Skincare Tips for Women in Their 40s

If you're in your 40s or you're about to be, there are certainly things you can be doing to take the best care of your skin. So in this video, we are going to talk all about skincare and procedures for your 40s. I'm Dr. Sam Ellis. I'm a board certified medical and cosmetic dermatologist in Northern California, and I'm here to help you understand your skin and help find products that work for you. So if that sounds good, give this video a thumbs up and subscribe. I would say most classically, it's when women get into their 40s that they start telling me as their cosmetic dermatologist, like, listen, Dr. Ellis, some things are happening and I'm not so pleased about it. So I really feel like focusing on the skincare and maybe the cosmetic procedures that you can have going into your 40s or once you are in your 40s is really important because that might be the first time people are really starting to consider these interventions. I think two main things happen in your 40s that make women go whoa, I woke up at 40 and feel like my skin changed or I looked like a totally new person and not in a good way. One is a lot of women are finishing their childbearing in their 30s and they hit 40s and now they've had years of being pregnant or sleep deprived and often a combination of both of those things. And they are just not looking or feeling their best. Also at that time in their life, they may not have really been prioritizing themselves and taking care of themselves. And so once they hit 40, they're really ready to start investing in a new way. The other thing that often happens to women as they get into their 40s and approach their 50s is they start going through menopause. And as the estrogen shifts down in the body, you can lose suppleness to the skin and you can really start seeing accelerated aging changes. Now, I do want to say 40s is just a number. We are using that kind of as a benchmark for where a lot of people start to notice these aging changes. But depending on your genetics and what your skin has previously been exposed to, and maybe how well you've cared for your skin over your lifetime, you may or may be not noticing these changes at this point in your life. Now, as women get into their forties, they may notice that their skin is starting to lose a little bit of elasticity. So it can be the first sign of jowls starting to form or a little bit of sagginess into the skin or some creepiness under the eyes or on the neck. The other thing people will tend to notice in their forties is that all of the sun damage that they have accrued over their lifetime really starts to come to the skin surface and they're going to start noticing things like brown spots and sun spots. Texturally, the skin also can start to change. So you might notice enlargement of the pores as well as the skin becoming drier or thinner. So whether you're 40 or not, if you're starting to notice these changes in your skin and you want to know what you can do about them, this video is for you. Now, before we get into interventions that you can do at home, products you can use, and things you can do in the office, I think it's really important to discuss how your lifestyle and how you treat your entire body changes how your skin appears. So if you're getting into your 40s and you're trying to look and feel like your very best self, having a well-rounded diet is really important. Having a good exercise regimen and working on maintaining your muscle mass can really help with the signs of premature aging. Along with eating well and exercising, getting ideal sleep is really important as well as managing stress. And I'm sure it's probably the most annoying thing to hear a doctor tell you, oh, manage your stress. But things you can do to make your life less stressful are super important because you might be taking care of small children. You might be taking care of aging parents. You might be dealing with interpersonal relationships. And all of those things accumulate. When you have stress hormones like cortisol coursing through your body, it can cause premature aging. Also, if you're starting to experience symptoms of menopause, whether that's difficulty with sleeping, hot flashes, mood changes, etc., I think it's really important to talk with your primary care provider about what things you can be doing to optimize that, including things like hormone therapy. So when we're looking to optimize our skin in our 40s, I think that really starts with a good foundation of consistent skincare. The number one and two things that you're going to want in your skincare routine are sunscreen and some type of topical retinoid. So sunscreen is so, so, so important. I feel like if you're watching a skincare video, you might be like, yes, Dr. Ellis, duh. But I cannot tell you how many patients come into my office every single day wanting to talk about in-office procedures like lasers and chemical peels and Botox. And when I get into their skincare, they're not wearing sunscreen on a regular basis. If you're going to be investing in these other procedures down the line, you need to protect that investment and SPF is where that's at. And the reason why sunscreen is the most important thing that you are going to put on your skin is because UV radiation, so light that comes from the sun, is the number one cause of premature skin aging. It breaks down the collagen, the structural support protein in your skin, and it causes damage to many other structures that reside there. When you have repeated exposure to UV radiation, and... even in low amounts. I'm talking walking to your car, sitting out at your kid's baseball game. That over time will lead to irregular pigmentation in the skin, fine lines and wrinkles, as well as sagging. So if you are protecting from UV radiation, whether that is with sunscreen, a hat, seeking shade, and preferably some combination of all of those, you are protecting your skin from for premature aging, as well as skin cancer. One of the protests I will often get when people talk about not wanting to wear sunscreen or not wearing it regularly is they can't find one that they like, whether that means it stings their eyes, they don't enjoy the texture, they don't enjoy the fragrance, they might have a sensitivity to it. But I think it is such a worthwhile investment to go out and buy like 15, 20 sunscreens. If you add all of that up, that might be several hundred dollars, but when you compare that to the several thousands of dollars you could spend in procedures over your lifetime, an investment to find a sunscreen you love is so, so worth it. Also, if you need some guidance in finding a good sunscreen, I have so many different videos with my favorites. Ideally, you are looking for something that is SPF 30 or higher and has broad spectrum coverage. And really all of the sunscreens that you can readily purchase in the United States have broad spectrum coverage. Another thing that is super important is that you are actually applying enough sunscreen. So sunscreen should not be applied sparingly. Like I watch my husband apply sunscreen sometimes and I just kind of want to die because it's like, like you need to get in there and slather your face. And I have an entire video dedicated to sunscreen mistakes I commonly see. But another one that tends to come up in women is that they are relying on the sunscreen or the SPF in their makeup for their sun protection. And the reality is you're just typically not applying enough foundation or enough. tinted moisturizer to really get the stated SPF that's on the bottle. So even if you have a foundation that's SPF 20 or 30, you're probably applying it in a way where you're getting SPF 3 or 5. And it's totally okay to use makeup that has sunscreen in it, but just make sure you are applying a dedicated sunscreen layer first. Second in line in order of importance when it comes to skincare after sunscreen is using a topical retinoid. For a quick review, retinoids are vitamin A derived molecules. They include things like retinol and retinaldehyde as well as prescriptions like retin-a also known as tretinoin i would consider them the best anti-aging topical that you can use besides sunscreen because they help with fine lines wrinkles irregular pigmentation and dullness now there is a very strong recommendation to not be using topical retinoids while you are trying to conceive or while you are pregnant so for a lot of women they've skipped retinoids for a vast majority of their 30s if they've been having kids now of course that doesn't mean women can't continue to have kids in their 40s but often women in their 40s are ready to be on a consistent topical retinoid because they're done with their childbearing years. If you would consider your skin to not really be sensitive, I think it's very appropriate to have a conversation with your dermatologist about getting prescription tretinoin or retin-A. Tretinoin, also known as retin-A, is a prescription retinoid, and it is also the most studied retinoid when it comes to showing improvement in signs of skin aging. So this includes things like helping with dullness, dark marks, fine lines, and wrinkles. However, tretinoin is not without potential side effects, the main one being irritation, skin peeling, dryness, sensitivity. So if you cannot acclimate to those side effects, and for a lot of people, if they're using tretinoin regularly over the course of months, their skin will get used to this, but some people's won't. And if you have the type of skin that is just not tolerating tretinoin on a regular basis, then there are other over-the-counter retinoids that you can get that are also very effective. If we're talking about retinoids that you can get without a prescription from a healthcare professional, the most potent thing that you can get over the counter in the United States is Differin, also known as Adapalene. Adapalene is considered a third generation retinoid, so it tends to be very targeted in the skin. So it tends to cause less irritation for people. It's really most studied for the treatment of acne because retinoids are very good at helping with acne. But there are also studies to suggest that it helps with skin aging as well. So if you can't tolerate prescription tretinoin, but you're still looking for something quite potent to help with signs of skin aging, adapalene is the next best option. Now, that being said, adapalene can still be too irritating for a lot of individuals. It also only comes as a gel in the United States, and that can just be an undesirable texture for some people, or they don't like how that product plays with the other things in their routine. So if you're not using adapalene or tretinoin, you can use a gel or a tretinoin. Hope is not lost, okay? There are great retinols and retinaldehyde products out there that also help with aging. For example, one of my absolute favorite topical retinoids is by Naturium. It's their retinaldehyde serum. It comes in two different strengths. So you can start with a lower strength and work your way up if you want to. And putting this on your skin every night under a moisturizer, you're gonna see improvements. Also, if you are new to topical retinoids and you're concerned about having issues with irritation or flaking or dryness, and lots of people have this concern, I have an entire YouTube video dedicated to beginner retinoid recommendations, as well as instructions on how to start a retinoid. One question I get from a lot of women in their forties when they're talking about skincare with me in the office is, is it too late? Like is all hope lost? And it is so important to know that if you are in your thirties, your forties, your fifties, or your sixties, it is never too late to start seeing improvements from good, consistent effects. of skincare. So let's say you're using sunscreen really consistently, you're applying, you're using the right amount, and you're using a retinoid in your routine. Let's talk about other skincare things that can be beneficial. I would say another great active that you can consistently ...incorporate into your routine is a topical antioxidant. And I prefer vitamin C if you can tolerate it because it is the most studied antioxidant when it comes to helping with signs of premature aging. So you hear a ton about how UV radiation can cause premature skin aging, but part of UV radiation is causing this oxidative stress in the skin. So UV radiation, as well as things like pollution, as well as things like your normal skin cells metabolism can generate these harmful molecules in the skin called oxygen-free radicals. Those free radicals just bump around on things in the skin and wreak havoc. They can cause premature destruction of your collagen. They can harm your DNA in your skin. So using a topical antioxidant to neutralize those oxygen-free radicals can help protect your skin. Under the category of vitamin C, there are many different types of vitamin C that can be incorporated into skincare. And L-ascorbic acid is the most studied type of vitamin C that has been shown to be effective. I knew when I was developing my own skincare line prequel that if I was going to have an antioxidant, which... I knew I wanted to have because as a dermatologist, it's one of my top recommended categories of products. I wanted to create a vitamin C serum that used L-ascorbic acid. And so I did. The reason I love the Prequel Lucent C vitamin C serum is because it has 15% L-ascorbic acid, as well as ferulic acid and another antioxidant called ergothionine that helps stabilize the vitamin C within that formula. Not only does this make for a super effective product, but it also makes it a bit more tolerable. So for people who have sensitive skin and are interested in trying a very effective vitamin C, this is a great option. Also, in my experience as a dermatologist, I've noticed that a lot of topical antioxidants are really expensive. So I wanted to make a product that was affordable and accessible. So if you already use vitamin C and you understand the benefits that it can have in your skin, incorporating this into your routine will be amazing. Also, if you've thought about incorporating a topical antioxidant, but you've been intimidated because you're worried that it's gonna cause irritation or it was out of your budget, this is a great option for you as well. So if you're using vitamin C, sunscreen, and a retinoid in your routine, which is what I would consider like the holy trinity of anti-aging skincare, you're going to apply your vitamin C typically in the morning on clean skin, use the rest of your skincare, and then finish your skincare routine with your sunscreen. It should be the last step. in your skincare. Then in the evening, you're going to wash your face, apply your retinoid, and then follow it with a moisturizer or any other serums that you're using. Aside from using a topical antioxidant, sunscreen, and a retinoid, another category of skincare that can be very beneficial as you're getting into your forties is a topical exfoliant. The whole purpose of an exfoliant in skincare is to help you shed that outer dead skin cell layer. Now you don't want to shed all of your dead skin cell layers. That's your skin barrier that helps protect and nourish your skin, but as we get older, our skin cells don't turn over as readily and you can get a buildup of dead skin cells on your skin, which leads to dullness. Exfoliants help break apart those dead skin cells so you can reveal smoother, brighter skin underneath. And exfoliants typically fall into main categories. You can have physical exfoliants, so things that actually scrub or abrade those dead skin cells off. And then you can have chemical exfoliants, which use some type of chemical reaction to break apart those skin cells. As a dermatologist and someone who wants to be respectful of the skin barrier, I tend to prefer chemical exfoliants, but I'm not totally against a physical exfoliant if you're doing it gently. Common exfoliating ingredients that tend to come up in skincare are usually acids. So things like glycolic acid, lactic acid, mandelic acid, salicylic acid, et cetera. Now exfoliation can be a very gentle process, or it can be a more intense process depending on what products you're using and with what frequency you are using them. So if you kind of need a guide to exfoliation and some recommendations based on what your skin is like, I have a whole video dedicated to that. I would say one of my favorite though, like all around exfoliants are the Dr. Dennis Gross Peel Pads. The reason for this is they're sort of individually wrapped and kind of like foolproof because they give you a measured dose. You're not gonna overdo it with these. Start by exfoliating just once a week. On the night that you're exfoliating, you're gonna skip your retinoids. So you're not gonna be using two irritating products at the same time. And you should notice within a few weeks of starting to exfoliate that your skin just has a better glow and more radiance to it. One mistake I see a lot of people make when it comes to incorporating many different products into their skincare routine is they're causing too much irritation to their skin. So for example, if you're using a retinoid regularly and then you start incorporating an exfoliant and your skin starts to feel... irritated or just like stressed out or it's just not looking its best, it's okay to skip the exfoliant. You don't need every single anti-aging thing in your skincare routine if it's not working for you. Now if you're already using all of those things and you're thinking like what else can I incorporate into my skincare routine that's going to give my skin that extra boost, you can consider incorporating things like peptide serums, growth factors, if you are perimenopausal sometimes estrogen creams can be helpful, and also if you feel like your skin is lacking moisture or isn't plump, even incorporating a hydrating serum like a hyaluronic acid serum or a glycerin serum can give you that extra boost. If you guys would like a video just dedicated to peptides, let me know and I can put that together for you. While I'm on the topic, of skincare and at-home treatments, I do want to give just sort of like my personal take on at-home skincare devices like microcurrent devices, red light, etc. because I think people do want to invest in these things and it's not always worth the investment. I think every dermatologist and esthetician has a slightly different opinion on these things. I personally have invested in red light therapy because I think there's the most tangible evidence out there that this is effective in improving collagen and overall skin texture. It's not been my experience, nor is there evidence that some of these microcurrent devices or things like Zip or NuFace lead to lasting changes in the skin. So if you're someone who's going to do something every day, understanding that it might not lead to lasting improvement, but you're okay keeping up with it, then these at-home devices can be helpful. Otherwise, I think they're worth a skip. I find a lot of my patients who are using these at-home devices are also investing in in-office procedures and using at-home devices to boost that. But if you are using at-home devices in replacement of in-office procedures, you're not going to get nearly the same result. For most people, and I know this is not within everyone's budget, but I think you're better off not investing in an at-home device and instead doing something in the office if you're having to pick between one or the other. And I don't just say that because I'm a cosmetic dermatologist, like The proof is in the pudding. I do these treatments all day long. There's tons of evidence that things like lasers, Botox, fillers, et cetera, really meet people's anti-aging skin needs in a way that does not really exist for at-home devices. And with that, let's talk about in-office treatments, because I think a lot of people see the world of cosmetics out there as very vast and kind of intimidating. And there's a lot of things you could do to your skin, but it's like, well, what is going to be the best for my skin? Not just now, but that's going to help me age better a decade from now. two decades from now, et cetera. And when I'm seeing patients in my office and we're having a cosmetic consultation, that's really what I'm thinking about. It's not just what are your skin goals in the moment, which is really important, but also how do you expect your skin to age over time? Are you planning on doing surgery in the future? These are all questions that I'm asking so I can get a better sense of what their goals are long-term. Now, when I'm thinking about in-office procedures that lead to rejuvenation, whether someone's in their 30s or their 60s, but I think this is very appropriate to talk about for a 40s video because- A lot of times this is the first time people are really investing in these treatments. I think about three different categories, complexion correction, optimizing texture, and facial balance. So let's talk about complexion correction first. This is usually for the correction of dark spots, redness in the skin, anything that makes the skin tone overall appear less even. Now you can do things like chemical peels for this because you're just like peeling off the entire top layer of the skin, which is great for brown spots. doesn't really do anything for redness. But in my office, I tend to lean more into the power of lasers because they can be more targeted and more effective for a variety of concerns. If you're thinking about ground spots or sunspots, and that's a big concern for you, there are a variety of resurfacing energy-based devices that can be used. Most commonly, people have heard about things like IPL or BBL that stands for intense pulse light or broadband light. They're in the same category of treatments, and those can help with brown spots and clearing them from the skin, and they can also help with redness. I love using IPL, especially for people who don't struggle with a lot of textural concerns and are really just looking to clear up their complexion. Now, it's really important to understand that a single treatment is not going to undo a lifetime of aging and sun exposure. So these do typically need to be done in a series, and how many you need is really going to depend on how much sun damage you have. as well as your baseline skin type. Now you don't have to use IPL to get rid of brown spots. There are other resurfacing lasers like Clear and Brilliant or even Fraxel laser that can help with that as well. If you wanna go more aggressive, you may have heard of something like Erbium or CO2 lasers and which laser treatments you choose to get are really based on what your concerns are, what your downtime is, what your budget is and what your aesthetic practitioner has available to them. If you deal with a lot of redness or dilated vessels on the skin, some people refer to these as broken blood vessels, then there are specific lasers that can target these, like a KTP laser or a Pulsedye laser. You may have heard of things like V-Beam or XLV, which are brands of those. Now, you just heard me say you can use IPL for redness and you can use these specific lasers for redness. Like, which one's better? And I always try to encourage patients to Look for the person who's treating them, not for the specific device. Because when we're thinking about the efficacy of your treatments, as well as the safety of your treatments, it really depends on whose hands the device is in. So for example, some practitioners might be able to get great results with treating redness with their IPL, while others might prefer to use a V-beam laser. One thing I will say though, is for a lot of people who are coming in, especially in their 40s, maybe they haven't done a lot to improve their skin yet in terms of in-office treatments. Sometimes they're not really even noticing the pigmentation or the irregular complexion. It's something that has sort of like slowly been getting worse over time. So they don't appreciate it and they might be more bothered by fine lines or the texture of their skin or some early sagging. But what I can tell you without a doubt is that if you clear up the complexion of your skin, you will look so much better. And I know the goal of this isn't to like always look younger and we don't always have to be trying to look like our 20 year old selves, but a lot of people are just coming in for a refresh or they want to look as good as they feel. And when you have a clear complexion, it is just amazingly transformative without changing how you really look. So you still look like yourself, but just brighter and refreshed. And typically once someone goes through that initial process of clearing up their skin, maybe with three to five treatments, depending on what they really need, then oftentimes for maintenance, they might be doing one resurfacing treatment a year to help maintain their results and keep up with the continued aging process that inevitably will ensue. So that's complexion correction, and that is sort of like one arm of rejuvenation. The next thing is textural improvements. So when you look at someone and you go, they look older, aside from noticing that their skin might have more spots or more discoloration, you're probably also noticing some textural changes in their skin, like enlarged pores or fine lines and wrinkles. So that's where things like Botox can be super beneficial. Botox relaxes muscles. So any lines that are being etched into your skin from repeated muscle movements, like raising your eyebrows or scowling, if you put Botox into those muscular complexes, you can relax them so that those lines don't continue to get etched in. I have lots of patients in their 30s who are already doing Botox, but if you've made it to your 40s and it's not really something that you've entertained, Oftentimes by that time, you do have some lines existing at rest. And by starting Botox at that point, you can often reverse a lot of those lines, which is important. Sometimes if you wait until your 50s or 60s till when you really need it, because a lot of patients go, I'm going to wait till I really need Botox. It's actually too late. At that point, those lines have been permanently etched in. They are too deep. And yes, by getting Botox, you can stall them from getting worse, but you can't actually get them to fade much over time. For a lot of women in their 40s, the most common places that I'm injecting Botox for them is in their scowl complex up here in their forehead and in their crow's feet. But for some women, we are using Botox in the lower face and in the neck as well. The reasons we often use it in the lower face are to help with people who chronically purse their lips. So do this because eventually over time you can start to form these lip lines and it's so much easier to prevent them than to treat them once they form. And I'm also often putting Botox in the chin area, and near the corners of the mouth to help with those downturned mouth corners or that frown position that a lot of women just sort of pulled their face in without even realizing it. And I often find that Botox in the lower face, especially for someone in their 40s, is really working in a preventative role so that there's not bigger problems to treat down the line. And Botox used throughout the face isn't just used to prevent lines and wrinkles, it can also just give a more serene or relaxed or open-eyed appearance. And that's another thing a lot of women will comment on as they get into their 40s is, They're not necessarily bothered by lines, but they're like, man, Dr. Ellis, I just look tired. Or my husband always asks, are you mad? And that can be because of how you tend to hold your face at rest. And Botox can add a little bit of levity or softness to the face to help with those expressions. Aside from using Botox to help with skin texture, we can also look to things like lasers to help with just general resurfacing. Now, I know I talked about lasers for helping with complexion correction, like brown spots and red spots. but other lasers or even sometimes the lasers I already mentioned with different settings can also help with pores, fine lines, skin texture overall. You can also use things like a deeper chemical peel to help with skin texture. I have chemical peels in my office. I do them for some patients. I generally prefer lasers if a patient is a good candidate because there's just a little bit more precision that you can do with that. Oftentimes too, chemical peels can be a more economic option for people if budget is something that they have to strongly consider. but I will tell you that chemical peels often require more treatments. There's also more downtime and just more risk associated with them. That being said, in skilled and experienced hands, I think chemical peels and laser resurfacing can be great options for addressing skin texture. So we're looking at complexion correction. We're looking at skin texture. The last sort of category that we are addressing, especially for women in their 40s, is facial balance. And when I'm talking about facial balance, I'm really thinking about the use of filler. So an injectable product that can help augment the shape of someone's face to either restore something that has been lost or to beautify the face. So for example, as we get older, some of us will lose volume in our temples or in our cheeks. And as that happens, that can make things like our under eye bags look more prominent, or it can make us look gaunt and aged. And so by using something like filler, we can either restore the loss of volume, or if someone never had that volume to begin with, and they feel like they just want to look more attractive, we can give them a cheek. or give them some temple volume so that overall their features are more harmonious with one another. Other places I think about doing facial balancing aside from the cheeks are in the lips or in the chin. If someone has a small or recessed chin, you can give them more chin projection to just make them look more attractive and provide more balance to the rest of their features. Now we can also use fillers to make someone look younger by smoothing some of the shadows that happen. So if you think about a baby's face, there's some So much light hitting all of the baby's face. It's what makes them look young. As we get older, we start to see a lot more shadowing. There's more hollows in the face. And by smoothing transitions in the face and helping with those shadows, we can give the illusion of a younger appearance. The key, I think, when using fillers is understanding that they are just one part of the anti-aging puzzle, and we cannot just rely on fillers. to do all the anti-aging things we want. We need to work on the skin, we need to work on the deeper structures and support them, and filler can just be one aspect of that. Aside from using traditional hyaluronic acid fillers like Juvederm or Restylane to give immediate shape or contour to the face, we can also think about using biostimulatory injectables like Sculptra, Radiesse, or even Renuva to stimulate collagen and fat production within the face to help smooth things out if we're losing volume over time. I also find that for some of my patients who are in their 40s, they're very nervous about looking weird. Like they might see women out in the community and go, I don't know what that is, but I don't want that. And I often find that's people who have been overfilled or they're using filler as like their main form of rejuvenation. And that's where I think the biostimulatory fillers and conservative use of hyaluronic acid fillers can really play nice with one another, where you're using hyaluronic acid fillers like Juvederm or Restylane. to give more structure or contour to the face. And then you're using these biostimulatory injectables that help with collagen and fat production like Radiesse, Sculptra, and Renuva to help smooth the skin, to help smooth the transitions. And that's where someone's gonna look a lot more natural. So those are all things you could do in a dermatologist's office. Those are non-surgical interventions. A lot of people in their 40s aren't really at the point where they're considering things like facelifts, but I will say a lot of people in their 40s will notice changes around their eyes, whether that's hooding of their upper eyelids, or... or bagginess under the eyes. These are very genetic things that tend to show up in our 30s or in our 40s. And so considering something like eyelid surgery in your 40s, I don't think is weird or aggressive or out of the question. There are lots of patients that I have that need something like a surgical intervention to truly address their under eye concerns. And then we can do less invasive things for the rest of their concerns. So those are all the things I would consider for someone who's approaching 40 or in their 40s. I know we talked about a lot of different things here. So of course, if you have questions about the procedures or about the products, definitely let me know in the comments. Also, if you've had any of these procedures, please tell me your experience. All of us would love to learn from what you have gone through. As always, thank you so much for watching. Don't forget to like this video and subscribe to the channel and I'll see you next time.

I'm a board certified medical and cosmetic dermatologist in Northern California, and I'm here to help you understand your skin and help find products that work for you. So if that sounds good, give this video a thumbs up and subscribe. I would say most classically, it's when women get into their 40s that they start telling me as their cosmetic dermatologist, like, listen, Dr. Ellis, some things are happening and I'm not so pleased about it.

So I really feel like focusing on the skincare and maybe the cosmetic procedures that you can have going into your 40s or once you are in your 40s is really important because that might be the first time people are really starting to consider these interventions. I think two main things happen in your 40s that make women go whoa, I woke up at 40 and feel like my skin changed or I looked like a totally new person and not in a good way. One is a lot of women are finishing their childbearing in their 30s and they hit 40s and now they've had years of being pregnant or sleep deprived and often a combination of both of those things. And they are just not looking or feeling their best.

Also at that time in their life, they may not have really been prioritizing themselves and taking care of themselves. And so once they hit 40, they're really ready to start investing in a new way. The other thing that often happens to women as they get into their 40s and approach their 50s is they start going through menopause. And as the estrogen shifts down in the body, you can lose suppleness to the skin and you can really start seeing accelerated aging changes. Now, I do want to say 40s is just a number.

We are using that kind of as a benchmark for where a lot of people start to notice these aging changes. But depending on your genetics and what your skin has previously been exposed to, and maybe how well you've cared for your skin over your lifetime, you may or may be not noticing these changes at this point in your life. Now, as women get into their forties, they may notice that their skin is starting to lose a little bit of elasticity. So it can be the first sign of jowls starting to form or a little bit of sagginess into the skin or some creepiness under the eyes or on the neck.

The other thing people will tend to notice in their forties is that all of the sun damage that they have accrued over their lifetime really starts to come to the skin surface and they're going to start noticing things like brown spots and sun spots. Texturally, the skin also can start to change. So you might notice enlargement of the pores as well as the skin becoming drier or thinner.

So whether you're 40 or not, if you're starting to notice these changes in your skin and you want to know what you can do about them, this video is for you. Now, before we get into interventions that you can do at home, products you can use, and things you can do in the office, I think it's really important to discuss how your lifestyle and how you treat your entire body changes how your skin appears. So if you're getting into your 40s and you're trying to look and feel like your very best self, having a well-rounded diet is really important.

Having a good exercise regimen and working on maintaining your muscle mass can really help with the signs of premature aging. Along with eating well and exercising, getting ideal sleep is really important as well as managing stress. And I'm sure it's probably the most annoying thing to hear a doctor tell you, oh, manage your stress. But things you can do to make your life less stressful are super important because you might be taking care of small children. You might be taking care of aging parents.

You might be dealing with interpersonal relationships. And all of those things accumulate. When you have stress hormones like cortisol coursing through your body, it can cause premature aging. Also, if you're starting to experience symptoms of menopause, whether that's difficulty with sleeping, hot flashes, mood changes, etc., I think it's really important to talk with your primary care provider about what things you can be doing to optimize that, including things like hormone therapy. So when we're looking to optimize our skin in our 40s, I think that really starts with a good foundation of consistent skincare.

The number one and two things that you're going to want in your skincare routine are sunscreen and some type of topical retinoid. So sunscreen is so, so, so important. I feel like if you're watching a skincare video, you might be like, yes, Dr. Ellis, duh. But I cannot tell you how many patients come into my office every single day wanting to talk about in-office procedures like lasers and chemical peels and Botox. And when I get into their skincare, they're not wearing sunscreen on a regular basis.

If you're going to be investing in these other procedures down the line, you need to protect that investment and SPF is where that's at. And the reason why sunscreen is the most important thing that you are going to put on your skin is because UV radiation, so light that comes from the sun, is the number one cause of premature skin aging. It breaks down the collagen, the structural support protein in your skin, and it causes damage to many other structures that reside there. When you have repeated exposure to UV radiation, and... even in low amounts.

I'm talking walking to your car, sitting out at your kid's baseball game. That over time will lead to irregular pigmentation in the skin, fine lines and wrinkles, as well as sagging. So if you are protecting from UV radiation, whether that is with sunscreen, a hat, seeking shade, and preferably some combination of all of those, you are protecting your skin from for premature aging, as well as skin cancer. One of the protests I will often get when people talk about not wanting to wear sunscreen or not wearing it regularly is they can't find one that they like, whether that means it stings their eyes, they don't enjoy the texture, they don't enjoy the fragrance, they might have a sensitivity to it. But I think it is such a worthwhile investment to go out and buy like 15, 20 sunscreens.

If you add all of that up, that might be several hundred dollars, but when you compare that to the several thousands of dollars you could spend in procedures over your lifetime, an investment to find a sunscreen you love is so, so worth it. Also, if you need some guidance in finding a good sunscreen, I have so many different videos with my favorites. Ideally, you are looking for something that is SPF 30 or higher and has broad spectrum coverage.

And really all of the sunscreens that you can readily purchase in the United States have broad spectrum coverage. Another thing that is super important is that you are actually applying enough sunscreen. So sunscreen should not be applied sparingly.

Like I watch my husband apply sunscreen sometimes and I just kind of want to die because it's like, like you need to get in there and slather your face. And I have an entire video dedicated to sunscreen mistakes I commonly see. But another one that tends to come up in women is that they are relying on the sunscreen or the SPF in their makeup for their sun protection. And the reality is you're just typically not applying enough foundation or enough.

tinted moisturizer to really get the stated SPF that's on the bottle. So even if you have a foundation that's SPF 20 or 30, you're probably applying it in a way where you're getting SPF 3 or 5. And it's totally okay to use makeup that has sunscreen in it, but just make sure you are applying a dedicated sunscreen layer first. Second in line in order of importance when it comes to skincare after sunscreen is using a topical retinoid.

For a quick review, retinoids are vitamin A derived molecules. They include things like retinol and retinaldehyde as well as prescriptions like retin-a also known as tretinoin i would consider them the best anti-aging topical that you can use besides sunscreen because they help with fine lines wrinkles irregular pigmentation and dullness now there is a very strong recommendation to not be using topical retinoids while you are trying to conceive or while you are pregnant so for a lot of women they've skipped retinoids for a vast majority of their 30s if they've been having kids now of course that doesn't mean women can't continue to have kids in their 40s but often women in their 40s are ready to be on a consistent topical retinoid because they're done with their childbearing years. If you would consider your skin to not really be sensitive, I think it's very appropriate to have a conversation with your dermatologist about getting prescription tretinoin or retin-A.

Tretinoin, also known as retin-A, is a prescription retinoid, and it is also the most studied retinoid when it comes to showing improvement in signs of skin aging. So this includes things like helping with dullness, dark marks, fine lines, and wrinkles. However, tretinoin is not without potential side effects, the main one being irritation, skin peeling, dryness, sensitivity. So if you cannot acclimate to those side effects, and for a lot of people, if they're using tretinoin regularly over the course of months, their skin will get used to this, but some people's won't.

And if you have the type of skin that is just not tolerating tretinoin on a regular basis, then there are other over-the-counter retinoids that you can get that are also very effective. If we're talking about retinoids that you can get without a prescription from a healthcare professional, the most potent thing that you can get over the counter in the United States is Differin, also known as Adapalene. Adapalene is considered a third generation retinoid, so it tends to be very targeted in the skin.

So it tends to cause less irritation for people. It's really most studied for the treatment of acne because retinoids are very good at helping with acne. But there are also studies to suggest that it helps with skin aging as well.

So if you can't tolerate prescription tretinoin, but you're still looking for something quite potent to help with signs of skin aging, adapalene is the next best option. Now, that being said, adapalene can still be too irritating for a lot of individuals. It also only comes as a gel in the United States, and that can just be an undesirable texture for some people, or they don't like how that product plays with the other things in their routine. So if you're not using adapalene or tretinoin, you can use a gel or a tretinoin.

Hope is not lost, okay? There are great retinols and retinaldehyde products out there that also help with aging. For example, one of my absolute favorite topical retinoids is by Naturium. It's their retinaldehyde serum. It comes in two different strengths.

So you can start with a lower strength and work your way up if you want to. And putting this on your skin every night under a moisturizer, you're gonna see improvements. Also, if you are new to topical retinoids and you're concerned about having issues with irritation or flaking or dryness, and lots of people have this concern, I have an entire YouTube video dedicated to beginner retinoid recommendations, as well as instructions on how to start a retinoid. One question I get from a lot of women in their forties when they're talking about skincare with me in the office is, is it too late?

Like is all hope lost? And it is so important to know that if you are in your thirties, your forties, your fifties, or your sixties, it is never too late to start seeing improvements from good, consistent effects. of skincare. So let's say you're using sunscreen really consistently, you're applying, you're using the right amount, and you're using a retinoid in your routine.

Let's talk about other skincare things that can be beneficial. I would say another great active that you can consistently ...incorporate into your routine is a topical antioxidant. And I prefer vitamin C if you can tolerate it because it is the most studied antioxidant when it comes to helping with signs of premature aging.

So you hear a ton about how UV radiation can cause premature skin aging, but part of UV radiation is causing this oxidative stress in the skin. So UV radiation, as well as things like pollution, as well as things like your normal skin cells metabolism can generate these harmful molecules in the skin called oxygen-free radicals. Those free radicals just bump around on things in the skin and wreak havoc.

They can cause premature destruction of your collagen. They can harm your DNA in your skin. So using a topical antioxidant to neutralize those oxygen-free radicals can help protect your skin.

Under the category of vitamin C, there are many different types of vitamin C that can be incorporated into skincare. And L-ascorbic acid is the most studied type of vitamin C that has been shown to be effective. I knew when I was developing my own skincare line prequel that if I was going to have an antioxidant, which... I knew I wanted to have because as a dermatologist, it's one of my top recommended categories of products.

I wanted to create a vitamin C serum that used L-ascorbic acid. And so I did. The reason I love the Prequel Lucent C vitamin C serum is because it has 15% L-ascorbic acid, as well as ferulic acid and another antioxidant called ergothionine that helps stabilize the vitamin C within that formula. Not only does this make for a super effective product, but it also makes it a bit more tolerable. So for people who have sensitive skin and are interested in trying a very effective vitamin C, this is a great option.

Also, in my experience as a dermatologist, I've noticed that a lot of topical antioxidants are really expensive. So I wanted to make a product that was affordable and accessible. So if you already use vitamin C and you understand the benefits that it can have in your skin, incorporating this into your routine will be amazing.

Also, if you've thought about incorporating a topical antioxidant, but you've been intimidated because you're worried that it's gonna cause irritation or it was out of your budget, this is a great option for you as well. So if you're using vitamin C, sunscreen, and a retinoid in your routine, which is what I would consider like the holy trinity of anti-aging skincare, you're going to apply your vitamin C typically in the morning on clean skin, use the rest of your skincare, and then finish your skincare routine with your sunscreen. It should be the last step.

in your skincare. Then in the evening, you're going to wash your face, apply your retinoid, and then follow it with a moisturizer or any other serums that you're using. Aside from using a topical antioxidant, sunscreen, and a retinoid, another category of skincare that can be very beneficial as you're getting into your forties is a topical exfoliant. The whole purpose of an exfoliant in skincare is to help you shed that outer dead skin cell layer. Now you don't want to shed all of your dead skin cell layers.

That's your skin barrier that helps protect and nourish your skin, but as we get older, our skin cells don't turn over as readily and you can get a buildup of dead skin cells on your skin, which leads to dullness. Exfoliants help break apart those dead skin cells so you can reveal smoother, brighter skin underneath. And exfoliants typically fall into main categories.

You can have physical exfoliants, so things that actually scrub or abrade those dead skin cells off. And then you can have chemical exfoliants, which use some type of chemical reaction to break apart those skin cells. As a dermatologist and someone who wants to be respectful of the skin barrier, I tend to prefer chemical exfoliants, but I'm not totally against a physical exfoliant if you're doing it gently.

Common exfoliating ingredients that tend to come up in skincare are usually acids. So things like glycolic acid, lactic acid, mandelic acid, salicylic acid, et cetera. Now exfoliation can be a very gentle process, or it can be a more intense process depending on what products you're using and with what frequency you are using them. So if you kind of need a guide to exfoliation and some recommendations based on what your skin is like, I have a whole video dedicated to that.

I would say one of my favorite though, like all around exfoliants are the Dr. Dennis Gross Peel Pads. The reason for this is they're sort of individually wrapped and kind of like foolproof because they give you a measured dose. You're not gonna overdo it with these. Start by exfoliating just once a week. On the night that you're exfoliating, you're gonna skip your retinoids.

So you're not gonna be using two irritating products at the same time. And you should notice within a few weeks of starting to exfoliate that your skin just has a better glow and more radiance to it. One mistake I see a lot of people make when it comes to incorporating many different products into their skincare routine is they're causing too much irritation to their skin. So for example, if you're using a retinoid regularly and then you start incorporating an exfoliant and your skin starts to feel... irritated or just like stressed out or it's just not looking its best, it's okay to skip the exfoliant.

You don't need every single anti-aging thing in your skincare routine if it's not working for you. Now if you're already using all of those things and you're thinking like what else can I incorporate into my skincare routine that's going to give my skin that extra boost, you can consider incorporating things like peptide serums, growth factors, if you are perimenopausal sometimes estrogen creams can be helpful, and also if you feel like your skin is lacking moisture or isn't plump, even incorporating a hydrating serum like a hyaluronic acid serum or a glycerin serum can give you that extra boost. If you guys would like a video just dedicated to peptides, let me know and I can put that together for you.

While I'm on the topic, of skincare and at-home treatments, I do want to give just sort of like my personal take on at-home skincare devices like microcurrent devices, red light, etc. because I think people do want to invest in these things and it's not always worth the investment. I think every dermatologist and esthetician has a slightly different opinion on these things. I personally have invested in red light therapy because I think there's the most tangible evidence out there that this is effective in improving collagen and overall skin texture.

It's not been my experience, nor is there evidence that some of these microcurrent devices or things like Zip or NuFace lead to lasting changes in the skin. So if you're someone who's going to do something every day, understanding that it might not lead to lasting improvement, but you're okay keeping up with it, then these at-home devices can be helpful. Otherwise, I think they're worth a skip.

I find a lot of my patients who are using these at-home devices are also investing in in-office procedures and using at-home devices to boost that. But if you are using at-home devices in replacement of in-office procedures, you're not going to get nearly the same result. For most people, and I know this is not within everyone's budget, but I think you're better off not investing in an at-home device and instead doing something in the office if you're having to pick between one or the other.

And I don't just say that because I'm a cosmetic dermatologist, like The proof is in the pudding. I do these treatments all day long. There's tons of evidence that things like lasers, Botox, fillers, et cetera, really meet people's anti-aging skin needs in a way that does not really exist for at-home devices. And with that, let's talk about in-office treatments, because I think a lot of people see the world of cosmetics out there as very vast and kind of intimidating. And there's a lot of things you could do to your skin, but it's like, well, what is going to be the best for my skin?

Not just now, but that's going to help me age better a decade from now. two decades from now, et cetera. And when I'm seeing patients in my office and we're having a cosmetic consultation, that's really what I'm thinking about. It's not just what are your skin goals in the moment, which is really important, but also how do you expect your skin to age over time?

Are you planning on doing surgery in the future? These are all questions that I'm asking so I can get a better sense of what their goals are long-term. Now, when I'm thinking about in-office procedures that lead to rejuvenation, whether someone's in their 30s or their 60s, but I think this is very appropriate to talk about for a 40s video because- A lot of times this is the first time people are really investing in these treatments. I think about three different categories, complexion correction, optimizing texture, and facial balance. So let's talk about complexion correction first.

This is usually for the correction of dark spots, redness in the skin, anything that makes the skin tone overall appear less even. Now you can do things like chemical peels for this because you're just like peeling off the entire top layer of the skin, which is great for brown spots. doesn't really do anything for redness. But in my office, I tend to lean more into the power of lasers because they can be more targeted and more effective for a variety of concerns. If you're thinking about ground spots or sunspots, and that's a big concern for you, there are a variety of resurfacing energy-based devices that can be used.

Most commonly, people have heard about things like IPL or BBL that stands for intense pulse light or broadband light. They're in the same category of treatments, and those can help with brown spots and clearing them from the skin, and they can also help with redness. I love using IPL, especially for people who don't struggle with a lot of textural concerns and are really just looking to clear up their complexion. Now, it's really important to understand that a single treatment is not going to undo a lifetime of aging and sun exposure. So these do typically need to be done in a series, and how many you need is really going to depend on how much sun damage you have.

as well as your baseline skin type. Now you don't have to use IPL to get rid of brown spots. There are other resurfacing lasers like Clear and Brilliant or even Fraxel laser that can help with that as well.

If you wanna go more aggressive, you may have heard of something like Erbium or CO2 lasers and which laser treatments you choose to get are really based on what your concerns are, what your downtime is, what your budget is and what your aesthetic practitioner has available to them. If you deal with a lot of redness or dilated vessels on the skin, some people refer to these as broken blood vessels, then there are specific lasers that can target these, like a KTP laser or a Pulsedye laser. You may have heard of things like V-Beam or XLV, which are brands of those.

Now, you just heard me say you can use IPL for redness and you can use these specific lasers for redness. Like, which one's better? And I always try to encourage patients to Look for the person who's treating them, not for the specific device.

Because when we're thinking about the efficacy of your treatments, as well as the safety of your treatments, it really depends on whose hands the device is in. So for example, some practitioners might be able to get great results with treating redness with their IPL, while others might prefer to use a V-beam laser. One thing I will say though, is for a lot of people who are coming in, especially in their 40s, maybe they haven't done a lot to improve their skin yet in terms of in-office treatments.

Sometimes they're not really even noticing the pigmentation or the irregular complexion. It's something that has sort of like slowly been getting worse over time. So they don't appreciate it and they might be more bothered by fine lines or the texture of their skin or some early sagging.

But what I can tell you without a doubt is that if you clear up the complexion of your skin, you will look so much better. And I know the goal of this isn't to like always look younger and we don't always have to be trying to look like our 20 year old selves, but a lot of people are just coming in for a refresh or they want to look as good as they feel. And when you have a clear complexion, it is just amazingly transformative without changing how you really look. So you still look like yourself, but just brighter and refreshed.

And typically once someone goes through that initial process of clearing up their skin, maybe with three to five treatments, depending on what they really need, then oftentimes for maintenance, they might be doing one resurfacing treatment a year to help maintain their results and keep up with the continued aging process that inevitably will ensue. So that's complexion correction, and that is sort of like one arm of rejuvenation. The next thing is textural improvements.

So when you look at someone and you go, they look older, aside from noticing that their skin might have more spots or more discoloration, you're probably also noticing some textural changes in their skin, like enlarged pores or fine lines and wrinkles. So that's where things like Botox can be super beneficial. Botox relaxes muscles.

So any lines that are being etched into your skin from repeated muscle movements, like raising your eyebrows or scowling, if you put Botox into those muscular complexes, you can relax them so that those lines don't continue to get etched in. I have lots of patients in their 30s who are already doing Botox, but if you've made it to your 40s and it's not really something that you've entertained, Oftentimes by that time, you do have some lines existing at rest. And by starting Botox at that point, you can often reverse a lot of those lines, which is important. Sometimes if you wait until your 50s or 60s till when you really need it, because a lot of patients go, I'm going to wait till I really need Botox.

It's actually too late. At that point, those lines have been permanently etched in. They are too deep. And yes, by getting Botox, you can stall them from getting worse, but you can't actually get them to fade much over time.

For a lot of women in their 40s, the most common places that I'm injecting Botox for them is in their scowl complex up here in their forehead and in their crow's feet. But for some women, we are using Botox in the lower face and in the neck as well. The reasons we often use it in the lower face are to help with people who chronically purse their lips. So do this because eventually over time you can start to form these lip lines and it's so much easier to prevent them than to treat them once they form.

And I'm also often putting Botox in the chin area, and near the corners of the mouth to help with those downturned mouth corners or that frown position that a lot of women just sort of pulled their face in without even realizing it. And I often find that Botox in the lower face, especially for someone in their 40s, is really working in a preventative role so that there's not bigger problems to treat down the line. And Botox used throughout the face isn't just used to prevent lines and wrinkles, it can also just give a more serene or relaxed or open-eyed appearance. And that's another thing a lot of women will comment on as they get into their 40s is, They're not necessarily bothered by lines, but they're like, man, Dr. Ellis, I just look tired.

Or my husband always asks, are you mad? And that can be because of how you tend to hold your face at rest. And Botox can add a little bit of levity or softness to the face to help with those expressions. Aside from using Botox to help with skin texture, we can also look to things like lasers to help with just general resurfacing.

Now, I know I talked about lasers for helping with complexion correction, like brown spots and red spots. but other lasers or even sometimes the lasers I already mentioned with different settings can also help with pores, fine lines, skin texture overall. You can also use things like a deeper chemical peel to help with skin texture.

I have chemical peels in my office. I do them for some patients. I generally prefer lasers if a patient is a good candidate because there's just a little bit more precision that you can do with that. Oftentimes too, chemical peels can be a more economic option for people if budget is something that they have to strongly consider.

but I will tell you that chemical peels often require more treatments. There's also more downtime and just more risk associated with them. That being said, in skilled and experienced hands, I think chemical peels and laser resurfacing can be great options for addressing skin texture. So we're looking at complexion correction. We're looking at skin texture.

The last sort of category that we are addressing, especially for women in their 40s, is facial balance. And when I'm talking about facial balance, I'm really thinking about the use of filler. So an injectable product that can help augment the shape of someone's face to either restore something that has been lost or to beautify the face. So for example, as we get older, some of us will lose volume in our temples or in our cheeks.

And as that happens, that can make things like our under eye bags look more prominent, or it can make us look gaunt and aged. And so by using something like filler, we can either restore the loss of volume, or if someone never had that volume to begin with, and they feel like they just want to look more attractive, we can give them a cheek. or give them some temple volume so that overall their features are more harmonious with one another.

Other places I think about doing facial balancing aside from the cheeks are in the lips or in the chin. If someone has a small or recessed chin, you can give them more chin projection to just make them look more attractive and provide more balance to the rest of their features. Now we can also use fillers to make someone look younger by smoothing some of the shadows that happen.

So if you think about a baby's face, there's some So much light hitting all of the baby's face. It's what makes them look young. As we get older, we start to see a lot more shadowing.

There's more hollows in the face. And by smoothing transitions in the face and helping with those shadows, we can give the illusion of a younger appearance. The key, I think, when using fillers is understanding that they are just one part of the anti-aging puzzle, and we cannot just rely on fillers.

to do all the anti-aging things we want. We need to work on the skin, we need to work on the deeper structures and support them, and filler can just be one aspect of that. Aside from using traditional hyaluronic acid fillers like Juvederm or Restylane to give immediate shape or contour to the face, we can also think about using biostimulatory injectables like Sculptra, Radiesse, or even Renuva to stimulate collagen and fat production within the face to help smooth things out if we're losing volume over time.

I also find that for some of my patients who are in their 40s, they're very nervous about looking weird. Like they might see women out in the community and go, I don't know what that is, but I don't want that. And I often find that's people who have been overfilled or they're using filler as like their main form of rejuvenation.

And that's where I think the biostimulatory fillers and conservative use of hyaluronic acid fillers can really play nice with one another, where you're using hyaluronic acid fillers like Juvederm or Restylane. to give more structure or contour to the face. And then you're using these biostimulatory injectables that help with collagen and fat production like Radiesse, Sculptra, and Renuva to help smooth the skin, to help smooth the transitions.

And that's where someone's gonna look a lot more natural. So those are all things you could do in a dermatologist's office. Those are non-surgical interventions.

A lot of people in their 40s aren't really at the point where they're considering things like facelifts, but I will say a lot of people in their 40s will notice changes around their eyes, whether that's hooding of their upper eyelids, or... or bagginess under the eyes. These are very genetic things that tend to show up in our 30s or in our 40s. And so considering something like eyelid surgery in your 40s, I don't think is weird or aggressive or out of the question. There are lots of patients that I have that need something like a surgical intervention to truly address their under eye concerns.

And then we can do less invasive things for the rest of their concerns. So those are all the things I would consider for someone who's approaching 40 or in their 40s. I know we talked about a lot of different things here.

So of course, if you have questions about the procedures or about the products, definitely let me know in the comments. Also, if you've had any of these procedures, please tell me your experience. All of us would love to learn from what you have gone through.

As always, thank you so much for watching. Don't forget to like this video and subscribe to the channel and I'll see you next time.

Transcript for:Skincare Tips for Women in Their 40s

Transcript for:
Skincare Tips for Women in Their 40s