The Long Game: why I plan anti-ageing over five years

Key takeaways

• Most anti-ageing results are temporary and the face keeps ageing, so a single big session is the wrong shape of plan.
• I start by asking where you want to be in five years, then plan backwards.
• The four steps are Assess, Protect, Restore and Maintain, in that order.
• Small, spaced steps over years usually look more natural than a lot done at once.
• I would rather tell you to wait than do a treatment you don't need.

Why do I think in five years?

I started chess at three and a half, and I played at the national level as a child. My coaches taught me the endgame first, then the middle game, then the opening. As a child that felt backwards. Later I understood. If you know what a won position looks like, you can judge whether today's move helps.

In chess you win if you checkmate the person, so it's about results. In anti-ageing the result isn't one day in the mirror. It's how your face looks across years.

See, what happens is, nearly every non-surgical result fades. Anti-wrinkle injections wear off in a few months. Fillers are absorbed. Even a surgical facelift, as the Mayo Clinic notes, does not stop ageing. So a plan that only thinks about this month is incomplete. It leads to chasing: a bit here, a bit there, until the face looks different rather than rested.

Five years is long enough to see a real pattern, and short enough to plan honestly.

What are the four steps of the Long Game?

Assess

At the face assessment, I ask what bothers you and what you don't want changed. I look at your face at rest and in movement, layer by layer: skin surface, muscles, volume, support. I take your health history. Then I explain. My article on what happens at a face assessment has the details.

Protect

This is the step people want to skip, and the one with the best evidence. A randomised trial in Australia, published in 2013, found that adults who used sunscreen daily showed no detectable increase in skin ageing over four and a half years, and 24% less ageing than those who used it now and then. A study of identical twins found that the longer a twin smoked, and the more sun they had, the older they looked.

So Protect starts on day one: daily sunscreen, a sensible routine, and honest talk about smoking and sleep. That is very important to understand. If we skip it, everything we do in Restore fades faster.

Restore

Only now do we talk about treatments. The menu at our centres includes anti-wrinkle injections, hyaluronic acid fillers, thread lifts, HIFU, radio frequency, Intragen, RecoSMA, laser therapy and PRP. You won't need most of these. Normally, one or two treatments, chosen for your main concern, do the work.

My rules for Restore: - Treat what matters most to you first. - Conservative doses and volumes. We can add at review. - One change at a time, so we both see what each one does. - Product and dose written down before treatment, every time.

Maintain

We plan maintenance at the start, not when the effect wears off. You see the yearly picture before you spend anything. Review dates are fixed on day one, and once a year we look at the whole plan: what to keep, what to stop. See your anti-ageing maintenance calendar.

What does "rested, not different" mean?

When people tell me what they want, it is almost never "make me look 25". It's "I don't want to look tired" or "I want to look like myself on a good day".

That is the goal. Friends should say you look well, not ask what you've had done. You should still be able to frown when you're cross and smile when you're happy. Faces that look overdone usually come from doing too much at once, or from chasing every line. My article on why some faces look overdone explains it.

Basically, small steps over years look like you, ageing well. Big steps in one go look like a change.

Why would I tell you to wait?

Because sometimes waiting is the right move. In chess, not every turn needs an attack. Some reasons I suggest waiting: - The concern is mainly sun damage or dryness, which skincare can improve over a few months. - You are in your twenties or early thirties and nothing has set yet. - You are pregnant, planning pregnancy or breastfeeding. - You are in the middle of weight loss and the face is still changing. - You are under pressure from someone else, not doing it for yourself.

The NHS advises thinking about why you want a cosmetic change, and taking time after a consultation to decide. I'd rather you leave with a plan and no treatment than with a treatment you didn't need.

How does the Long Game work at Dr Tvacha?

The Long Game Anti-ageing Plan runs at our four centres: Thane, Andheri, Bandra and Dahisar. The face assessment is Rs 499. After it, your plan is quoted in writing. Injectables are priced per treatment, with the product and dose written down before treatment. Review dates are fixed on day one, and the maintenance plan is part of the first conversation. I don't push. I offer options and tell you what I'd do; the decision is yours. You can read the full Long Game Anti-ageing Plan, see when to start anti-ageing, 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.