The challenge of being a woman seems almost never ending, from navigating those hormonal swings as a teenager through to the same as a peri and post menopausal woman! What those hormonal driven teenagers don’t have to navigate however are the skin, musculature and facial bone changes that come with age and life experience! And these in themselves bring the biggest challenge; how to address them in a subtle, natural way to maintain freshness but not look like you have tried. The best starting point is to find a practitioner who understands what is going on from a biological and physiological perspective.

So what is actually going on?

Whilst the way and degree that that women age varies dramatically woman to woman, the underlying processes are the same, just influenced in severity by genetic and external influencers such as sun damage and diet. Regardless of the speed and degree to which changes take place, the first signs include the appearance of small wrinkles, atrophy (shrinking) of subcutaneous fat, and decreases in collagen and elastin production. Skin cell turnover, the rate at which our skin renews itself also slows….have you noticed how quickly a graze on a baby’s leg repairs itself?

Over time, gravity and muscular aging produce more evident folds and skin becomes looser. With age, the skin becomes drier and thinner and there is a loss in the skin texture and elasticity. All of these factors culminate in varying degrees of wrinkle expression; tear trough deepening, an increase in the nasolabial fold, a drop of the angle of the mouth, tightening and more prominent platysmal bands (those ligaments that run down the neck), changes in skin pigmentation and broken blood vessels (telangiectasia). Coupled with this, is a skin which is more irritable, itchy, redder and skeletal bone changes which change the frame that our skin and fat sits on.

All of these changes increase over time and menopause helpfully speeds things up as it adds to skin dryness, ligament dehydration, loss of elasticity and fat loss!

So can anything be done to slow it or fix it?

Bringing us neatly to the golden question… what can be done about it? There are many answers to this, broadly divided into diet, exercise, skin care, non-surgical approaches and finally surgery (not for this BLOG). Whatever approach you take, it should be subtle, gentle and aimed at restoring freshness, eliminating tiredness and replacing some of the lost plumpness, but not change the way you look or over correct. With that in mind, here is a whistle-stop tour of what is out there..

Diet

There is no doubt that what we eat affects the way we age and the life we live, including the length of that life. Vegetarians live longer than most and those who weigh less also enjoy more time here on earth. The issue however, is, does this type of diet reduce the outward signs of aging; lax, wrinkly skin? Well, whilst not magic, a healthy diet can certainly help. So what foods should you increase or decrease in your diet.

Inflammatory foods and antioxidants

There is a school of thought that foods that create inflammation are pro-aging. So cutting these out may help and these include sugar, refined carbohydrates, gluten, dairy, alcohol, processed meats and artificial trans fats. This combined with too much time out in the sun is a leading cause of aging – 80% of wrinkles are sun related. The sun creates free radicals that can permanently kill off healthy skin cells. A poor diet can do the same. Eating antioxidant-rich foods that contain carotenoids like tomatoes, carrots, kale, broccoli, spinach and pumpkin can protect the skin and reverse some of the damage.

Omega fatty acids and hydration.

Keeping skin well-hydrated is one of the best ways to prevent dry skin and wrinkles. Omega fatty acids -3, 6, and 9 are vital to maintain skin cell walls and this aids hydration. Salmon, walnuts, flaxseeds, chia seeds, coconut oil, olive oil and avocado are all packed with these crucial omega’s.

Amino acids.

Another cause of wrinkles is the weakening of collagen and elastin in the skin that happens as we age. Amino acids found in protein can help rebuild and repair damage to the collagen and elastin which diminishes with age. So fresh meat, fish, eggs, tofu, some grains, nuts, and seeds are the best source of essential amino acids.

Phytoceramides.

As we age, the epidermis (the skin’s outer layer) thins, making it susceptible to dehydration and wrinkling. Production of ceramides— molecules that keep the skin firm — starts to slow down. Phytoceramides are plant-based ceramides found in wheat germ, brown rice and spinach, so adding more of these to your diet can help to protect the skin’s outer layer.

Fermented foods.

Probiotics regulate digestion and put good bacteria back in the gut, which can also help skin look healthy. Sauerkraut, kimchi, kefir, and fermented vegetables are all probiotic-rich. You can also buy probiotics which do the same job but be warned, the best are expensive and need to be kept in the fridge or freezer. I often recommend Symprove.

Exercise

There are definitely two sides to this coin, so as with everything in life, moderation and variation are key.

When exercise is good for aging skin.

Exercise increases blood flow, helps nourish skin cells and keep them in prime condition. Blood carries oxygen and nutrients to cells throughout the body, including the skin. As well as providing oxygen, blood flow helps to eliminate waste products, including free radicals.

In a small study, researchers at McMaster University in Ontario found that exercise may not only keep skin younger, but may also reverse skin aging, even in people who take up exercise later in life (`see link to research at end). So the message is good; it’s never too late to start!

When is exercise not so good?

As much as exercising can help to slow down the ageing process of your skin, continuous high impact training can promote skin sagging. The constant and repetitive impact during running can break down elasticity and connective tissue in the skin.

So what now I hear you cry? You should still exercise, but jogging on more shock absorbing surfaces (treadmill not pavement), swimming, cycling and HIIT training are all great ways to keep your body and skin taut, toned and healthy. And mix it up. Do some cardio with toning work such as pilates, yoga and stretching. And here is my little secret, because I run hidden in my garage I wear a face support when I run… the type used after facelift surgery – who knows, I might just look silly or I might be helping!

Skincare

Boring as it may be, sunscreen and moisturiser are the two most important anti aging products you can invest in. And when I say sunscreen I mean stand alone factor 30, 365 days a year! If you can see outside then there are harmful sun rays even if its cold! Eskimos have massively sun damaged skin. And the screen that you think you are using in your cream or foundation is a waste of time. You would have to pile it on a centimetre thick for there to be enough to be useful. So sunscreen under any moisturiser and/or foundation you wear is a must. I like Heliocare SPF but this is a personal choice depending on skin type.

Vitamin C for the skin is a potent antioxidant that can neutralize free radicals and aid your skin's natural regeneration process, which helps your body repair damaged skin cells and so improves skin laxity, thickness and texture. The issue with vitamin C is how you get it delivered, as it degrades easily. So you need to make sure that the form you use is protected against degradation and from a trustworthy company.

Thereafter you need a good serum and moisturiser for your make up base and a good cleanser. I have fallen in love with Merumaya Cosmetics and it isn’t only the super products and integrity of the brand, it’s the inspirational founder, Maleka Dattu – another marvellous midlife woman. Having a long history working within the Estee Lauder family and finally as the general manager of Origins, she learnt her trade from the bottom up and had a clear vision of what a good skincare range should deliver. So she put her money where her mouth is and set out to create her own range from scratch! So for me this is the brand, especially the Iconic Youth Serum. It is of course very personal, so look for vitamin C, a good serum, a good moisturiser and cleanser and for one that works for you.

And what about retinoids I hear you saying…. Yes, they are also essential for collagen regeneration and wrinkle reduction. Personally I use a prescription strength retinoid but they are not easy to tolerate and many people can’t bear the redness and dryness they get. So the next best thing is Retinol and Merumaya delivers here to. I would say, if you do nothing else, make sure you have a retinol or retinoid in your skin care regimen. And I have spoken to Maleka Dattu about this BLOG and she has kindly offered a something special to Marvellous Midlife readers to trial any product. As Maleka says “beauty has no age”, and this is the mantra that she has worked to when creating her range. So see the link at the end for your code if you want to try.

So having addressed everything from diet through to sunscreen, there are of course the slightly more invasive but non surgical approaches to aging beautifully and more and more women of all ages are coming round to the benefits of adding to their regime in this way.

Non surgical approaches

Non surgical approaches to aging should sit comfortably alongside your diet and exercise approach for maximal effect. Now it’s all well and good if you started your botox at age 30 and slowly added to it over the years so you have had the benefits of prevention, but what if you didn’t and you have just woken up with the rest of us to a lined and tired look in the mirror that seemed to arrive overnight. Well rest assured, it’s not too late but you do need a skilled aesthetics practitioner who will look at your face as a whole and not just attempt to fix problem areas. For example, if the lines form your nose to your mouth are deepening and your practitioner only discusses putting fillers under them to lift them it may be time to get a second opinion. It is likely that your malar fat pads in your cheeks are moving southwards and that replacing this volume in the cheeks will give you a much more natural result and lift the nasolabial folds as it does so. Sometimes the fix is not where you think it is! So start with a full assessment and get a variety of approaches… oh and start small, you can always add to it, it’s harder (but not impossible) to undo things.

So where to start? A combination of the following is usually where we would end up but botox is an excellent start point;

Botox

Simple, almost no side effects, safe (in the right hands) and it’s gone in 4-6 months if you don’t like it! Botox is an invaluable tool at any age. It does what it says on the tin and temporarily paralyses muscle, so again, a skilled and experienced practitioner is key. Don’t be tempted by cheaper beauticians and other unqualified practitioners. Its your face, it deserves the best and the best is a medically trained doctor/dentist who understands the muscle anatomy and so where to inject. Botox softens lines between the brows, on the forehead and around the eyes. It can also get rid of the tight ‘ropes’ that can appear in the neck (remember Ulrika Jonsson), lift the corners of the mouth that turn down with age and soften a gummy smile. And don’t fall into the trap of believing that botox means an expressionless and non moving face, if the person you go to is good, it doesn’t mean that at all. (My face is full of botox and you can see me move my eyebrows/brow on my VLOG!). It can also help migraines and is a miracle worker for TMJ Dysfunction.

Hydrators

It’s the crepe skin texture and dryness which is one of the main giveaways to age and if you can address that you can look fresh and well rested without any other major changes or work. There are several ways of achieving this. There are some excellent fillers on the market that are injected superficially and sit in the dermis of the skin to attract water. Some are injected all over the face/neck/hands (Restylane skin boosters and Juverderm Volite) and some in set points to diffuse (Profhilo). Most need a repeat treatment after a month but they really do work and are great at improving overall texture without puffing or lifting.

Fillers

In the right hands fillers can be an excellent way of restoring some of the lost volume that results in that sagging tired look. Just replacing the lost volume in the midface or cheek area, lifts everything below and gives a nice fresh subtle plumpness that is associated with youth. Often people ask for ‘tear trough’ treatment and expect filler to go directly into the area under the eye or into the ‘dark circles or hollows’. In Fact the tear trough area is technically difficult and should only be carried out by a practitioner who is experienced and confident because, if done poorly, may result in unsightly lumps. Often it is not needed, and filling the midface instead supports the tear trough and sorts the issue nicely. I find that for the midlife woman, this is one of the most restorative and natural treatments but the filler has to be soft and pliable for midlife skin, something like Restylane refyne.

Lips are a real giveaway when it comes to the stamp of time on our faces. They get thinner and less plump and often develop small lines bleeding out from the edges (vermillion border). These can be particularly troublesome in terms of wearing lipstick and I see and hear of many women who just give up on this part of their make up regimen. Well there is good news; if this is you, it can be sorted really well with a very very tiny slither of filler all around the vermillion border. This restores the lip outline, helps banish the thin vertical lines and allows lipstick wearing again. And this also helps support the lip and tackles the volume issue. But if proper volume restoration is desired then a small volume of filler into the lip body can be added. And no, of course you don’t want or have to have a trout pout or duck lips! You do need a practitioner who understands the lip anatomy and that what women want from lip fillers at 21 is very different to that desired at 51.

Temples can be a real issue as we age. They can become sunken as fat is lost naturally. This can give the face a skeletal look, which is aging, and it is especially seen in women who are on the thinner side and/or do a lot of exercise, especially running. Its so simple to solve with fillers just injected into the area to lift the temple back to where it should be. It’s a simple intervention with no down time and makes a major difference and yet it is often neglected when people assess the midlife face for rejuvenation.

And you would be amazed at how building a chin, or straightening a nose can change someone’s entire profile. And it’s never too late. I built a chin for a woman in her 70’s and she cried at the difference it made. She emailed later to say that for the first time in her life she was happy to have photos at any angle! Both are simple procedures with predictable results, but if it is your nose, make sure it’s an experienced medical professional who does it… there are lots of danger areas in the nose, but in safe hands it’s a brilliant treatment.

And finally in the filler field. I have developed an area of interest in scarring. It’s amazing how women go through life caring for others but often living with the stigma of old scarring. Come midlife when our responsibilities change, we often have time for a greater focus on ourselves and I often see women reaching this new chapter and deciding to tackle those scars that they didn’t have time to address earlier but wanted to. It isn’t easy which is why not many people do it. You never know how a scar will react until you start trying to lift it with a filler. You always leave looking worse than when you arrive because I need to work under every area and do some subcision if needed (scar breakdown), so you need a couple of days to repair and see the improvement. However, using either hydrators or normal fillers I almost always see an improvement and usually its an improvement that no amount of laser/peels/prp/micro-needling have achieved.

PRP

PRP works by using your body's own platelets. Blood is taken from your arm and spun in a centrifuge to separate out the platelets and add them back in much greater concentrations. These platelets contain growth factors which stimulate the regeneration of tissue. This enhanced plasma is then injected into the skin in dozens of tiny injections which then stimulate the skin to regenerate, grow new collagen and elastin and improve the overall look. It can also be used to stimulate hair follicles to grow new hair! It is very good for overall retexturing and for targeting otherwise difficult to treat areas such as the skin around the eye. You do need 4-5 days down time as you look pretty sunburned after the procedure… but it could be worth it!

Dermaroller

Probably the most scientifically proven treatment for overall skin texture improvement, pigmentation and acne scar treatment and collagen growth. A small barrel covered in needles which is, after topical anaesthetic is applied, rolled over the face and causes bleeding and damage to the dermis. It is this damage that breaks down scar tissue and stimulates collagen growth. You need 3 treatments, 6 weeks apart and then probably one a year for maintenance although some patients have them more regularly because it works well for them. This is one of the few treatments used in the NHS for acne scarring. It can even be combined with delivering vitamin C or other nutrient packages. You do need 2-3 days down time as this also produces a very sunburnt look.

Laser/Radiofrequency

There is a plethora of lasers and radio frequency treatments out there. Aimed at skin resurfacing, scar improvement, skin tightening, and hyperpigmentation there certainly is value in many of them. IPL for hyperpigmentation works well for those aging sun spots and I can vouch for that! Radiofrequency heats the skin and causes the collagen to tighten and regenerate and so the skin above the area not only tightens but also regenerates over time and the texture improves. They are nice treatments for maintenance and general overall skin improvement and I would see them as a nice add on to any skincare regime. I have previously had treatment with Teresa Tarmey in West London and so can recommend her thoroughly. Link at end.

Peels

Peels have been around for a long time and go in and out of fashion. They are often used alongside lasers and can offer good short term brightening. Claims are often made for superficial peels being good for treating fine lines and wrinkles, large pores and dark spots, and to help skin tightening and that medium-depth peels can help treat skin that has a significant amount of photo damage, sun spots, mild to moderate acne scars, crepey skin under the eyes or dark circles. My advice would be to do your research and ask the practitioner to show you before and after results that show improvement on skin similar to yours! Teresa Tarmey combines a very light peel with lasers when you have an all over facial treatment with her.

So as can be seen there are lots of solutions for the many challenges presented by midlife skin and this is by no means a definitive list but covers the main players. The most important issue is that the practitioner you choose should be medically trained and skilled in assessing and treating the older face and skin. It really isn’t one size fits all and in my experience, what we marvellous midlife women want, is not something that they have never had. So not shiny new enormous lips, cheeks or a non-moving forehead but rather a subtle brightening that makes us look fresher well rested and not so tired. And trust me, in the right hands this is achievable, So please, do your homework, don’t be shy - ask for before and after pictures on women of a similar age and with similar skin types and take your time, don’t be rushed into a treatment. My mantra is always, “Let’s start slowly, we can always do more, there is no rush”.

• More info about Dr. Renee Hoenderkamp
  
  My clinic website is www.nonsurgicalclinic.co.uk

• To see examples of my current work follow me on Instagram (please) @TheNonsurgicalClinic

Watch below to see Laura from Marvellous Midlife and Dr Renee chatting about all things midlife including perimenopause, anxiety, relationships and more click on the link https://youtu.be/ozVqROoWZ5c