Aesthetic goals and attitudes about Medical Aesthetics may tend to change as a patient ages. Spark brought together a panel of experts who shared their experiences on how aesthetic goals and treatments may vary by age. 

Janet Allenby, DO, FAOCD, is a board-certified dermatologist specializing exclusively in aesthetic treatments and has been practicing for more than two decades. Based in Palm Beach County, Florida, Dr. Allenby is world-renowned for her injection methods and is a respected lecturer in the United States and abroad.

Amy Hatcher, APRN, is a board-certified family nurse practitioner and certified master aesthetic injector with over 15 years of experience in aesthetics. As the co-founder of her practice in Tennessee, she takes pride in her ability to help meet her patients’ goals through aesthetic treatments.

Denisse Serrano, PA-C, is a board-certified dermatology and aesthetic medicine provider in New York City who turned to Medical Aesthetics after three years as a physician assistant in emergency medicine. She was drawn to Medical Aesthetics by the long-term relationships providers in the field are often able to foster with their patients.

With extensive backgrounds practicing Medical Aesthetics, our experts have long-term adult patients of all ages. They consider treating different age groups as building blocks of a pyramid—with younger patients at the top with fewer treatments—that expands to include more tools and treatments as a patient ages. Read on for their valuable insights about how they build relationships and keep up with their patients’ changing needs. 

The 20s are a common entry point for Medical Aesthetics.

Patients often start to show an interest in Medical Aesthetics in their 20s. Amy told Spark that, in her experience, social media inspires interest for these younger patients to learn more. She says that thanks to platforms like Instagram®, she finds that patients in their 20s are well-informed about what’s out there and which aesthetic procedures they are interested in. They’ve done their homework and may even know what brands and procedures they want to discuss before they come to her office.

Despite patients in their 20s making appointments for various procedures, skincare is a main treatment recommendation for these patients.

Dr. Allenby: “The foundation is always going to be skincare: keeping collagen growing, using growth factors, and using sunscreen every day. I encourage patients to live a healthy life—it’s kind of the key to everything. This is the age patients are addressing deflating lips and the dark circles around their eyes. This age group wants to be preventative, and they are willing to work at it.”

Denisse: “My favorite thing to start a 20 year old on is a really good skincare regimen. That's a priority of mine, and I have three simple steps: Number 1 is to wear sunscreen every day. Number 2 is to use an antioxidant serum. And number 3 is to use a vitamin A derivative at night, whether it be a retinol retinaldehyde or retinoid prescription from a dermatologist.”

Our experts observed that patients in their 20s are starting to express an interest in dermal fillers for lip augmentation. When Denisse sees patients who request lip augmentation, she tells them, “’Let's also talk about other things that I think would make you look like your most-natural self.’ And if they could benefit from dermal filler in their lips, and I think it's going to look natural on them, I will proceed with treatment. I'm also making sure that they are thinking about other things like acne, dry skin, or other modalities that will be beneficial, even at that age.”

While aging or collagen loss may not be an immediate concern for patients in their 20s, their effects are just around the corner. For 20 year olds, our experts told Spark that they focus on ways to prepare their young patients for these future concerns.

Our experts agree: When treating patients in their 20s for skincare or facial injectables, educating them about the aesthetic treatments is an important part of treating this age group.

Addressing the facial concerns at 30.

Our experts hear from patients in their 30s that things like flattening in the cheeks and loss of shape in the chin first become mentionable concerns, in addition to the wrinkles they are noticing. It’s at this age when our experts typically recommend injectables like dermal fillers for volume loss, and neuromodulators for temporary improvement in frown lines between the eyebrows.

Amy: “Clients are noticing fine lines and wrinkles. I think it's a great time to introduce injectables to their other treatment options.”

Our experts share that dermal fillers are often recommended for addressing age-related volume loss in the cheek area.

Denisse: “For patients in their 30s, you might start incorporating energy-based devices more heavily because at this point, they are likely losing fat pads and experiencing bone degeneration.”

Dr. Allenby: “Down here in Florida where you’re getting more sunlight, I see more patients with tissue changes that are indicative of sun damage. For those patients, we may recommend intense pulsed light (IPL) devices or aggressive laser treatments, like very light CO₂ or chemical TCA peels. The aim is to keep the skin texture and color youthful and appearing fresh as sun damage prematurely ages the skin.”

Beyond the face, Denisse adds, “At this age, some women have already had children, so they may want to start thinking about body contouring devices.”

By 40, it’s often about correction.

Our expert panel tells Spark that correction is frequently a patient’s goal as they age into their 40s. All three experts continue to build on the foundations established earlier, but they also start turning to more treatments in their toolboxes and opening the scope of possibilities with options like injectable treatments and energy-based devices for temporary improvement.

Dr. Allenby: “I want patients to understand what they're dealing with. I have patients view photos of themselves from all angles—frontal, 45 degrees, 180 degrees—so they can appreciate the changes in their own faces. This helps us make an optimized treatment plan for fillers, neuromodulators, PDO threads, and skin quality improvements. Then they follow up 2-3 times a year as appropriate for additional treatments as the effects are temporary.

Patients in their 40s still have some hormones, so the skin usually benefits from that; the tissues are still responsive, and they haven't lost their fat pads as much as when they creep through the 40s into the 50s. When they become more perimenopausal, you see significant structural and texture changes often due to hormone loss.”

It’s with these common physical changes in mind that Dr. Allenby makes her recommendations: “In the late 40s, we try to increase the amount of time before considering a facelift, so we may recommend tightening devices that use radiofrequency or ultrasound, or different devices created to tighten and improve structural changes. At this point, we also start addressing changes of the body; for example, unwanted fat bulges, cellulite, and muscle tone.”

Amy: “As clients move into their 40s, they begin to notice changes in volume, and fat pads are losing volume and beginning to shift downward. For me, it's really important that we see the whole patient. We continue to encourage skincare—and to start making regular visits with our aestheticians more important—so they're beginning to get more action-based facials. We're using more active products, such as products with vitamin A, vitamin C, Kojic acid, and growth factors. We're beginning to think about collagenesis using microneedling with radiofrequency or even some skin resurfacing-type lasers. And then for sure, neuromodulator treatments. And with dermal filler, we're treating to correct, trying to lift, contour, and volumize.”

Building on these recommendations, Denisse also includes biostimulatory agents. “Biostimulatory agents play a huge role, such as some lasers and body contouring devices. But being really good about keeping up with regularly scheduled injectable treatments is a priority at this stage, and also keeping up with hyaluronic acid dermal fillers.”

With these additional treatments being added to the mix, our experts told Spark they generally start seeing their 40 year old patients three or more times a year, whereas their younger patients who are getting fewer types of treatments are coming into the office once or twice a year.

Amy notes another interesting factor for patients in their 40s. “They don't always want to tell their friends about their treatment, and they don't always want their before-and-after pictures shared. They might be a little quiet about their experience and treatments. But on the other hand, our 20-somethings often want you to post their pictures; they want you to tag them; they want to take a picture with you. This attitude is amazing for our field and helps contribute to the growth of Medical Aesthetics! These young adult patients often shout about it from the rooftops.”

The importance of honesty at 50, 60, and beyond.

For older patients, it’s about finding balance between what outcomes a patient is looking for and what treatments will most likely help to achieve their aesthetic goals. Some conversations may be difficult to have, but our panel of experts emphasize honesty and transparency. 

Dr. Allenby: “You always have to be honest. Maybe by the 50s or 60s, they really might benefit from surgery so you would be doing a disservice by pursuing treatments that may help them temporarily or to some degree—but not achieve the outcome that they're really looking for. Know there's no shame in discussing surgical procedures such as facelifts. At this point you are using all the tools in your toolbox, supporting treatments, and increasing the frequency of treatments to multiple times a year.”

Our experts tell Spark that one way to navigate these conversations is to bring patients in on the thought process behind your recommendations. Denisse: “It’s all about educating the patient and letting them in on what we're thinking. We may not be able to use medical jargon, but patients will do research, and they have resources to understand and develop confidence in your recommendations to help them achieve their aesthetic goals.”

Now that we’ve considered how to approach treatment conversations at this age, what specifically do our experts recommend for these older patients?

Amy: “By the time we're in our 60s, we move away from augmentation treatments and are focused on temporary corrective treatments. So with dermal filler in particular, there is contouring and lifting that can be achieved. It's absolutely my favorite treatment. Energy-based treatments definitely have a space at this age, but I'm an injector. So I refer patients to other providers in my practice who specialize in lasers. I love what neuromodulators and dermal fillers can do temporarily, and I focus on that.”

When treating patients who are over 50 and 60, our experts say it’s important to look at the big picture. Or, as Denisse puts it: “I like to remind my patients the aging process is multimodal. So, we have bony degeneration, fat atrophy, and skin laxity. If my patients don’t want to pursue surgery and they just want to focus on temporary improvements, that's perfectly fine. You'll still achieve results toward their aesthetic goals.”

Helping patients see progress.

Before-and-after photos are a great way to help patients understand the treatments you’re recommending. 

Denisse often tells patients: “‘I'm going to take some photos of you so that you can see yourself from different dimensions, not just from the front view but also from the side view. And then we're going to analyze your anatomy and assess you. I’ll tell you what I think we should do and give you the best options.’ Then we go through the photos to come up with treatment recommendations.”

And good photos, taken with the proper equipment, appropriate angles, and good lighting can go a long way. Not only will photographs help your patients establish a treatment baseline, they also help track results. Photographs often help illustrate progress. 

No matter the age of your patient or if their goals are augmentation, temporary treatment, or correction, the underlying truth remains the same: patient satisfaction is always in focus.