There is a recent trend of famous actresses and models embracing ageing and encouraging other women to do likewise. It is refreshing, certainly far more so than the famous women of similar vintage claiming all they use is olive oil. We now have some famous and beautiful faces that are showing us firsthand what ageing in our 40s and 50s can look like, if we simply allow nature to take its course: Paulina PorizkovaSarah Jessica Parker to name a few. It is certainly brave of these women and others like them to do so, especially in an industry where looks are seemingly everything. At Skin Essentials we don’t believe in defying ageing, or helping patients look like mutton dressed as lamb, rather we recognise that ageing is a disease, a decline in our bodies and our skin, that over time, for many of us, can also affect our self esteem, our morale and especially if we are working, how others see us. For us, the aim and goal is always a holistic approach to ageing well, whatever that may look like for each individual, man and woman, though our society disproportionately places a heavier emphasis on women than on men to look ageless forever. With that in mind, I though I’d do a case study on some famous faces and their aging process in their 50s, which is the decade of peak decline for most women, if nothing is presumably done. Caveat - as actresses and models, each of these women had stunning bone structure in her youth to begin with, which offsets a lot of the signs of ageing in our 40s and 50s - high cheekbones, strong chin and jawline, when most of us begin to notice sagging and jowling as early as our late 30s if our lower face is not strong and well defined. Sarah Jessica Parker 56       At 56 the actress is openly and freely embracing the ageing process and good on her!  Note - she has a strong side profile to begin with and being always slim, she never really developed any significant jowling, except where the skin has sagged due to 3 factors:  - bony loss - around mouth, including chin and angle of jaw; around orbits of the eyes - fat pad loss and movement downwards  - ligament laxity due to loss of support  - hooding of her eyes in part due to bony loss around the eye sockets but I also suspect, due to drooping eyelid skin  Many of these are amenable to tweaks not to hide the fact she is 56 but to help her appear less tired and grumpy, what I refer to as “negative signs”. The signs in an ageing face that elicits unwanted comments about looking tired, sad, angry and may lead others to see us as being untrustworthy.  Paulina Porizkova 54  A supermodel with impeccable bone structure as evident in her youth, the perfect heart shaped face, she continues to wear it well into her 50s, with only noticeable changes due to her bone structure. Paulina is another one ageing naturally and she does it well!  In fact, barring anti wrinkle treatment, and skin therapies (which she takes up consistently to improve skin structure and quality) her bone structure will likely continue to carry her for years to come with minimal drooping even around the eyes and lower face.  My main issue when women in their 40s and 50s urge others to embrace ageing is this:  - it is admirable that they do so and encourage us mere mortals to accept ourselves as we are - it is equally telling that these are often individuals who, by virtue of their career choices, are usually in the top 1% in terms of looks and have at their disposal, immeasurable amounts of money and staff as well as genetic advantage that the rest of us simply do not have.  - just as telling, many of these supermodels and actresses have made more money in their youth than most of us will see in our lifetime, such that they can afford to retire far earlier than we would. For those of us who continue to work till 65 or later, especially if in customer facing roles, we still have to look well enough that we don’t solicit unwanted comments or pity because we look “like you should be retired”, a comment made to one of my patients in her 60s.  Ultimately what anyone does or does not choose to do, we ought to be supportive and if we cannot, simply go past. As a doctor, like all doctors, I see and hear firsthand the impact careless comments have on someone’s self esteem and psyche, and the very real fears some have around their careers in their 40s and 50s when competing against younger fresher faces.  I advocate for looking your best at every age and stage, rather than looking like the latest face or trend of the day.  Just as we advocate for exercising regularly to keep your heart strong, and keeping your brain young through exercising it with mental activities, learning a new language and more, so it is with our skin and faces if we want to invest for years to come - we must make the time, effort and budget to enable us to indulge in our faces and our skin that will allow us to like what we see in the mirror for years to come.     

The 50s are often the decade where it may feel like it all goes downhill, especially if you are female.  Perimenopause may have begun to make its mark known from your mid 40s, but it is often not until menopause that many women begin to struggle - the plummeting in oestrogen levels can cause an impact on most of our systems, from mood, to brain fog to dry skin, hair loss and more.  This is the time, if it is appropriate to do so, to talk to your primary care provider about your options including and especially for MHT or HRT, aka hormone replacement therapy. Menopause is nature's way of allowing us a reprieve from the draining and exahusting role of childbearing and caring for young children but with improved quality of life and function, many of us will live to our 80s and it makes no sense to be chronically miserable in our skin (literally!) and body and deprived due to outdated ideas of what we ought to accept as being normal; additionally a holistic approach will ensure that any in-clinic procedures we formulate with and for you will strengthen each other to help you live life to the best of your ability.  That said, your 50s are the time when if you've maintained some degree of care of your skin in the preceding decades, you will begin to see them pay off dividends now, as you continue to build on it.  Many women tell me they look in the mirror and no longer recognise themselves. Others regularly get unsolicited comments from colleagues and friends and family about how tired/ cranky they look as well as questions asking if they are ok. If these women are still working outside the home, this can be challenging and sometimes demoralising since we place such an emphasis on the way we present to the world and how we are seen based on it.  Even if you've thus far done the bare minimum or even neglected your skin, it's never too late to begin, as long as you have realistic expectations of what is and is not possible.  For many women who have done nothing to date and who find themselves disliking what they see in the mirror now which is usually a myriad of things- age spots (brown discolourations), deepening wrinkles even at rest and sagging skin due to volume loss. Sagging is by far, the biggest issue for this age group.  Many non invasive techniques may be insufficient and this may be the perfect time to consider minimally invasive surgical options or,  if budget and downtime allows, we can refer to plastic surgeons who can address this concern with you if needed via a face and neck lift.  If surgical options are not feasible for you, read on to see what else you may wish to consider to help improve your skin quality over the years and decade to come.  1. Eyelid Correction Surgery Often recommended for people in their 40s, this continues to be a staple for many people in their 50s also, not just for vanity but also because in many people the drooping eyelids which began in their 40s begin to affect functional ability, especially at the end of the day or when tired, when they might droop a bit more, or with the use of anti wrinkle when even a judicious dose of treatment to the forehead lines causes discomfort. Some patients also report chronic headaches that resolve post eyelid correction surgery.  This surgery is undertaken in clinic under local anaesthetic and most patients tolerate this very well. There is some downtime as with most procedures involving the eye area, and we would suggest a week or two of time off work, not due to any disability but due to expected swelling and bruising as the wound heals. Results are permanent and last years until further skin sags over the eyes again.  2. Dermal Fillers  If you first explore medical aesthetics in your 50s, it may be sagging and volume loss that brings you in for an opinion. Hollowing under the eyes, eyebags (which may only be amenable to surgery), excess skin around the eyes as well as jowling around the lower face and deep smile lines may be causes for concern as well as the seemingly overnight appearance of a double chin due to volume loss and sagging of skin from above.  Used judiciously dermal fillers may be used to replace some of the volume loss while we work on the deeper underlying issues, which will take longer and require planning, time and budgeting. The risk of too much dermal filler of course, is that they risk overfilling and leading to a caricature so it is best to stick to a practitioner who understands medical aesthetics and whose work you like.  3. Skin Therapies  By far and away, the mainstay of skincare in your 40s and up is effective skincare that is personalised to you and your concerns. In our 20s and sometimes even our 30s, we may get away with dabbling and trying every new trend that erupts on the scene, but by our 30s, we begin to see signs of a childhood with too much sun, or active facial muscles or chronic sun damage that never quite turned into an actual sunburn.  Fine lines and wrinles on animation as well as the appearance of dark discolouration on the skin begin to accelerate with age and over time if we do nothing in addition to progressive collagen loss that leads to a loss of plumpness and glow in our skin.  For most patients who are adequately volume replaced, my go-to in clinic is a combination of collagen induction therapies using biostimulator fillers 6-12 monthly as well as a series of skin therapies personalised to your skin concerns, with our skin therapist.  Most skin therapies take time, and a series of regular treatments to begin to see effects - usually 3-6 months minimum, in conjunction