Aging doesn’t happen in a single moment. It’s more like a slow shift, layer by layer, shaped by both our genetics and the way we live. Part of it is written in our DNA — the natural pace at which our bodies change. The rest is written by our choices, the environments we’ve lived in, and the little exposures that happen every single day. Sunlight, pollution, the food we eat, whether we smoke, the stress we carry — they all leave a mark. Over the years, these factors touch every layer of the face, from the very surface of the skin down to the deepest structural framework.
The first changes usually show in the skin. Somewhere in our mid-twenties, collagen production begins to drop — about one percent every year. Collagen is the scaffolding that holds the skin firm, and elastin is the spring that helps it snap back. Both begin to weaken, especially if the skin has had a lot of sun exposure. The outer layers become thinner, fine lines start to form, and the skin can’t hold moisture as well as it used to. Pigment cells start misbehaving, leaving uneven tones or sunspots. And as our cell turnover slows, that fresh, bright glow begins to fade.
Underneath the skin lies a network of various size of fat pads, carefully positioned to give a face its youthful fullness. In our younger years, they’re plump and exactly where they should be. But as time goes on, the deeper fat pads in the cheeks, temples, and under the eyes start to shrink. That’s when hollows appear, the midface looks flatter, and the contours soften. The fat pads that sit closer to the skin start to drift downward as the ligaments holding them loosen. This can create jowls, deeper folds around the mouth, and even fullness under the chin — not because there’s more fat, but because it’s shifted from higher points of the face to lower ones due to gravity.
Beneath the fat is a layer we call the SMAS — the superficial musculoaponeurotic system. Think of it like the fabric of an umbrella, with the ligaments acting as thin rods holding it open. When we’re young, that fabric is tight and resilient. But as collagen and elastin weaken, it stretches and loosens. Even though the SMAS is still anchored to the ligaments, gravity slowly pulls it down. This is one of the key reasons we see sagging in the mid and lower face and changes in the neck. The face losses its oval-shape to a more squared-shape. The bottom part of face and neck seems to carry more tissue and look heavier.
The bones quietly change too. The jawline becomes a little narrower, the cheekbones a little flatter, and the eye sockets a touch wider. These shifts are subtle, but they set the stage for the soft tissue changes to become more obvious.
That’s why people in their thirties often still look fresh — they’ve got strong collagen, even fat distribution, and skin that renews itself fairly quickly. By the fifties and sixties, the pace of change picks up. Fat has shifted, bone support has lessened, and the skin’s natural repair system has slowed. Sun exposure, pollution, and years of expression lines all leave their imprint. Hormonal changes, especially after menopause, can thin the skin even further.
The good news is, there’s a lot we can do — and it starts earlier than you might think. One of the simplest, most effective habits you can build is wearing sunscreen every day. I always recommend mineral sunscreens with zinc oxide or titanium dioxide. They create a physical barrier, work the moment you put them on, and are gentle on sensitive skin. And yes, you need it even when it’s cloudy or you’re indoors near windows.
When it comes to beauty, it’s important to understand that there are some patterns we all respond to, no matter where we’re from. Across every culture, symmetry, proportion, and certain traits linked to fertility are consistently seen as attractive. Symmetry signals health and good development. Balanced proportions between the thirds and fifths of the face create harmony. Features like a stronger jawline in men or fuller lips and larger eyes in women are signs of hormonal vitality. These things are built into us on an evolutionary level.
But while biology has its constants, society shapes its own trends. Right now, social media plays a huge role in defining what’s “in.” Unfortunately, it often promotes exaggerated features — oversized lips, overly high cheekbones, skin smoothed to an unnatural degree. This can create pressure, especially for young people, to change their appearance before they’ve even finished developing. I see patients in their early twenties who’ve been thinking about cosmetic treatments since they were thirteen. I won’t work from filtered selfies, because those proportions rarely look natural in person.
For prevention, we start with the basics — sunscreen, retinoids for collagen stimulation, and non-invasive treatments like IPL or BBL to keep skin clear and even. But when we’re talking about the forties through sixties, that’s when surgical treatments can often make the most meaningful difference because they address changes happening deep beneath the skin.
Fat grafting is one of my favorite tools for restoring natural-looking fullness. We take fat from somewhere like the abdomen or thighs, then carefully place it in areas like the cheeks, temples, and under the eyes. Because fat contains regenerative stem cells, it can also improve skin quality over time.
Eyelid surgery, or blepharoplasty, can open and brighten the eyes by removing excess skin, repositioning fat, and tightening muscles — all while preserving your natural shape and expression. If the brows have drifted lower, a brow lift can gently return them to their original position, smooth forehead lines, and lift the heaviness from the upper face.
And when the lower face and neck need lifting, I turn to the preservation deep plane facelift. This technique is especially valuable for people in their forties through sixties because it works at the structural level where aging has the greatest impact. Instead of simply tightening the skin, the preservation facelift lifts and repositions the SMAS — the strong connective layer that links the facial muscles to the skin. By releasing key ligaments and restoring the SMAS to a higher, more youthful position, the cheeks are lifted, the jawline is defined, and the neck appears smoother. The “preservation” aspect means less skin undermining instead undemining the deep layer to lift the SMAS and natural fat pads vertically rather than removed more fat, so the results are soft and natural instead of hollow or tight. This deeper approach creates a rejuvenation that looks authentic, moves naturally with expression, and can last for many years longer.
The most successful results come from treating the face as a whole — skin, fat, and the SMAS and its anchoring ligaments, — rather than focusing on one layer alone. Aging is a multi-layered process, and rejuvenation works best when it’s just as comprehensive.
For me, the goal has never been to erase the years completely. It’s about restoring balance, vitality, and confidence while keeping what makes you, you. The best compliment is when someone says, “You look happy. You look rested.” They don’t need to know why — just that you look like yourself, only fresher.