One of my patients once walked in with her kids, a girl aged 6 and a boy aged 1. After my session with her ended, she said her daughter had some cosmetic skin concerns too! The little girl told me that her skin felt rough while her brother’s was softer and she, in her words, ‘No like it. As we age,we desire to have the skin of a baby’s— chubby, plump, and soft and bouncy, so that when you pinch it, it bounces right back.
All of us see and notice what happens to the skin on top. There are enough anti-ageing products on the counter and advertisements to highlight them and educate you on signs of skin ageing. Here’s a quick recap:

  •  Dryness that needs hydration.
  •  Dullness that needs illuminating essence.
  •  Dark spots and pigmentation that needs diminishing.
  •  Wrinkles that needs to be smoothened.
  •  Sagging skin that needs a lift.

If you thought all these changes on the skin are because of ageing alone, you’re mistaken.
While we grow into beautiful adults, our bone structure gets more defined, the fats go leaner, and the face gets more contoured. All this happens with the skin still glowing with youth. We love that part of ageing or ‘coming of age’ as we like to call it. By the time we hit 25, the tired look under the eyes, the dry skin, and may be the hollow pockets under the eyes start to bother us. A lot of people come to me at this age just saying, ‘Doc I just look tired all the time, even though I sleep well and do all things right by the book.’ This is when you know you are turning towards the wrong side of skin ageing. The first sign that your skin has started ageing is that it looks dehydrated. There is pigmentation, may be just a difference of tone on the face, and a few dark patches by the side of your eyes, dryness, and the pores look larger. The fine lines and creases start to show. Your skin looks dull.
Gradually you see fine lines and collagen and elastin begins to ease from the tight youthful mesh. You move to the 40s and see shadows on the cheek—the area in front of the ear—prominent laugh lines, crow’s feet, frown lines, and down turned corner of the mouth with a permanent stressed out and sad expression.
If you indulge in rapid weight loss and excessive cardio, then you can even get a ‘Runner’s Face’ i.e. gaunt, bony, and sucked out. Your body might look lean but the face does not match up, and you people asking you if you are feeling well or not, especially in India.
In your 50s, you see hollows along the temples and under eyes, cheeks sag down, and the face tends to divide into sections, with bulges over the laugh lines and jowls. Pigmentation could be a part of all of this at any age.
What you need to understand is that all that you see on your face is not what happens on the skin surface alone. So the beauty solutions may need to go beyond just application of the product on the skin alone. A lot of the symptoms are the result of what happens beneath.
We, however, know that the first sign of ageing is dryness and dullness due to the changes in the skin itself. The skin cells start to lose moisture. The ceramides that protect your epidermis also start to become less effective, leaving your skin vulnerable to outside irritants. Dead cells on top do not slough off easily and the clumped melanin stays on with it, making you look dull and darker. All of this is further aggravated through sun exposure.
Your skin defence 1:
> Sunscreen
> Exfoliator
> Moisturizer
> Night cream with collagen boosters
> Omega-3 supplements
> Beauty nap (mid-day, 20 minutes)
> Good night’s sleep,workouts, and balanced diet
At your skin doctor’s:
> Regular hydrating Medi-Facials
> Superficial peels
> Radio frequency
> Mesotherapy with non-cross linked hyaluronic acid.
The second sign of ageing is change in skin tone or even pigmentation.
You will also start to notice patchy skin which may be just due to the accumulation of dead cells on the top layer and the melanin clumped with it. As you age, your skin’s capacity to naturally peel off the dead layer is impaired and brown spots occur due to clumping together of excessive melanin at one spot spurred by the UV rays and hormones.
Your skin defence 2:
> Avoid sun between 10 am to 4 pm
> Follow all the points mentioned in the defence 1list
> Skin lightening cream at night
> Vitamin C serum under the sunscreen
> Antioxidant oral supplement
At your skin doctor’s:
> Peels
> Q switched Nd Yag lasers
> Mesotherapy with vitamin C and other antioxidants
The third sign of ageing is thinning skin and wrinkles. As your skin ages, the collagen and elastin regenerate less and the structure gets damaged. The skin starts to thin and lines appear on various areas of your face starting with under eyes, around the eyes, around the mouth, and forehead. Prolonged and excessive exposure to harsh sun could lead to leathery thickness of the skin, what we call Solar Elastosis.
Your skin defence 3:
> All on list 1
> Collagen boosting night creams
> Amino acid and essential fatty acid supplements
At your skin doctor’s:

  •  Radio frequency
  •  Collagen stimulating lasers
  •  Medium depth peels
  •  Micro needling
  •  Botox
  •  Platelet rich plasma

The fourth sign of ageing is facial sagging. This is where all the structures of the face come into the picture. Your features actually start to droop. The nose tip falls, the jaw and the mouth sag, and so do the eye and your brow.
After all the gyan I have given you in this section, you must know that each one of us ages differently, the reason being:
> Genes
> Lifestyle and Environment
> Attitude
> Bone structure of your face—this resorbs as you age too
If during your youthful days, you had high cheek bones, a well-defined jaw line, and arched eye brows, you will age beautifully. If on the other hand you are not so blessed with a defined bone frame and have a round face, you have to be prepared. As you grow old, you will notice your face collapsing much faster. It will bulk up at the lower part, leading to jowls and lax under the chin and neck areas. Get some fillers placed strategically just above the bone and all glory would be restored. This is where your doctor’s aesthetic sense, i.e. the art with the science, counts.
Your skin defence 4:
> All from list 1 and 3
> Workouts and weight training
> Vitamin D3 and calcium supplements
At your skin doctor’s
Fillers, I tell you, are the true gift medical science gave aesthetics. They are my all-time favourite tools. The results are instant—like a blow dry for the hair—and last up to a year. I always tell my actor patients that fillers are like a theatre performance—you get to know the audience’s reaction instantly and it’s a great kick to the artist. It is so beautiful to see faces transform right in front of you, unlike lasers and other treatments where we work long sessions and repeatedly many a times and the results are like a movie that releases months later.
Contributing structures under the skin
Ageing and your facial muscles. The other component that contributes to your beauty are the facial muscles.
Unlike the rest of the body, they are attached to the skin above and not the bone below. So each time they contract to make an expression, they drag the skin along which leads to the formation of expression lines. Botox can be your saviour here. This does not mean lessening your facial expressions. It’s about selectively relaxing the muscles to an extent that the unwanted negative and depressing expression lines are removed.
Sometimes your muscles also bulk up, leading to changes in the shape of your face. This is called hypertrophy. When you chew excess gum or have a habit of grinding your teeth at night or when in stress, one of the muscles of mastication, the masseter, bulks up, causing the lower face to look very broad. Even in such cases, Botox injections can de-bulk the muscles to narrow down your face. Beware! Don’t try to get it too narrowed down or you may end up looking unnatural.
A few muscles in your face could go in constant contraction, like the depressor at the corners of your mouth. This makes you look sad all the time with a down turned mouth. Minute shots of Botox into that muscle is all it takes to put the joy back in your smile. Other features like the brow shape and the dipping tip of your nose can all be beautified with Botox. Also, Botox applied to the Platysma muscle on the jaw line helps you stop tugging your face down. This treatment is popularly called Nefertiti treatment.
Facial fat pockets are another important component contributing to a youthful face. If you are born with a fuller face, you tend to remain fresh looking and attractive most of the times. If not, the first sign of tiredness sets in as the fat pocket under your eye shifts and resorbs. Likewise, fat in the other sections of your face either resorbs like the cheeks or descend like in the jowls making you look less attractive. They have a sequence in the way they show change while you age.
In a journal published by the Department of Plastic Surgery, University of Texas, titled ‘The fat compartments of the face’, authors Rod J. Rohrich, M.D. and Joel E. Pessa, M.D. say, ‘The subcutaneous fat of the face is partitioned into discrete anatomic compartments.
Facial ageing is, in part, characterized by how these compartments change with age.’ The numbers in this picture indicate the order in which these fat pockets are affected as you age.
Your beauty defence:

  •  Do not lose weight drastically
  •  Consume at least 2 spoons of oil/ghee per day
  •  Take essential fatty oil supplements

At your skin doctor’s:

  • Fillers to add what is lost
  • Lipo dissolve to dissolve what has bulged up and decended

The Ageing Timeline:
Age 25–30: Visible ageing begins when the skin cell renewal starts to slow down.
Age 30–35: Expression lines become more prominent as collagen and elastin start to break down.
Age 35–40: Static lines begin to appear. Skin starts to thin. Skin becomes noticeably more dry. Shift of facial fats become noticeable.
Age 40 onwards: The change may suddenly be visible, especially with Indian skin types. If you are petite with a good bone structure and stable body weight, you would have enjoyed a blessed skin up until now, and at 40 it all seems to suddenly give up—skin, face, and body!
Age 50 onwards: Facial muscles sag along with the other structures like fat. Bone framework and teeth support is compromised and skin appears fragile.