Anti-ageing in your 40s

Key takeaways

• The 40s are when the face moves from surface changes to structural ones: volume and early loosening.
• Daily sunscreen and a retinoid remain the base. They protect any treatment you add.
• For women, perimenopause can change the skin quickly: drier, thinner, sometimes more pigment.
• Each concern has a matching treatment. One treatment rarely fixes everything.
• Decide where you want to be at 50, then plan one or two steps a year rather than many at once.

What changes in your face in your 40s?

Normally, people in their forties tell me something like, "Doctor, I look tired in photos, even when I'm not." That is usually the first sign of the structural changes.

See, what happens is, three things start to overlap: - Lines that stay. Frown lines, forehead lines and crow's feet that were only visible with expression in your thirties now show at rest. - Early volume loss. The fat pads in the cheeks and under the eyes begin to shrink and move down slightly. The face looks flatter and more tired. - Early laxity. The skin loses some firmness. The jawline begins to soften and the folds from nose to mouth deepen.

On top of that, sun damage from earlier decades shows up as spots and uneven tone. Weight matters too. A study of identical twins found that in people over 40, a somewhat higher body weight was linked with a younger-looking face, while under 40 it was linked with an older one. Fat in the face supports it as we age. That is very important to understand if you are losing weight in this decade. My article on the face after weight loss goes into it.

What about perimenopause and the skin?

For women, the forties often bring perimenopause. Estrogen levels start to swing and then fall, and the skin often becomes drier, thinner and less firm. Older research found skin collagen falls steadily in the years after menopause. Some women also notice more pigment, adult acne or sensitivity.

This is a hormonal change, not only a skin one. If you are also having hot flushes, poor sleep, mood changes or irregular periods, speak to a gynaecologist. At our Thane centre, Dr Anagha Karkhanis runs midlife care one floor above. My article on menopause and your skin has more.

What still matters most every day?

The base doesn't change in your forties, and it still gives the best value: - Daily broad-spectrum sunscreen. A randomised trial of adults found daily users showed no detectable increase in skin ageing over four and a half years. - A retinoid at night, if tolerated. Your skin may be drier now, so pair it with a richer moisturiser. - A moisturiser suited to drier skin. What worked in your thirties may not be enough. - Not smoking. In the twin study, the longer a twin smoked, the older they looked. - Protein, sleep and strength training. They help your body and the tissues under your skin.

Which treatment fits which change?

This is the table I go through with patients. One concern, one matching treatment.

A few honest notes on these: - Fillers in the forties: a little goes a long way. I'd rather put back some support in the cheek than fill every fold. The FDA lists the cheeks among approved areas for absorbable fillers and is clear that the most serious risk, though uncommon, is accidental injection into a blood vessel. That is why the injector's training matters. - Tightening devices: a 2020 meta-analysis of HIFU found moderate improvement in the face and neck with short-term safety. Moderate is the right word. It suits early laxity, not significant sagging. - Thread lifts: the published evidence on how long the lift lasts is limited, so I discuss them carefully. See thread lifts explained.

How do I avoid looking "done"?

Basically, by doing less, more slowly. The faces that look overdone are usually the ones where many things were done at once, or where volume was added to chase every line.

What I do: - Treat the one or two concerns that bother you most, then wait and look again. - Keep doses and volumes conservative, especially the first time. - Respect your expressions. You should still look like yourself when you smile or are cross. - Write down product and dose each time, so the next session builds on the last rather than guessing.

That is what I mean by "rested, not different". My article on why some faces look overdone explains it further.

How do I plan the next ten years?

I play chess the way I was taught: endgame first. So ask: where do I want to be at 50? Usually: a face that looks rested, with healthy skin, a defined jawline and no obvious "work".

Then work backwards: 1. Daily protection, always. 2. Address the biggest structural change first, gently. 3. Add one thing at a time, with a review in between. 4. Fix a maintenance calendar so nothing gets added without a reason.

I would rather you spend modestly every year than a lot in one go. You can see a sample rhythm in your anti-ageing maintenance calendar.

How I approach anti-ageing in your 40s at Dr Tvacha

At a face assessment, I look at your face at rest and in movement, ask what you want to change and what you want to keep, and map each concern to the right layer. I tell you if I think you should wait. If we go ahead, the plan, product, dose and fee are written down before you pay. You can read about the Long Game Anti-ageing Plan or find our centres in Thane and Mumbai.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.