
2. Skin Texture and the changes that occur due to lifestyle, sundamage and hormonal changes over the decades
3. Tissue Volume and the global volume loss in the face that impacts all of us due to ageing and especially accelerates through perimenopause and beyond.

These are the three interdependent mechanisms of facial ageing — and proactively managing them leads to better aesthetic outcomes that may allow you to delay or even avoid surgery. 

1. Muscle Tension – Not looking “Mad, Bad, Sad”

Problem: Overactive muscles lead to lines, furrows, and unintended facial expressions (e.g.looking unapproachable; grumpy, sad)

Goal:

• Reduce Wrinkles and improve skin quality over time  without paralysing the face 
• Maintain Animation: careful dosing to preserve natural expression while softening harsh lines.

It’s not just about freezing movement but restoring emotional congruence so you look the way you feel on the inside. 

2. Skin Texture – “Makeup can be optional”

Problem: Poor skin quality (uneven pigmentation, rough texture) makes makeup necessary to “mask” ageing and textural flaws.

Goal:

• Uniform Pigmentation and a subtle skin glow. 
• Smooth Texture such that makeup truly becomes a means to self expression not a mask to disguise imperfections. 

When your skin is healthy and luminous, makeup becomes a choice, not a necessity — a marker of successful rejuvenation.

3. Tissue Volume – Not looking “Saggy and Tired”

Problem: Volume loss in parts of the whole face ( fat pads deflate, bone is lost) leads to a deflated, aged appearance. Hormonal changes due to pregnancy, lactation and then perimenopause and beyond can accelerate this, making women look and feel saggy, sad and tired. 

Goal:

• Replacing lost volume judiciously to restore some of the hallmarks of youth. 
• Stimulating Collagen to maintain skin elasticity and quality over the coming years

Volume is the part of the triad that is hardest to convince women to agree to due to the abundance of women who have gone overboard, leading to pillowfaces. Restoration done well should be carefully planned and strategic — not just filling, but rebuilding the underlying scaffold and then maintaining it for years to come. 

Take Home message 

In the ageing face, an ad hoc, “retail medicine” or DIY approach to medical aesthetics is doomed to fail. Likewise, going from clinician to clinician is likely over time, to lead to a garish outcome that is not in line with good work and results. 

The ageing face needs one clinic, one clinician to oversee and plan the treatments and then execute and maintain the results for years to come for best results. 

• Treating just one component (e.g., wrinkles alone) leads to unnatural or incomplete results.
• The triad encourages clinicians to evaluate the face in full context: how it moves (tension), how it looks (texture), and how it’s supported (volume + collagen).

The surrounding phrases (“Mad, Bad, Sad,” “Makeup isn’t optional,” “Saggy and Tired”) are cues that patients use to describe their reasons for coming in, which we can then convert to a treatment plan to help improve their concerns.