The Best Skincare Routine & Products For Your 40s

AUTHOR - DR. DAVID JACK

In my clinic in London, I see patients at many different stages in life. Most commonly, people start thinking about skin ageing in their late 30s or early 40s so this is probably an important age to discuss on here when it comes to treatments and skincare.

In this post I’m going to go through the changes you might be seeing in your skin (and face generally!) in your 40s. I’ve also listed some options about how you can best manage these changes with skincare and in-clinic treatments.

What happens to the skin in the 40s?

There seems to be some big changes in the skin as you transition from your thirties to your forties. The effects of ageing become increasingly evident on the face, as the skin begins to sag as a result of collagen damage and volume loss related to both genetic ageing and sun exposure earlier in life (even if you’re now using sunscreen every day) and the ever present pull of gravity. Changes in hormone levels can reduce the oiliness of the skin, and environmental exposure to pollution, smoking and alcohol can all have significant effects on the skin at this stage in life.

Why does my face look different in my 40s?

With gravity and diminishing facial volume, the overall anatomy of the face starts to change. An imbalance between the downward pulling (depressor) muscles and the upward pulling (elevator) muscles of the forehead (the frontalis) contributes to the general descent of the face. As a result, characteristic lines appear, including crow’s feet at the side of the eyes, increasingly deep frown lines and compensatory horizontal forehead lines. This imbalance of the youthful resting muscle tone in the face continues to worsen with time, so it’s good to do something about it when you’re first starting to see these signs of ageing.

The effects of sun damage not only appears as collagen loss and fine lines, but areas of hyperpigmentation often start to appear in your 40s in the form of stubborn brown marks in sun exposed areas. In addition, patches of melasma might also be present if you’ve been pregnant at some stage.

What skincare should I be using in my 40s?

The 40s are all about repairing past damage to the skin, from excessive sun damage (even as far back as early childhood) and protecting further damage. Core to this is the use of antioxidants and sunscreen on a daily basis. UV damage from the sun is the number 1 cause of extrinsic (i.e. non-genetic) ageing in the skin, so avoiding this is paramount to protecting the skin against the daily bombardment with oxidising UVA and UVB light. I suggest using a high factor SPF 50 moisturiser my ALL DAY LONG is an antioxidant-rich SPF50+ screen which protects against both UVA and UVB light). For more information on sunscreens check out my blog on how to choose a sunscreen.

Oxidative stress and inflammation result from UV exposure and also other factors such as glycation, smoking, and general metabolism. These processes cause damage to collagen and DNA and enhance the natural genetic ageing that occurs with time. Thankfully, we now live in a time where there is an abundance of products which help reverse these effects and can even enhance repair of existing damage to the skin. This is not a complicated process - use of a simple streamlined skincare routine is all that you need - a morning serum to give a boost of antioxidants in the morning and a night cream to support the skin as it repairs overnight. My top ingredients to look out for in skincare are:

• Vitamin C - Vitamin C is an important co-factor in many chemical reactions in cells. This includes acting as a co-factor in collagen formation by fibroblast cells of the dermis of the skin, tyrosinase inhibition in the melanocyte cells of the epidermis (resulting in inhibition of melanin formation and reduction of hyperpigmentation) and potent antioxidant activity. The latter effect is perhaps one of its most important - the skin is exposed to oxidative stress as a result of both external factors (such as UV light and pollution) and internal metabolic reactions. This oxidative stress results in the production of damaging ‘free radical’ molecules, which vitamin C neutralises as a result of this antioxidant activity. Vitamin C also complements and boosts the activity of other antioxidants ingredients such as vitamin E, vitamin A, Ferulic acid, resveratrol and glutathione - each one supporting the other’s beneficial activities. Vitamin C can, and should, be used daily on an ongoing basis. It is safe to be used over the longer term and has very few (if any) negative effects. Several studies have highlighted that even at low concentrations (as low as 0.15%), topical application of vitamin C can be effective in reducing hyperpigmentation and increasing fibroblast collagen production.
• Retinol and the retinoids - Retinoids are forms of vitamin A, which is a fat soluble vitamin that can penetrate through the surface of the skin to exert direct effects on the DNA of cells of the skin. I love retinoids in skincare as they offer a myriad of benefits, including regulating sebum production (which is particularly useful for people with oily skin issues such as acne), regulating cell division (increasing turnover) and reduction in pigment production. They also have a potent effect on the fibroblast cells of the skin which causes them to increase their production of collagen and elastin, so have good anti-ageing benefits and can reduce the appearance of fine lines and wrinkles. There is also good evidence to show that retinoids can actually prevent early stages of skin cancers by enhancing cell differentiation and promoting destruction of abnormal cells.
• Niacinamide (also known as nicotinamide or vitamin B3) - Niacinamide is a potent antioxidant with multiple skin benefits, including anti-acne and barrier repairing properties. Seen as an alternative to retinoids in those who are retinoid-intolerant, it is increasing in popularity as an ingredient in anti-acne skincare. It also is anti-ageing and can help protect against blue light damage to the skin, as well as being suitable to be used with other antioxidant ingredients in skincare such as vitamin C.
• Azelaic acid is an increasingly popular ingredient in skincare. Often found in anti-acne and anti-rosacea products, it has potent anti-inflammatory and anti-oxidant effects. It has many beneficial effects on the skin including reduction of rosacea and inflammatory skin conditions, treatment of hyperpigmentation (it is a tyrosinase inhibitor) and protection of collagen and elastin from oxidative stress

Is there any skincare I should avoid in my 40s?

Often the skin will start to get slightly dryer in your 40s vs your 30s so harsh ingredients such as salicylic acid and even higher strengths of AHAs such as glycolic acid are often unnecessary. Instead, I favour the ingredients I mentioned above such as Vitamin C and E, Azelaic acid and hyaluronic acid. Moisturisers can help to reduce dryness, which may be more of an issue in your 40s than your 30s - I’d look for one with a good blend of active ingredients (such as Azelaic acid, hyaluronic acid, Vitamin B5) to combat this.

Which treatments should I have in my 40s?

• Thinning skin and reduced skin quality: In your 40s, skin thinning can be addressed quite effectively using some of the new ‘biostimulating’ or ‘biorevitalisation’ treatments that have become available in recent years. These are designed to stimulate collagen and elastin production in the dermis of the skin, which has become thinned over time - so over time will -re-thicken the skin and tighten and lift where it has become lax. My favourite collagen boosting treatments include:
• Morpheus8 - Morpheus8 has quickly become one of the best known skin quality improving treatments. It uses a form of ‘fractional radiofrequency', designed to treat ageing skin using patented silicone-coated microneedles that penetrate into the skin, create micro-injuries and heating up to 4mm deep into the skin, and in turn cause a remodelling reaction to boost collagen and elastin levels. This in turn stimulates lifting and tightening of lax areas of skin over a 3-6 month period. Compared to other fractional technology, such as carbon dioxide laser and other forms of fractional radio frequency (e.g. profound RF and secret RF) Morpheus8 doesn’t only penetrate deeper into the skin but it also minimises downtime (and risk of pigmentation vs other laser technologies). It is an ideal treatment for anyone in the public eye for this reason - there is very minimal downtime, the risk of looking odd is virtually non-existent and the results are reliable.
• Profhilo - Profhilo is one of a new generation of injectables known as ‘biorevitalisers’ or ‘biostimulators’, which utilise the body’s own responses to create rejuvenating effects. It is made from hyaluronic acid, like fillers, but works in a different way. With Profhilo, the concentration of HA is far higher than in dermal fillers but with a much more runny, fluid consistency. This causes it to have more of a collagen stimulating effect on the skin itself, rather than adding deep volume. Unlike in fillers, where the HA molecules are tightly stuck together, profhilo consists of a very high concentration of free floating hyaluronic acid molecules. Usually two to three sessions are recommended (one month apart from each), to repeatedly stimulate your collagen-producing fibroblast cells and give the best longer term effects. Profhilo two main effects: Firstly (shorter term), it hydrates the deeper layers of the skin, giving a transient plumpness and hydration; Secondly (longer term), the free floating hyaluronic acid molecules trick the skin into thinking it’s been injured (due to the chemical effect of free hyaluronic acid molecules at this high concentration) - so stimulate the fibroblast cells of the dermis layer of the skin to ramp up their production of collagen and elastin, causing thickening of the dermis and overall lifting/rejuvenation.
• Nucleofill - Nucleofill is a next-generation biostimulation treatment that works in a similar way to Profhilo. It is injected to stimulate production of new collagen and elastin in the dermis of the skin. In this way it helps rejuvenate areas of skin laxity and may help over time to lift and tighten the skin. Nucleofill is made from high molecular weight polynucleotide chains, which are highly viscoelastic, meaning that the skin will regain it’s ‘bounce’. Over time, Nucleofill helps to improve the skin’s microcirculation, hydrate the skin deeply and over time it may reduce the appearance of fine lines and wrinkles. 2 treatments, two weeks’ apart are recommended. Nucleofill should be performed every 3-6 months for optimal results.
  
  
• Sun damage, pigmentation and thread veins - Pre-existing sun damage to the skin is often quite apparent by your forties, with patches of hyperpigmentation and thread veins starting to appear on sun-exposed areas. These can be easily treated with laser and/or IPL to even out skin tone and stop thread veins from becoming any bigger.
• IPL (intense pulsed light) technology - is a light-based treatment. IPL systems generate a high powered source of light which is of a particular set of wavelengths that interact with targets in the skin (i.e. brown and red things), causing the target to absorb the light energy and turn heat and destroy the target. The targets are usually either melanin granules in patches of hyperpigmentation or haemoglobin in thread veins. In my clinics, I use the Lumecca IPL system. Lumecca has the highest peak power of any system on the market and has a very finely calibrated wavelength setting to effectively target pigment and vascular lesions in a minimal number of sessions. It also has an in built cooling system to minimise damage and burns. In this way it can be used to target brown pigmentation marks and thread veins at the same time. Usually 2-3 sessions are suggested, about 3-4 weeks apart.

Pigmentation in darker skin types in your 40s:

Certain lasers can be used to treat up to skin type VI for hair removal - most of which operate at higher wavelengths, e.g. Nd:YAG at 1064nm, but these will be fairly ineffective for treatment of pigmentation. Generally in darker skin types, I would have a different approach to treatment, treating with numerous tyrosinase inhibitors and in Melasma in darker skin, using treatments such as azelaic and tranexamic acid.

Fine lines and wrinkles in your 40s:

• Botulinum toxin - Patients are often nervous when it comes to having injectables for the first time, but often these are the most effective treatments for fine lines and wrinkles, if done subtly and carefully. Thankfully, more nuanced, whole face microdose techniques are becoming the norm, as practitioners become more sophisticated in their injection techniques and are more knowledgeable and considered in assessing the individual’s anatomy. The change in muscle dynamics of the face that I discussed is more the target for botulinum toxin injections rather than individual lines and wrinkles, per se. Over time, as the face ages and the pull of gravity (as well as volume change in the bony structure of the face and the facial fat pads) cause a general downward descent of the facial structure. Botulinum toxin acts to relax muscle pull and is used to partially reverse these changes. Doses will be selected that are relatively higher in the downward pulling muscles (and therefore lift), and lower in the lifting muscles - to give a general lifting effect, whilst subtly reducing the appearance of age related lines.

Volume loss in the face in your 40s:

• Dermal fillers - Dermal fillers are a group of injectable medical products designed to add volume to tissues. There are many different types of fillers, such as hyaluronic acid fillers (the most common type), collagen stimulating fillers (such as sculptra) and permanent fillers (such as silicone, which is not sold in the U.K. any longer). Fat transfer might also be considered a ‘filler’. Generally speaking, fillers can be injected into areas to replace lost volume and revitalise the skin. There are many different consistencies and forms of fillers, for use in different areas, and the technology is improving rapidly.  Most commonly, dermal fillers are made from hyaluronic acid, a long chain glycosaminoglycan (GAG) molecule, based on lots of linked sugar and amino acid molecules. This substance occurs naturally in the skin and connective tissues so when it is injected it is not generally recognised as being a ‘foreign’ substance. The skin constantly turns over hyaluronic acid so it is gradually broken down into the component molecules over time (often 6-18 months).
• Most commonly I see patients for general facial revolumisation as a result of volume loss related to ageing and sun damage - so the face would be treated as a whole (I’d generally inject depending on the individual’s face and assessment of where the volume has been lost, which may include mid face, temples, jawline, around the mouth and nasolabial areas, and also the chin and corners of the mouth as part of this). Other very popular specific areas to have filler are the undereye area -tear trough, nose the non-surgical rhinoplasty - and also the lips and around the mouth (e.g. for barcode lines). More unusual areas which are increasing in popularity are the earlobes and back of the hands!