Why Your Face Changes in Your 40s and 50s, and Why More Filler Isn't Always the Answer

Have you ever looked in the mirror and thought, I don't necessarily look older, I just look... different? Maybe your face looks more tired. Your jawline doesn't feel quite as defined. Your cheeks seem flatter, lines around your mouth have become more noticeable, or your skin simply doesn't have the same firmness it once did.

It's very common to start noticing these changes in your 40s and 50s. And one of the most important things I explain to patients at PureMed is this: Facial ageing isn't simply a case of losing volume, so adding more filler isn't always the answer.

What actually happens to your face as you age?

When we look at an ageing face, we're looking at several different layers. Changes can happen in:

• the underlying bone structure
• facial fat and its distribution
• muscles
• collagen and elastin
• skin thickness, texture and elasticity

Hormonal changes around perimenopause and menopause can also affect the skin. As oestrogen levels change, collagen production, hydration and elasticity can decline. That means the face you see in the mirror is the result of several changes happening together.

This is why I don't believe in simply looking at an individual line and deciding to fill it. I want to understand why that line or change has appeared in the first place.

Why can the lower face start to change?

This is one of the most common things women mention to me. You might notice:

• a softer or less defined jawline
• heaviness around the lower face
• marionette lines
• folds around the mouth
• flatter cheeks
• changes around the chin
• looser or thinner-looking skin

It's tempting to look at one of those areas and think, I need filler there. Sometimes filler absolutely is appropriate. But sometimes the visible concern is being caused by changes somewhere else.

For example, reduced support through the mid-face can affect how the lower face looks. Skin laxity may be contributing. Collagen loss may be affecting the quality and firmness of the skin. Often, it's a combination.

So, is filler bad as you get older?

Absolutely not. I use dermal filler regularly and it can produce beautiful, natural-looking results when it's used for the right reason. The important question is not: "Should I have filler?" It's: "What am I actually trying to correct?"

If we're trying to restore lost volume, improve proportion or provide structural support, filler may be exactly what I recommend. Cheeks, chin, jawline, lips and other areas can all potentially benefit from carefully placed filler depending on your anatomy and what you want to achieve.

But if the main issue is skin laxity or declining skin quality, repeatedly adding volume may not address the real problem. That's where treatment planning becomes much more important.

When might I consider Sculptra instead?

Sculptra works very differently from traditional dermal filler. Rather than simply placing volume into a particular area, Sculptra is a collagen-stimulating injectable treatment. The results develop gradually as your body responds to the treatment.

For the right patient, this can be particularly appealing because the change isn't designed to happen overnight. Over time, the aim is to improve support and restore some of the structure that has gradually been lost.

I often discuss Sculptra with patients who tell me: "I want to look fresher, but I don't want people to know I've had anything done."

It isn't a replacement for filler in every situation. Sometimes filler is more appropriate. Sometimes Sculptra is. And sometimes I may recommend using the two strategically as part of a wider plan.

What if the problem is skin laxity?

This is another reason I don't automatically reach for filler. If I'm looking at a face and thinking that laxity is playing a significant role, adding more volume isn't necessarily going to give us the result we're trying to achieve.

Instead, we might discuss treatments aimed at tightening or improving the skin and underlying tissues. At PureMed, that may include treatments such as Laser Lift or RF microneedling, depending on the individual. Again, the important part is identifying what we're treating first.

And what about skin quality?

You can have beautifully balanced facial proportions and still feel that your face looks tired because the skin itself has changed. Things such as:

• fine lines
• uneven texture
• pigmentation
• enlarged pores
• dryness
• dullness
• crepey skin
• loss of firmness

need a different approach from volume loss.

Depending on the concern, I may discuss treatments including microneedling, RF microneedling, polynucleotides, skin boosters, peels or medical-grade skincare. Improving skin quality can make an enormous difference to how fresh the face looks without changing the shape of your face at all.

Why combination treatment can look more natural

There is sometimes a misconception that having a treatment plan involving several different treatments means having more work done. It can actually mean the opposite.

If several different things are contributing to what you're seeing, using small amounts of the right treatments in the right places can be much more subtle than asking one treatment to do everything.

For example, a treatment plan might focus on:

• structure
• collagen
• skin quality
• laxity

rather than simply: more volume.

That doesn't mean everyone needs four treatments. Some patients need one. Some need several treatments spread over time. And sometimes my recommendation is to leave an area completely alone.

How I assess an ageing face at PureMed

When you come to see me, I'm not just looking at the line or area you've pointed out. I'm looking at your face as a whole. I consider your facial structure, proportions, volume distribution, skin quality, movement and areas where support may have changed.

I'll also ask what actually bothers you. Because there is a big difference between treating something because it exists and treating something because it genuinely bothers you.

From there, we can decide what should be prioritised, what can wait and what I don't think you need at all.

For me, good aesthetics isn't about doing as much as possible. It's about knowing what to treat, what not to treat and when enough is enough.

"I know I look different, but I don't know what treatment I need"

That's completely normal. You don't need to diagnose your own face before booking an aesthetics consultation. In fact, I'd much rather someone came to me saying: "I don't know what I need. I just want to look fresher."

That gives us the opportunity to assess what has actually changed rather than starting with a treatment you've chosen from Instagram.

You might need filler. You might benefit more from collagen stimulation, skin tightening or improving skin quality. Or the best result may come from a carefully planned combination over time. The treatment should follow the assessment, not the other way around.

A more considered approach to ageing

My aim at PureMed isn't to make a 50-year-old woman look 25. It's to help you look like you - just fresher, more rested and more confident in what you see in the mirror.

Ageing is normal. Wanting to address some of the changes you notice is normal too. The key is understanding what's changing and choosing treatments that work with your face rather than simply adding more product.

If you've noticed changes in your face but aren't sure whether filler, Sculptra, skin treatments or something else would be most appropriate, the best place to start is with an assessment.

PureMed Aesthetics, Winslow, Buckinghamshire
Consultations are available for personalised facial and skin treatment planning.