What Really Happens to Our Faces as We Age?
- 10 hours ago
- 5 min read
Facial ageing is far more complex than the gradual appearance of lines and wrinkles. As we get older, we lose collagen and elastin, facial fat changes position and volume, the supporting structures beneath the skin alter and even the bones of the face gradually remodel. For women, hormonal changes during and after menopause can affect the skin too. Together, these changes can alter everything from the shape of our cheeks and jawline to the appearance of our eyes, mouth and neck.
Put photographs of yourself at 25, 35, 45 and 55 side by side and the changes can be surprisingly difficult to pinpoint. You still look like you, but perhaps your cheeks aren't quite as full or your jawline has softened. Maybe the lipstick shade you've worn for years suddenly doesn't seem to sit quite the same way around your mouth. It is tempting to put all of this down to wrinkles. In reality, that's only a small part of the story.
The face ages in layers. Skin changes, certainly, but so do the fat compartments beneath it, the ligaments that support the tissues, muscle and even the underlying bone. Those changes happen gradually and interact with one another, which is why treating an ageing face is rather more complicated than simply finding a wrinkle and filling it.
The image above is a useful illustration of that progression. It shows a face moving from the relative fullness and smoothness associated with youth through increasing lines, volume changes, skin laxity and changes around the eyes, mouth and jaw.
Real life, of course, is considerably less orderly. There isn't a point at which you turn 40 and acquire fine lines, or celebrate your 50th birthday and promptly lose your jawline. Genetics plays a part, as do hormones, sun exposure, smoking, weight changes, general health and the way your individual face is constructed. Two women of exactly the same age can therefore age very differently. And that is precisely why I believe good aesthetic treatment should begin with understanding the face in front of you, rather than treating somebody according to their age.
It's not simply that our skin becomes less elastic
When we think about facial ageing, skin tends to get most of the attention. As we get older, the production of collagen and elastin reduces, and skin becomes thinner and less able to spring back in quite the way it once did. Years of facial movement begin to show as lines around the eyes, forehead and mouth, while accumulated sun exposure can become more visible through pigmentation and changes in texture.
For women, menopause can make some of these changes feel considerably more sudden. Falling oestrogen levels affect collagen, hydration and skin thickness, so patients will often tell me that they feel as though their face has changed markedly within only a few years. But look beneath the skin and there is much more happening.
The youthful face has a different structure
Younger faces tend to have more volume through the cheeks and mid-face, creating the softer contours we associate with youth. Over time, facial fat doesn't simply disappear. Some fat compartments shrink, while others can descend or become more prominent.
At the same time, the structures supporting the face change. The result can be flattening through the cheeks, hollowing around the temples or eyes, deeper folds between the nose and mouth, and increasing heaviness lower down the face. This is one reason why somebody can look in the mirror and think, I look tired, despite feeling perfectly well - because they aren't necessarily just seeing the wrinkles.
Even our bones change
This is perhaps the part of facial ageing that surprises people most. The facial skeleton isn't fixed for life. Bone remodels as we age, and changes around the eye sockets, cheeks, jaw and other areas alter the underlying framework supporting the soft tissues above.
Imagine changing the frame underneath a piece of fabric. Even if the fabric itself remained unchanged, it would sit differently. Our faces are infinitely more complex, but the principle helps explain why looking only at the skin can never give us the whole picture.
It also explains something else I see frequently in clinic. A patient may arrive convinced that she needs one particular treatment because she has seen it on Instagram, a friend has had it, or she has identified one feature she wants to change. But once we look properly at her facial anatomy, the treatment she thought she needed may not be the one I would recommend at all.
So when should you start having aesthetic treatments?
There isn't a correct age. I don't believe in reaching 40 and deciding you ought to have Botox, any more than I believe somebody in their 60s or 70s has somehow left it too late. The more useful question is: what, if anything, is bothering you?
For one person it might be pigmentation or skin quality. For another, hooding around the eyes. Someone else may be perfectly happy with her lines but dislike the increasing softness beneath her chin. Another patient may simply want to look a little less tired without anybody being able to identify what she has had done.
Those are very different concerns and they require very different conversations. It is also where aesthetics can go wrong when treatments are approached as a menu. Botox does one thing. Dermal filler does another. Skinboosters, polynucleotides, Morpheus8 and surgery all have different indications, limitations, risks and potential results.
More treatment isn't necessarily better treatment, and newer doesn't automatically mean better either. The important thing is knowing what you are trying to achieve in the first place.
You don't have to want to look younger
This is perhaps the distinction I find most important. Most of the women I see don't walk into my clinic asking to look 25 again - they want to look like themselves. They might want their eyes to look less heavy, their skin to look healthier or the lower part of their face to feel a little firmer. They may want to address something that has bothered them for years, or a change that seems to have appeared almost overnight.
That is a perfectly reasonable place to start. You can be interested in aesthetic treatments without wanting to transform your face. You can dislike one aspect of ageing without believing that ageing itself is something to be ashamed of. And you can ask about a treatment without committing yourself to having it. In fact, I would much rather somebody understood her options properly before making any decision at all.
Curious about aesthetics? Come and ask me
On Thursday September 17th I'm hosting an evening at Stanbrook Abbey Hotel in Worcester devoted to exactly these conversations. I'll be talking about how and why our faces change as we age, what different aesthetic treatments can genuinely achieve, where their limitations lie and how I assess which approaches may - or may not - be appropriate for an individual patient.
We'll talk about the skin treatments you'll have heard of and some of the newer technologies available - like our new Quatum10 FaceTite - as well as surgical options including blepharoplasty. Most importantly, there will be plenty of opportunity to ask questions.
The evening isn't a consultation and you won't be expected to book a treatment. There will be no being singled out in front of the room and told what you “need” doing. It is simply an opportunity to get proper information from a consultant surgeon, in a relaxed setting, and ask the questions you may have wondered about but never quite known who to ask. Come on your own or bring a friend and make an evening of it.
Curious About Aesthetics?
Thursday September 17th 2026, 6.30pm-10pm
Stanbrook Abbey Hotel, Worcester
Tickets £20, including a welcome drink. *Booking fee applies.
If you've ever looked in the mirror and wondered what exactly has changed?, this event a great place to start.
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