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Sign of Ageing

How we age and our approach, treatment and evaluation of facial ageing

Positive ageing is a focused approach to creating a natural refreshed look.

One of the most common comments that I get from women that I treat is:

“I feel happy and energetic, I don’t feel any different from when I was younger. But when I look in the mirror, I want to look the way that I feel.”

Positive ageing is all about looking the best version of yourself.

Specialist Skin Solutions Mother and Daughter

Noticeable ageing can begin from 30 onwards.

Treating these changes earlier can help to slow the process.

The good news is that there is now a range of proven medical treatments, that are very effective.

They include:

  • Muscle relaxants.
  • Dermal fillers.
  • Cosmeceuticals (Prescription only medical grade anti-ageing products).
  • Dermal treatments that range from lasers, microdermabrasion, peels and micro-needling

In this article we will go through:

  • Overview of what happens to the face as we age.
  • Treatments for women to refresh and rejuvenate their skin.
    • Muscle relaxants.
    • Dermal Fillers.
    • Dermal treatments that range from lasers, microdermabrasion, peels and micro-needling.
    • Skin care that works.
  • The complete natural face approach by Dr Beldholm.

How we age


To understand the skin’s ageing process you need to know what it consists of. There are four basic layers:

  • The epidermis.
  • The basement membrane.
  • The dermis.
Skin Structure

The subcutaneous layer

New cells form from the lowest level of the epidermis, gradually rising upwards towards the outer layer (the stratum corneum). It is here where they are eventually worn off, with newer ones beneath replacing them.

As we become older, this outer layer of the epidermis becomes slightly thinner. The cells that are being made at a lower level are also dividing and replacing themselves more slowly. Therefore, healing time is affected, along with a decrease in the production of more new skin cells. This reduction in new cells causes some of the visible signs of ageing as the skin becomes thinner. Ageing affects nearly all of the structures in the skin.

  • Collagen becomes thicker and changes in character, leading to more wrinkle formation and less elastic skin.
  • Elastosis (an accumulation of amorphous elastin material) occurs, leading to the characteristic loss of skin elasticity which is considered the hallmark of ageing.
  • With age, glycosaminoglycans (molecules in the skin that bind water) also decrease, leading to a less hydrated skin. (Dermal Fillers work in a similar way to glycosaminoglycans by binding water.
  • Melanin production also decreases with age, leading to older skin being more predisposed to sunburn. This is why it’s important to continue wearing sunscreen throughout life.
  • Loss of vascularity (blood supply) to the skin has a number of adverse consequences, including decreased blood flow and healing, diminished nutrient exchange, impaired temperature regulation, lower skin temperature and skin pallor.
  • Decreases in subcutaneous fat also lead to a loss in facial volume. Gravity also pulls facial structures down, leading to a number of characteristic changes including loss of cheek prominence, skin folds, lines, jowls and overhanging brows.
Skin Ageing Infographics


There are two main causes of wrinkles. As the muscles controlling facial expression are constantly at work, over time they produce dynamic wrinkles – that is lines only apparent when muscles are contracting. However, as we age, these wrinkles become deeper and deeper, finally becoming permanent or static wrinkles.

The most common examples of static wrinkles are frown and smile lines. Frown lines can lead to a person constantly looking angry or worried. Constant muscle contraction can also cause headaches. The most effective initial treatment for these wrinkles are muscle relaxing injections.

Fine wrinkles are formed by the gradual degeneration of ageing skin combined with the gravity-related fall of facial skin and the loss of subcutaneous fat. However, the most significant factor in skin ageing is sun exposure. Initially, a dermal filler can be used to plump up and hydrate the tissues. Other treatments such as skin peels and Dermaroller, in addition to specialised skin care products, can also improve the quality of the skin dramatically.


As we age, there are substantial changes in the bone skeleton of the face. For example, the cheekbones get smaller, thereby contributing to the loss of their youthful, plump appearance. The mandible (jawbone) also changes. Although there is a constant loss of bone with ageing, these changes can be accelerated by things like tooth loss.

The role of the sun in ageing

Without protection, just a few minutes of sun exposure each day can cause noticeable changes to the skin. Freckles, age spots, spider veins on the face, rough and leathery skin, fine wrinkles that disappear when stretched, loose skin, a blotchy complexion, actinic keratoses (thick, wart-like, rough, reddish patches of skin), and skin cancer can all be traced to sun exposure.

The amount of skin damage that develops depends on a person’s skin color and their history of long-term or intense sun exposure. People with fair skin who have a history of sun exposure develop more signs of damage than those with dark skin. In the darkest skins, damage is usually limited to fine wrinkles and a mottled complexion. Such damage occurs over a period of years.

With repeated exposure to the sun, the skin loses the ability to repair itself, and the damage accumulates. Scientific studies have shown that repeated ultraviolet (UV) exposure breaks down collagen and impairs the synthesis of new collagen. The sun also attacks our elastin. Sun-weakened skin ceases to spring back like skin protected from UV rays. Skin also becomes loose, wrinkled, and leathery much earlier with unprotected exposure to sunlight. People who live in sun-intense areas, such as Australia, can show signs of sun damage in their 20s.

While it may seem that the signs of such damage appear overnight, they actually lie invisible beneath the surface of the skin for years. UV photography captures the damage accumulating beneath the surface of the skin years before the signs actually appear.

To prevent excessive and premature ageing, Dr Beldholm recommends incorporating a daily sunscreen into your skin care regime. Generally, this is applied in the morning to the face and other exposed areas. Our Dermal Therapist can select a product for your skin type from our extensive range of non-greasy, user-friendly products. Please note that these top quality sunscreens are also suitable for acne-prone skin, whereas over-the-counter varieties may actually increase acne.

The role of smoking in ageing

Tobacco smoke contains over 4,000 chemical compounds including tar, carbon monoxide, nicotine, hydrogen cyanide, acetone, ammonia, arsenic, phenol, naphthalene, cadmium and polyvinyl chloride. Many of these agents are toxic and at least 43 can cause cancer, including nitrosamines and benzopyrines. Nicotine is the chemical responsible for the addictive nature of cigarette smoking but is not the major component associated with smoking-related disease. The many ill-effects of smoking are well documented. Smoking affects all of the body and considerably speeds up ageing. It is responsible for the deaths of 19,000 Australians each year. This is estimated to be 80 per cent of all drug-related deaths.

Cosmetically, smoking causes many characteristic adverse effects on the skin and other structures. Tobacco smoking is the risk factor responsible for the greatest burden of disease (loss of health and premature mortality) in Australia, accounting for 12 per cent of the burden in males and seven per cent in females. About one in two regular smokers dies of a smoking-related disease. Those who die lose, on average, 16 years of life.

Tobacco is a known or probable cause of at least 25 diseases, including lung and other cancers, heart disease, stroke, emphysema and other chronic lung diseases. People who smoke also have higher rates of wound infection following surgical procedures.

Smoking prematurely ages skin by between 10 and 20 years. It also increases the likelihood of facial wrinkling threefold, particularly around the eyes and mouth. Smokers can look gaunt, often developing a sallow, yellow-grey complexion and hollow cheeks.

Smoking also doubles or trebles your risk of developing psoriasis. Although the damaging effects of cigarette smoke on skin are irreversible, it is likely that further deterioration can be avoided by stopping smoking. Second-hand smoke is also likely to have an ageing effect, albeit at a reduced rate.

Approach, treatment and evaluation of facial ageing

Sign of Ageing

In assessing the face, it is easier to divide it into three sections.

Each section needs a different approach, with different surgical procedures to improve the appearance of each area. The appearance of the neck also needs to be taken into consideration.

The upper face

Signs of ageing in the upper face are generally as a result of muscle contraction, weakening of the ligaments and loss of fullness in soft tissue, causing the appearance of horizontal and vertical wrinkles. These include wrinkles around the eyes that form when we smile, and lines between eyebrows as a result of frowning. The height of the eyebrows also reduces over time, creating a tired or “hooded” look to the eye area.

The mid-face

Understanding the ageing of the midface is important as the perception of facial attractiveness is generally based around the synergy between the eyes, nose, lips and cheekbones. The primary causes of ageing here are changes in the bone structure, reduced soft tissue volume and the movement of fat. One of the first noticeable signs is the development of the “nasolabial fold” (the fold of skin that runs from the edge of the nose to the corner of the mouth). This is formed when the fat and soft tissue that normally sits high on our cheeks starts to lower. Such a change is often combined with the formation of “tear-troughs” – areas of volume loss under the eyes, often perceived as dark circles – and a general reduction in the youthful fullness of the cheek area.

The lower face

As muscle tone decreases in our 40s and 50s, the lower face generally begins to show visible signs of ageing. In the lower face, loss of volume and loosening of the ligaments cause soft tissue to accumulate near the jaw and chin, creating jowls. This loss of volume can also give the impression that the chin is widening. The lips are a key focus point when communicating, as well as in terms of attraction. Over time, the outer layer of the lips becomes thinner and the corners of the mouth can begin to droop into a mouth frown. The v-shaped area of the upper lip (known as cupid’s bow) begins to flatten out and lips become elongated, losing their youthful fullness. Vertical lip lines can also begin to appear (which is what causes lipstick to bleed).


No one wants a double chin or “turkey neck”. However, from late teens on, some people notice the hereditary feature of a chubby neck. Indeed, just looking at their relatives indicates that diet and exercise are not going to fix the problem! Liposuction is generally very effective for these fatty accumulations up to the age of about 40. After 40 years, men and women who are ageing relatively normally note a laxity of skin and sagging muscles under the chin. A mini-lift is the treatment of choice at this age and can result in a marked “firming” and tensioning of the underlying muscles of the upper neck. After about age 45, fat and sagging skin combine to make the problem more severe and at this stage a necklift or a facelift is a better option.

Common skin concerns as women grow older

Mid Face Model - Specialist Skin Solutions

Peri-oral lines

Peri-oral lines are also referred to as “smokers lines” however, they do not only occur in smokers. They are partly due to volume loss in the mouth area, as well as sun damage and the frequent movement of the mouth.

What can be done about it?

  • Dermal fillers
  • Derma stamp with PRP
  • Laser genesis

Age spots

Age spots are sun damage that has developed over the years causing visible dark areas on your skin.

What can be done about it?

  • A skin brightening range, lightens the age spots and brightens the skin’s appearance.
  • Sun protection to protect skin and prevent further damage.
  • Laser LIMELIGHT to lighten the dark spots and reduce the appearance of new spots.

Uneven skin texture

A lifetime of sun damage and exposure to the elements can take its toll in the form of rough, uneven skin texture.

What can be done about it?

Dermastamp helps refine skin texture and stimulates collagen production. Adding PRP can significantly improve the effects. We use a medical grade skin care range to reprogram your skin.

Open pores

As the skin ages the loss of collagen can relax the skin making your pores appear bigger. Sometimes the larger pores can get clogged and congested.

What can be done about it?

Medical grade peels refine the texture of the skin, adding derma stamp and laser genesis can further smoothen the skin out to reduce the pores. We provide you with medical grade home care products to allow you to maintain the results.

Dull looking skin

The effects of ageing and sun damage can make your skin look dull, which can emphasis fine lines and wrinkles.

What can be done about it?

  • Medical grade peels to refine the top layer of skin.
  • Phase II – laser genesis to tone and brighten skin.
  • Maintain and improve your skin with medical grade skin care products with active ingredients.

How a Facelift Makes a Difference in Your Appearance

Dr Beldholm FRACS Theatre

A facelift focuses on treating saggy skin.

This can either be in the:

  • Mid face
  • Lower face and jaw line
  • Neck area

Every patient is different and the approach is therefore different.

Quite often a combination of procedures, such as necklift and upper blepharoplasty, in addition to the facelift are required.

When performing a facelift, I am lifting and tightening the skin. Combining a necklift procedure with a facelift will address neck bands and loose skin on the neck. I will quite often perform liposuction on the neck as well. This is especially good for women that have a lot of neck fat associated with hanging skin (turkey neck). Adding liposuction and tightening the tissues of the neck makes a big difference to the definition of the jaw and neck area, rejuvenating this area substantially.

Modern facelifts and Necklifts are all about natural results.

Dr Bernard Beldholm’s approach to a natural looking face

Dr Bernard Beldholm Meeting with Patient

Medical science is progressing very fast. There has been significant advances even in the last 12 months.

The key to providing a great result is to take a holistic natural approach.

We are not just filling a line here and there but we are restoring the structures, from superficial to deep.

However, before we start any treatment the key is to sit down and find out what each and every patients wants. There is no one size fits all. Our approach is as individual and unique as you are.

Once we have established what it is that you want to achieve, then we go to work on creating your specifically tailored programme. This can include:

Your skin

  • With proven doctor only skin care products.
  • Extensive range of dermal therapy options.

Your deeper structures

  • Proven premium fillers

Lines and wrinkles

  • With muscle relaxants

Double chin treatments

Facelift and Neck lift surgery

Non-invasive treatments can do a lot for your facial ageing. At some stage however the sagginess will be too much for these treatments and this is when you should consider a facelift or necklift.

It is important to realise that the best results from a facelift is achieved when combined with dermal therapies for your skin as well as muscle relaxants and fillers as these are all complementary.

Our plan for you

1. Call now for a consultation on 1300 370 307.

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2. Sit down with our Doctor or nurse to discuss treatment.

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3. Receive your dermal filler treatment.

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4. Walk out of the clinic with a big smile!

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