Why your face changes in midlife, and what you can actually do about it

Think your face is changing just because you're getting a few more wrinkles? Think again. Your face isn't just ageing on the surface. Beneath those new lines and softer contours, your bones, fat, muscle and supporting tissues are changing too. And by your 40s and 50s, those changes can start to become much more apparent.

So, if you have reached your midlife years and suddenly feel as though your face has dramatically changed, you're not imagining it. Those hollows under your eyes, the softer jawline or those less defined cheekbones aren’t just down to a few more wrinkles. According to Dr Riaz Agha, a plastic and reconstructive surgeon at Harley Clinic, facial ageing is about far more than what happens on the surface with changes happening beneath the skin as well.

‘Ageing is very much a three-dimensional process,’ he says. ‘The skin is the part we can see, but underneath it there are changes taking place in virtually every layer of the face. As we get older, we gradually lose collagen and elastin, so the skin becomes thinner, less elastic and less able to spring back. At the same time, the deeper structures are changing too. Facial fat, which is arranged in distinct compartments, can lose volume, change position and become less evenly distributed with age. The retaining ligaments and other supporting tissues are also changing, while the underlying facial skeleton itself remodels over time. The result is not simply wrinkled or loose skin. It is a change in the architecture of the face.’

‍This certainly explains why those plump, rosy, apple cheeks we once took for granted are heading south, our eye sockets are starting to look like deathly hollows, and our once-sharp jawlines are edging into turkey territory. Genetics, facial anatomy, hormonal changes, sun exposure, smoking and weight fluctuations can also influence how and when changes appear. By midlife, the combination of all these changes can become much more noticeable which may explain why you feel your face has drastically changed over the years.

‘These distinctions matter, because if you misunderstand the cause of the changes, you can end up choosing skincare and treatments that do not address them,’ he adds. Which is a useful thing to remember the next time Instagram tells you that you need the latest beauty fad. It also explains why you can’t treat facial ageing as purely a skin problem.

So where does skincare actually fit in?

‘Skincare can improve the quality and appearance of the skin itself,’ says Dr Agha. ‘What a cream cannot realistically do is restore significant facial volume loss, reposition deeper tissues or reverse age-related changes to the facial skeleton.’

In other words, don't expect an £80 moisturiser to work like a facelift. However, depending on the ingredients, some evidence-based skincare can help with pigmentation, texture, fine lines, hydration and some effects of sun damage. Dr Agha adds that retinoids have good evidence for improving signs of photo-ageing, while daily sun protection is one of the most useful things you can do to protect your skin over the long term.

Dr Riaz Agha

What about collagen?

Collagen has become one of the biggest buzzwords in midlife beauty, from powders and supplements to treatments designed to stimulate the body's own collagen production. The evidence around oral collagen supplements is mixed. Some research suggests certain hydrolysed collagen products may modestly improve measures such as skin hydration and elasticity, but studies vary.

‘There are also treatments that work by creating a controlled stimulus intended to encourage the skin's repair response and collagen production,’ he says. ‘Depending on the treatment, there can be evidence for improvements in aspects of skin quality.’

Dr Agha's advice is to be wary of allowing the word ‘collagen’ to do too much of the selling. ‘”Stimulates collagen” has become an extremely powerful marketing phrase,’ he says. ‘Patients should ask: what is the evidence for this particular treatment, what degree of improvement can I realistically expect, what are the risks, and is collagen loss the main issue I am trying to correct?’

If your concern is pigmentation, rough texture, fine lines or sun damage, Dr Agha says you’re mainly looking at skin quality, so skincare or skin treatments may be able to help. If it’s hollowing or loss of fullness, volume could be part of the issue and there are treatments that can help. Significant sagging or jowling is a different story, though, and may require a medical or surgical approach.

‘Start with the problem you are actually trying to solve rather than starting with a treatment you have seen online,’ he says. That sounds obvious, but how many of us have Googled a facial treatment because we've noticed something in the mirror, or seen something online without even considering if it’s right for us.

He also warns against anything promising a ‘facelift without surgery’. ‘Non-surgical treatments can be useful for the right person and the right concern, but they have limitations.’

His advice is refreshingly straightforward: ‘Sometimes the best treatment is no treatment at all and a responsible practitioner should be comfortable saying that,’ he states. Perhaps the most useful message is that facial ageing isn't a problem that automatically needs solving. Good skincare, sun protection, exercise, sleep, nutrition and not smoking all have a role in supporting healthy ageing. But none of them, and no aesthetic treatment, can actually stop the clock.

‘The objective should not be to make a 50-year-old look 25,’ he adds. ‘Successful facial rejuvenation should be about looking healthy, balanced and refreshed while still looking like yourself.’

‍And this feels like a much more appealing goal than chasing an increasingly unrealistic version of youth.

Dr Agha’s top 3 tips for keeping your face looking healthy and natural

1.     Protect the skin you have. ‘Be consistent with sun protection, avoid smoking and use evidence-based skincare rather than continually chasing the newest trend.’

2.     Look after your health. ‘Exercise, nutrition, sleep and maintaining a reasonably stable, healthy weight matter. Your face is part of your body; we shouldn't treat facial ageing as though it occurs independently of everything else.’

3.     If you are considering aesthetic treatment, treat the anatomy rather than your age. ‘Don't have a procedure simply because you have reached your 40s, and don't assume that every change requires filler or surgery. Have a proper assessment, understand what is actually causing the feature that bothers you, and choose the least invasive intervention capable of achieving a worthwhile result.’

Dr Riaz Agha is a plastic and reconstructive surgeon at Harley Clinic. To find out more about his work visit harleyclinic.com