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What are the best aesthetic treatments for those in their 40s?

Getting old is inevitable. Towards the end of your 20s, you begin to lose your baby fats, revealing a more feminine, womanly look. When you reach the 30s, you will start to notice that it takes extra effort to shed weight off as the decline of our metabolism becomes increasingly visible with loss of muscle mass of about 3-8%! At the age of 40, most people find that it’s the ‘tipping point’ when skincare products do not work anymore and new signs of ageing are showing up everyday!

There isn’t a miracle treatment that addresses all the changes that occur with ageing. But don’t feel that you have to accept these signs of ageing. There are plenty of options available to reverse (some of) these signs! Doing regular treatments in this decade will set you up for more natural outcomes and minimize the need for more invasive and drastic treatments in your 50s and 60s!

In this article, I have classified the best treatments based on specific concerns to make it most relevant to you.

Wrinkle treatments

Wrinkles that are related to facial expressions are the frown lines, crow’s feet, bunny lines and the forehead lines. These lines are normally seen with facial expressions. However, as we age, we lose collagen and elastin, repeated facial expression can result in more prominent wrinkles commonly seen at the age of 40.

Botox is the most effective treatment for such wrinkles. Botox works by blocking chemical signals that cause muscle contraction. By limiting such movements, the dynamic expression lines will soften. The effect of Botox generally only lasts for about 3 months and repeated injections are required. Regular botox treatment in the 40s will prevent wrinkles from deepening further to form ‘static lines’. These expression lines are seen even all the time even when no expression was made. This is commonly present in the 60s and 70s. Botox is a very commonly done procedure, and does not usually cause a frozen look if it is done at an appropriate dose.

If botox is not something you would consider at this stage, you should consider other collagen stimulating treatments discussed below.

“Saggy” lines treatment

The cause of laugh lines and marionette lines around the corners of the mouth are very different from the above mentioned expression lines and the approach to treat them is not the same. As we age, we lose muscle and fat especially in the mid face (from under eyes to the corners of the mouth), when the original volume is lost the skin sags downwards. These lines are accentuated as our skin gets thinner and loses its elasticity.

To address volume loss issues, the most direct way is to inject fillers to replace the lost volume. There are different types of fillers and HA fillers remain the most commonly used filler across the world as the results are reproducible, correctable and has a low risk of complication compared to collagen stimulating fillers. Ulthera, commonly known as the non-invasive facelift, is a procedure that stimulates collagen and elastin production in the deeper layers of the skin. Ultraformer III works with the same technology that is able to improve the appearance of laugh lines by tightening and lifting the midface, contouring the lower face. Both Ulthera and Ultraformer III are very popular treatments in our clinic as they do not involve injections and foreign body, the results are natural as collagen is produced by your own body. Profhilo is a new technology biostimulator that contains HA. Although they contain the same kind of substance found in fillers, they are designed to work differently. They are injected into the dermis where collagen is stimulated. This treatment is able to improve skin hydration, improve texture and lifts saggy skin.

Double chin treatment

The best way to lose your double chin is probably to lose weight if you have been gaining weight. 

The most effective treatment is probably a mini-liposuction procedure performed by plastic surgeons. At the age of 40, you may not be ready to go under the knife yet and non-invasive energy devices like Ultraformer III can serve a dual function purpose of creating a coagulation zone in the adipose layer that will ‘kill off’ some fat cells and simultaneously tighten the saggy skin around the double chin and neck region to prevent or delay the development of ‘turkey neck’ when you get into the 70s.

Eye bags treatment

Eye bags are a common concern with ageing. The skin around the eyes is the thinnest on the body. This is the reason why sagging and wrinkles are first to appear around the eyes.

As we age, the skin starts to lose elasticity and the supportive tissue and muscles that support the lower eyelids start to weaken. As fat tends to accumulate around the eyes and it starts drooping too, the eye bags become increasingly prominent.

The most effective way to treat eye bags is probably surgery too. However, even then the outcomes are not always satisfactory and long-lasting.

Fillers can be used to ‘support’ the eye bags and fill up the area between the cheeks and the eye bags to ‘camouflage’ the contours caused by the eye bags. By selecting patients suitable for this procedure, most patients can see immediate improvements, which last for for about 12 months. Ultraformer III is equipped with the latest MMFU technology in a ultra slim 2mm cartridge specially designed for the lower eyelids and periorbital region. Although with MMFU technology, where it aims to heat up and ‘dissolve’ the fat away and tighten the skin simultaneously, changes are gradually observed and it may take you about 2-3 sessions for you to appreciate the results.

Pigmentation treatment

Despite best efforts to minimise UV damage with regular sunblocks, pigmentations are sometimes inevitable as the production of melanin is regulated by many other factors such as hormonal changes with pregnancy, use of contraceptive pills, genetics and decrease in cell renewal.

Hyperpigmentation includes conditions like melasma, sun spots (solar lentigines), freckles etc.

The first line of treatment for pigmentation is usually a combination of prescription creams. As creams are less targeted and can take months before results can be seen, combination therapy with lasers are widely used. The latest researches agree that pulsed-dye lasers and pico lasers are safe and effective treatments for hyperpigmentation. 

Dull skin tone treatment

If you have been blessed with good skin and this is the only problem that concerns you, you have a much easier problem to deal with. As we age, our skin turnover slows down and at this point, you might start to notice that the youthful glow is diminishing.

You can start by including a gentle peel or a retinol to help skin cell turnover. Although peels and retinol are not recommended to be used together. Alpha-ret is a combination of AHA and retinol, this formulation combines two gold standard ingredients of anti-ageing. Other skin brightening agents such as Vitamin C, niacinamide, Kojic acid, arbutin, tranexamic acid can help with radiance too! If products are not able to help you achieve the results that you want, you can consider toning lasers that help to improve skin turn over and skin tone. If you would consider more invasive treatments, Restylane skinboosters, Rejuran injections, and Profhilo are injectable skin ‘nutrients’ that can hydrate the skin, stimulate collagen and increase the thickness of the skin.

Hormonal acne treatment

Hormonal acne affects women more than men. Dealing with hormonal acne at this age is annoying and frustrating. Especially metabolism rate is slower at this age, the pimple takes a longer time to recover and the residual post-inflammatory hyperpigmentation can take months to resolve. Topical creams may not be sufficient to control the situation. Additional treatments such as chemical peels, pulsed-dye lasers, pico lasers can be useful in reducing inflammation and speed up the recovery acne marks. Occasionally, oral antibiotics or tretinoins are prescribed for acne refractory to other treatments.

In most cases, hormonal acne resolves by the mid 40s. We do eventually grow out of this phase. The purpose of treatment is to minimise inconvenience caused by acne, as well as treating acne early to prevent scarring that are more difficult (and costly) to treat subsequently.

Pores, Fine lines, Irregular texture treatment

As we age, the loss of collagen in the dermis results in depressions causing fine lines, increased pore size and deteriorating texture of the skin. Overall collagen stimulating procedures helps to correct these changes. As collagen is laid down by your own body, it takes months and repeated procedures to achieve the best results.

Resurfacing lasers such as fractional pico lasers and fractional CO2 lasers induce heat to the superficial layers of the skin (1-2mm)  that helps to stimulate collagen and rejuvenates the skin. It is recommended for 3-5 treatments  every 4-6 weeks.

Infini, fractional RF is able to stimulate collagen to up to 3.5mm. It is less commonly done as an anti-aging procedure as the downtime and pain is less bearable compared to other anti-ageing treatments. However, the combined mechanism of microneedling and radiofrequency is able treat depressed acne scars simultaneously and treat deeper wrinkles compared to fractional CO2. It takes 2-3 sessions to get the best results.

Ulthera and Ultraformer III are commonly done that helps to improve the elasticity of the skin to help to tighten and lift. As the energy is targeted into the deeper layers of the skin with the intention to lift, textural changes in pores and fine lines are not as prominent when compared to resurfacing lasers and Infini.

Collagen can be induced by heat with the above mentioned procedures. It can also be induced by biostimulators such as Rejuran and Profhilo. These anti-ageing injectable treatments directly inject these collagen stimulating substances for skin rejuvenation, hydration and elasticity. Profhilo has also shown the ability to lift moderately saggy skin. This treatment is exceptionally popular with individuals who have sensitive skin who do not want to undergo ‘heat’ treatments. Patients with eczematous skin have also noticed instant improvement in deep hydration of the skin and reports less frequent flares.

Neck lines/decolletage treatment

Neck lines and decolletage are treated with the intention to increase the thickness and collagen levels of the skin. All the above mentioned collagen stimulating treatments for treating the face would be applicable to treating the neck and chest.

Comparing the skin between the face and neck, the skin on the neck (and decolletage) has fewer sebaceous glands and decreased blood supply. Therefore, thermal injury induced by fractional CO2 for neck rejuvenation is associated with increased risk of hypertrophic scarring, infection, hypopigmentation and post-inflammatory hyperpigmentation.

However, fractional CO2 remains a safe and effective treatment for neck and decolletage rejuvenation when this procedure is performed with caution. The risk can be further reduced by using newer generations of fractional CO2 lasers like edge fractional laser, which limits the area of superficial thermal damage that reduces the downtime and associated risks.

Body toning treatments

When we consider treatment of the body, we usually look for a combination of both skin tightening and lifting, as well as, fat reduction. Ultraformer III has MMFU (Mirco and Macro Focused Ultrasound) powered cartridges designed to transfer concentrated ultrasound energy into narrow areas for lifting and broader areas of concern for body contouring. Ultraformer III is a safe and effective treatment for the body with improvements seen best at 3 months after initial procedure.


Medical Director

After graduating from the National University of Singapore, Dr Boey’s journey in aesthetics brought him to esteemed institutions such as Harvard Medical School, American Academy of Aesthetic Medicine and Queen Mary University of London in diverse cities like Seoul, London, Boston and New York.