Maintaining beauty is not merely a pursuit of vanity; it reflects vitality, confidence, and well-being. For many women who enter their 60s, 70s, and beyond, maintaining their appearance is a way of preserving their identity and sense of agency in the world. They typically seek treatments that allow them to age gracefully, with an emphasis on natural improvements rather than dramatic changes. Prevention, rather than correction, is at the core of optimal aging in my practice and starting early with interventions such as biostimulators, skin quality enhancements, and skin boosters can delay or even minimize the need for more aggressive measures later. Mature women may begin their journey with topicals and noninvasive skin treatments before progressing to dermal fillers as volume loss becomes more noticeable.
However, I advocate for a more strategic and regenerative protocol for women over 50; one that blends biostimulators, hyaluronic acid (HA) fillers, and advanced skin boosters to deliver optimal, natural-looking results that enhance facial harmony. While my protocol is completely sufficient for many, these nonsurgical options don’t eliminate the value of surgical intervention.
As a surgeon, I often advise patients to wait until they are 55 or older for more extensive procedures such as a facelift, but I recommend that upper face aging be addressed sooner rather than later. Procedures such as mini facelifts, browlifts, blepharoplasty, or rhinoplasty can be incredibly impactful when done at the right time because they can allow women to wait longer to undergo extensive surgery, such as deep plane face and neck lifts, and not rush into these procedures. Undergoing an upper or lower blepharoplasty early can significantly improve both appearance and quality of life1 by reducing heaviness, correcting under-eye hollowness or puffiness, and refreshing the overall expression. This article explores the evolving aesthetic goals of women over 40 and the most effective treatments to meet their needs with a focus on natural-looking outcomes.
ADDRESSING BODY CHANGES
As women transition from their reproductive to post-reproductive years, they reach menopause, which leads to accelerated biological aging and epigenetic aging.2 This rapid internal aging is driven primarily by ovarian aging, as the ovaries are the first organ to age in the human body.3 Changes also occur to the skin—specifically, the stratum corneum, as the ceramides become less abundant and shorter in length.4 We always optimize hormone replacement therapy and seek to mitigate menopause and perimenopause symptoms as soon as we meet patients. As part of my integrative aesthetics approach, all my mature patients receive labs and are treated with a full-body analysis, including supplements, peptide therapy, hormone therapy, and other interventions if necessary. Along with these bodily changes, patients begin experiencing changes in their appearance as internal aging is reflected on the exterior.
Cutaneous aging can occur through intrinsic aging, which includes atrophy of the dermis, altered dermal collagen, elastin, and glycosaminoglycans, and a reduction in the number and biosynthetic capacity of fibroblasts.5 Extrinsic aging, or photoaging, occurs through ultraviolet radiation damaging the connective tissues of the dermis, which is then seen through the loss of elasticity, increased dryness, pigmentation, deep wrinkling, and impaired wound healing.6 As these two biological pathways of aging occur, changes are seen in facial bone, fat, muscle, and skin. Bone recedes and remodels with age, as seen with the loss of definition, decrease in height of the chin, pyriform and maxillary recession, alar base widening, shortening of the upper jaw, and orbital bone resorption.7 As these bones remodel and supporting ligaments weaken, the overlying fat pads also reposition, leading to an unfavorable distribution of fat.
This fat pad repositioning especially occurs in the periorbital, midface, and lower jaw regions, while fat atrophy is typically seen in the forehead, periorbital, and perioral areas.7 This results in hollowing of the temple and jowling as fat is displaced from the cheek to the lower face, lateral nasolabial fold, and lateral labiomental crease.7 As a result, the midface begins to hollow, and the periorbital region can appear sunken or tired.
With repetitive muscle contraction, superficial and deep dynamic wrinkles appear more prominent. While many may attribute this to muscles weakening with age, it occurs because the relative pull of the muscle becomes greater on the less resistant tissues, which may cause hyperdynamic expressions,7 which appear unnatural. An example of this is seen when the vertical “smoke” lines form around the perioral skin, which occurs because the orbicularis oris muscle pulls with greater force on the surrounding skin. Lastly, the skin serves as the most outward and evident sign of aging.
With photoaging and UV radiation, melanocytes become hyperactivated, which leads to senile lentigo, or age spots.8 UV light induces cellular senescence, which accumulates in the skin with aging and promotes tissue dysfunction by secreting factors known as senescence-associated secretory phenotype (SASP), inducing senescence in neighboring cells through paracrine signaling.9 The mechanistic target of rapamycin (mTOR) has emerged as a potential target for combating cellular senescence and aging, as it is responsible for cell growth, survival, protein synthesis, and limiting autophagy. Evidence has shown that mTORC1, the mTOR-complex 1, is required for cellular senescence to occur,10 and that inhibition of mTORC1 in primary fibroblasts resulted in a delay of senescence and reversal of some of the outcomes.11 Inhibiting mTORC1 with rapamycin, a drug known to activate autophagy, has been shown to reduce markers of cellular senescence, inhibit expression and secretion of inflammatory cytokines, and prevent mitochondrial dysfunction.12 Rapamycin was also found to increase lifespan in both male and female mice, even when implemented later in life, which completely countered the previous belief that intervention late in life can only have minimal impact on longevity.13 These biological mechanisms of skin aging manifest visibly: Fine lines deepen into wrinkles, texture becomes crepey, youthful volume is lost, and pigmentation spots become more pronounced and visible. Collectively, these changes can create a disconnect between how a woman feels and how her skin presents to the world.
EMERGING REGENERATIVE PATHWAYS
Fortunately, in recent years, nonsurgical interventions have advanced significantly, offering more natural, regenerative solutions for mature skin. The focus of many innovative treatments in regenerative aesthetics has shifted toward extending the span of your health (healthspan) and of your skin (skinspan) by stimulating your body’s natural regenerative pathways. Among the most common treatments for this population are skin boosters like polynucleotides (PN), exosomes, micronutrient priming, biostimulators like calcium hydroxyapatite (CaHA) and poly-L-lactic acid (PLLA), and evidence-based topical skincare regimens.
Polynucleotides have emerged as one of the most promising regenerative tools for mature skin. Derived from purified DNA fragments from sperm cells of Oncorhynchus mykiss (salmon trout) or Oncorhynchus keta (chum salmon),14 polynucleotides—specifically polydeoxyribonucleotide (PDRN)—stimulate human skin fibroblast growth and support tissue repair.15 PDRN has also shown to promote angiogenesis, cellular activity, collagen synthesis, soft tissue regeneration, skin priming, and revitalization, and can be used to treat hyperpigmentation.16
Leading innovations in this field include Toskani’s Lumicen, which contains pure 3% sodium DNA. This can be applied during and after microneedling or mesoneedling the skin and aims at improving flaccidity, improving fine wrinkles, and improving dry and dull skin. Rejuran’s Healing Essence contains 2% Hydrolyzed DNA, aimed toward promoting a healthier-looking complexion. Promoitalia offers many skin booster options as well that can be paired with microneedling, including NucleoSkin and EXO NAD. NucleoSkin contains PDRN, hyaluronic acid (HA), and glutathione and is said to be a bio-restructuring solution with a plumping, lifting, and regenerating action. EXO NAD is formulated to rejuvenate, restore, and enhance skin vitality through exosomal technology, epitalon peptide, GHK-Cu, NAD+, and other biomimetic peptides. The kit includes a biphasic peel (epitalon and glycolic complex), a gold-infused pH normalizer for instant soothing and balance, and a longevity serum. The efficacy of topical NAD is not well established, but one study found topical NAD to have similar effect on psoriasis plaques compared to anthralin cream.17
While these products are fairly new in the industry, most PDRN skin boosters are considered safe as PDRN is extracted and purified at high temperatures, which allows for the recovery of >95% of the pure active substance with inactivated proteins and peptides.14
Exosomes are another innovative modality that holds particular value for aging skin. These nanosized vesicles, secreted by stem cells, contain growth factors, cytokines, proteins, lipids, and microRNA that facilitate intercellular communication and skin regeneration.18 Exosomes promote collagen synthesis, reduce oxidative stress, and enhance wound healing, which indicates that they can be particularly useful in anti-aging therapies.18 For women over 40, exosomes offer an elegant way to amplify the effects of skin rejuvenating treatments, such as microneedling and other laser device procedures, while improving the recovery time. Their ability to accelerate healing also makes them particularly well suited for patients with thinner, slower-healing skin.
In addition to PN and exosomes, biostimulatory injectables, such as PLLA and CaHA, can be a powerful tool for mature skin. Unlike traditional fillers that provide immediate volumization, these agents stimulate the body’s own collagen production, offering a natural restoration of youthful volume. Galderma’s Sculptra, a PLLA, is an injectable implant that is US Food and Drug Administration (FDA) approved for addressing facial fat loss linked to antiretroviral therapy-induced lipoatrophy in HIV patients. It can produce collagen type I fibers, and the duration of its action is 12 to 24 months.19 In my mature patients, I use my Signature Magic Matrix Technique, whereby I layer PLLA around the temples and along the lines of ligaments, as this product seems to restore the adhesion that is lost with the attenuated ligaments by promoting fibrosis and a Velcro-like effect. CaHA is a biodegradable filler that immediately restores volume and subsequently stimulates the production of collagen and elastin.20 This production has been shown to increase the deposition of collagen type I and collagen type III, as well as increase the levels of elastin expression and angiogenesis.20 CaHA can be used undiluted, diluted with a 1:1 ratio, or hyperdiluted with 1:2 and 1:3, as I typically do in my practice for my mature patients to take full advantage of CaHA’s biostimulatory effects. Within my Magic Matrix Technique, I use a hyperdiluted version of Merz Aesthetics’ Radiesse to improve facial drooping for mid-face and lower-face volume restoration, which consistently yields high patient satisfaction rates and results in my practice.
Along with biostimulators, neuromodulators and HA fillers can be used for a full-face approach. Filler remains a cornerstone in soft tissue augmentation, helping to restore volume across aging facial features. In my technique, I restore the undereye area with supraperiosteally injected HA fillers and microneedle the area with a skin booster, which results in beautiful outcomes that look natural and have minimal to no downtime. With age, the lips also lose their youthful, plump volume, which can be improved with the conservative injection of HA filler.
BEYOND VOLUMIZATION
In addition to volumizing treatments, such as HA fillers, professional skin treatments like chemical peels and energy-based devices play a vital role in improving skin quality, tone, and texture.
Chemical peels remain a tried-and-true treatment for treating visible signs of aging—especially pigmentation, rough texture, and fine lines. When used judiciously, superficial to medium-depth peels can dramatically improve overall skin appearance with relatively short recovery periods. Glycolic acid, trichloroacetic acid (TCA), and Jessner’s solution are common choices, and peels can be customized based on skin sensitivity and treatment goals. For mature skin, peels are particularly effective in brightening a dull complexion and evening out discoloration, often caused by decades of sun exposure. They also help stimulate collagen production and can be used to treat not only the face but also the neck and chest, areas where aging is often most visible. Peels are an accessible option for patients seeking consistent maintenance without more invasive procedures.
Additionally, laser technology continues to be one of the most effective interventions for mature skin when used strategically. Ablative lasers, such as fractional CO2 and erbium, can dramatically improve texture, reduce wrinkles, and tighten lax skin by stimulating collagen remodeling. While these treatments do come with downtime, many patients over 40 are willing to make that trade-off for longer-lasting, more significant results. In fact, practitioners often feel more comfortable using ablative lasers in this demographic because the risk of overcorrection is lower, and patients are less likely to seek extreme “quick fixes.” Non-ablative options are also valuable for those looking for gradual improvement with minimal disruption to their daily routine. Lasers can be used not just on the face, but also on the neck, chest, and hands to create a refreshed and cohesive appearance. In addition to lasers, radiofrequency (RF) devices have become a popular modality when treating mature skin due to their ability to deliver controlled heat deep into the dermis, promoting nucleogenesis and neoangiogenesis without disrupting the skin’s surface.21 This can lead to a more tightened, taut appearance.
TREATMENT STARTS AT HOME
While in-office procedures are powerful, a structured daily skincare regimen remains foundational. For mature skin, consistency and ingredient quality matter. A gentle, non-stripping cleanser helps preserve the skin barrier, while targeted ingredients like retinoids and peptides promote cell turnover and improve firmness. Tretinoin is effective in improving the clinical appearance of photoaging in terms of wrinkling, hyperpigmentation, and lentigines (age spots) as early as 1 month and lasts after 24 months.24 Antioxidants, such as vitamin C, should be used to protect against environmental damage and support a brighter complexion. Moisturizers should be deeply hydrating with ceramides, as that has been proven to improve signs of xerosis (dry skin),25 and daily use of broad-spectrum sunscreen is non-negotiable to protect against photodamage. My KD Wellness Line includes cutting-edge, bioregenerative KD Peptide Complex, which includes GHK-Cu copper, glutathione, and my proprietary blend of powerful peptides. Using high-quality, medical-grade skincare can elevate your patient’s outcomes, resulting in a rejuvenated, youthful exterior. Many women in this age range already practice basic skincare habits, but a well-designed and physician-guided routine can further enhance their skin’s health and extend the longevity of professional treatments.
CONCLUSION
Taken together, these intervention options that I utilize, including polynucleotides, exosomes, biostimulators, and surgery, offer a comprehensive, effective approach to the nuanced aesthetic needs of women over 40. Sometimes surgery may be necessary, but when used thoughtfully and in combination, regenerative solutions can significantly restore skin quality, support tissue regeneration, and provide results that feel authentic and sufficient for many women. These regenerative solutions can also prime their skin to have youthful collagenization in preparation for surgery. More than simply chasing youth, these women are seeking to reflect their vitality, confidence, and lived experience. The goal isn’t to look dramatically different; it’s to look like the best, most vibrant version of themselves. With the right tools and a patient-centered approach, regenerative aesthetic medicine can help make that possible.
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