KEY POINTS:
Apparently, I could use some IPL to sort out my facial pigmentation and the odd red vein, micro-dermabrasion and a bit of botox to look a much better version of myself. Or I could invest in skincare with more active ingredients and a course of non-surgical facelifts to tighten the trail of time.
The prescription comes when I go to a couple of leading skin clinics, to find out about the latest in anti-ageing treatments. Being still a bit averse to tinkering, I decide to check out a few super-charged facials (see my report on page 6).
What we're trying to discover are the options between standard skincare and surgery for women (and increasingly men) looking to hang on to their youthful appeal. This is big business, as the plethora of clinics and salons now offering appearance medicine and advanced skincare shows. And it doesn't come cheap, but it's an investment more and more people are prepared to make.
It's about looking the best you can for your age, says Caci clinic trainer Sylvie Wallington. Over at the Skin Institute it's a similar line. As surely as 40 is the new 30 - at least in attitude - women are refusing to accept the inevitability of ageing and are doing their best to, if not turn the clock back, at least confuse time.
There's a whole trend to more ageless women, says Caci clinical adviser and nurse specialist, Jackie Smith - that whole thing of "I don't have to live with ageing".
The experts are among the most realistic people you'll talk to. They may be in business prescribing treatments, but they know decade by decade what the signs of ageing are and how New Zealand women with their high exposure to the sun are subject to accelerated skin damage.
"People come in with these expectations that you can make miraculous changes," says Smith, adding that significant changes are possible but it's about setting priorities.
The Skin Institute's cosmetic nurse leader, Sally Ellison, emphasises the good results that can be had, but is frank about what will last or not. She says lovely results can be had with fillers and botox and enjoys what she considers the creativity of combining them. Everyone's face is different and you've got to treat everyone differently.
If you ask women who have had little lines filled, plumped up the bits that are starting to sag, or undergone rejuvenation treatments - and who doesn't know people in that category nowadays? - the responses are mostly positive. It's an appearance-conscious world, especially for women, many of whom are happy to have a little help from appearance medicine.
But looking at the more extreme examples of women who don't know when to say no can be scary, and that's why other women - just as interested in trying to ward off the less flattering effects of ageing - are opting to spend their money instead (or initially) on firming facials and by pumping known anti-ageing ingredients into their skin, either superficially or internally.
The foundation of a beautiful face is beautiful healthy skin, says Dr Lynn Theron, a principal at Clinic 42. This Epsom clinic recently held an information evening for its clients, many of whom happily admit to having had a bit more than a facial. One of the women I chatted to was recently divorced and thinking of investing in a facelift. I couldn't see that she needed it. But that's a very personal decision. My cousin had a nose job to rid herself of what I thought was a rather handsome Roman nose and she's never regretted the surgery.
With improvement now being more acceptable and available, the worry is that insecurity about their looks will lead some women in an ultimately futile quest for eternal youth. The flip side of that argument is that improving one's appearance is simply a case of technology advancing, and independent means giving women options not to bow to the inevitable.
The client's wishlist
Clinics report that younger women are now making appointments, though the hardcore of the anti-ageing business is those aged 35-55.
Younger women are mostly booking in for skincare (facials and treatments for problems like acne) and for laser hair removal, though more are trying botox in their early 30s as a wrinkle preventive. Once women hit their 30s they're sometimes distracted with young children, coming out of that stage and wanting to become yummy mummies, or they're fancy free and happy to spend on their appearance. Often they want help with skin tone, including early signs of sun damage, and to ward off more visible lines.
In their 40s these concerns step up. As cell turnover slows, exfoliation, peels using alpha-hyrdoxy acids and micro-dermabrasion are options. To treat pigmentation and red veins, laser treatment is often recommended. It works by locking on to the pigmentation in the skin and essentially zapping it.
Newer laser techniques include a virtual facial resurfacing, whereby the top layer of skin is basically burnt off, revealing newer, fresher skin beneath. The heat action is said to renew collagen production beneath. This and peels are not treatments to be taken lightly, and skin will appear red, then flaky afterward, before it clears. IPL also carries a slight risk of permanent changes to pigmentation and works better on the fair-skinned.
Pre- and during menopause, as estrogen and collagen production drops (around 30 per cent goes in five years), skin loses its elasticity and becomes duller, treatments are often about combating this (as above) and attendant moisture lost, by continuing to relax or plump out lines with botox, fillers and massage.
Breakouts and pigmentation problems can also occur during this time of hormonal changes.
Post-menopause, women still seek treatments, especially to lift skin tone and texture, encourage cell turnover and to continue to address pigmentation problems on the face and hands.
Becoming more aware of the skin's changing condition and what can be done for it, tends to mean women embark on a range of courses.
The new frontier
Supplements are increasingly coming into play and are the new frontier in the anti-ageing market, with more women being prescribed both external and internal remedies. Topical treatments go only so far and though many of the new facials are aimed at encouraging the infusion of the likes of anti-oxidant Vitamin A deeper than the skins surface layer, there's a growing trend to encourage women to simply swallow what they're lacking.
With food today, a lot of vital ingredients are lost before we even eat them, says Caci's Sylvie Wallington. She recommends a healthy diet with plenty of essential fatty acids (found in nuts, seeds, deep sea fish, flaxseed and fish oils). It's not just about selling products.
Vitamin C is also important as it stimulates collagen production (but isn't stored in the body). The anti-oxidants that help slow ageing are found in a host of fruit and vegetables including the so-called superfoods such as berries and green tea. Extracts of these are found in more and more anti-ageing skincare products from natural and organic ranges to those of big cosmetic companies.
The skincare
Claims about the effectiveness of ingredients are enthusiastic, but confusing for customers.
Clinics say they carry more effective or specialised skincare (Caci promotes Murad and the Skin Institute Environ, both specialist ranges aimed at dealing with environmentally damaged skins). It's true that due to regulation, retail products are usually less intense in formulation than those dermatologists use, and clinics that individually adjust their prescriptions, but some people feel the derma and cosmeceutical ranges are more intense than most women need, especially when younger.
Big cosmetic companies would say they spend more money on research and development and have a bigger range of options for women of different ages and skin types (the likes of Estee Lauder, Lancome, L'Oreal and Elizabeth Arden have ranges that step up in intensity for different age groups).
Elizabeth Arden was the first to introduce a new generation wonder ingredient to the mainstream - Prevage, pioneered by Allergan the parent company of botox. Prevage (and the clinic range Priori) contains idebenone, a superceutical molecule that helps block ageing stress.
The usually smaller botanically or organically based skincare manufacturers say their products are purer, which is one reason they often have a shorter shelf-life. This type of range tends to make much of the absence of fillers, preservatives and dyes (often from the petrochemical industry) the main cosmetic houses commonly use. But then, the big houses would say their products have stood up to rigorous testing and some of the ingredients they add (silicones, waxes etc) give their cosmetics the very smoothness and effectiveness women want. Many skincare ranges have moved, however, to research alternative natural replacements as the public increasingly asks what's in their face care.
So it comes down again to customer choice and trying to do your own research if you're motivated or concerned.
Expect in the future, though, more of an emphasis on ingredients sourced from the natural world and those with measurable results.
The interesting developments are where the ideas and expertise from the three strands of cosmetic manufacturers - dermaceutical, multi-national and organic or near to - come together. One example is Snowberry, a New Zealand developed range of anti-ageing skincare that takes a natural, but highly scientific tack.
Anti-ageing formulations are now seen across all strands of skincare, from sunblocks to exfoliators and moisturising face and eye creams, but are at their most potent in serums.
The consensus
There's a few things everyone agrees on and that are worth looking out for in your skincare.
Vitamin A, Retinol or Retin-A as it's usually known in skincare, works to combat ageing at a dermal level.
Peptides are beneficial, being a compound that links amino acids and stimulates cell growth, repair and skin appearance.
Anti-oxidants are nutrients that neutralise free radicals. (Free radicals are unstable atoms or molecules generally caused by excessive UVA and UVB exposure that can cause cellular instability; damage collagen, the main skin structure protein; elastin, a protein that gives skin its elasticity; and lipids, the naturally occurring oil in skin.)
Excessive alcohol, smoking and stress are bad for skin.
Excessive sun exposure is the single biggest skin-ageing accelerant, causing what's called photo-ageing.
Toni-Anne Arbon, National Training Manager from L'Oreal, says though each age group needs a targeted skin care regime, there is one essential item that should be in every women's handbag - a good sunscreen. After that it's a case of matching skin-appropriate skincare to age group.
The providers
If the skin damage is already done and you're ready to go beyond your usual routine, then it's not a bad time to be looking around. The market is increasingly competitive, meaning prices vary and good deals can be had, but quality varies also and as this is a largely unregulated area, you need to choose your providers with care.
Just a few weeks ago a laser, valued around $150,000 was stolen from a reputable North Shore clinic, leading to warnings that in the wrong hands this could cause severe skin damage and if offers of super-cheap treatment were made, beware.
Your best bet is to go to established clinics or salons, seek specialist referrals from dermatologists and ask around for recommendations from people you trust.
A preliminary consultation before you sign up to any treatment is a good idea and will give you time to make sure you're comfortable with what's on offer, the price and the experience of the staff.
Bigger clinics often have registered nurses on hand and sometimes even doctors and dermatologists attached to them.
They're likely to have invested in the latest medical-grade lasers and equipment. Caci has 25 branches nationwide and the Skin Institute has five in Auckland. Other established clinics include the Appearance Medicine Centre in Parnell and the Face Place.
Beauty therapy salons should certainly not be discounted, but make sure you're dealing with people with a track-record. They, too, are increasingly investing in good gear and training. Salon staff have often worked in skin therapy for many years and are familiar with the needs of their clients, offering a personalised service.
Leading Birkenhead salon The Elements is one place that has seen more of its business moving from traditional facials and has invested in upskilling and the latest technology. Managing director Jude Luke enjoys the ability to individually tailor treatments.
Customers want the new advanced treatments because they see the results, she says.
Madonna - and child
Good suncare and skincare are the foundation for maintaining a youthful appearance, and if you throw in good genes, healthy living, exercise, a happy disposition and the serendipity of good fortune, there's no reason you won't be as attractive at 50 as 15 - but there will inevitably be changes and few women welcome them.
Sagging skin, loss of brightness, elasticity and volume in the face, all highlight the march of time. Extreme measures to tackle this decay are now more accessible and we're not talking Catwoman plastic surgery anymore, but a cunning contrivance of intervention. Look at Madonna, she's 50, but she isn't scarily stretched.
We all know something is going on, though no-one is saying. New York magazine recently used Madonna as an example of the New, New Face.
What is the new, new face you may wonder? Well, it's said to be the re-engineering of an ageing face into something more akin to a younger one. Natural, but not.
It's also said to account for the strangely youthful look of many modern celebrities. They're not exactly victims of the knife and they've no doubt had many different procedures short of that, but what they have got in common when their facial features are analysed is a youthful look in sections of the face where, by rights, they should be sagging.
Leading Auckland plastic surgeon Tristan de Chalain says the new face he is working on is about volume and contour, not just tightening, and the mid-face lift is now the tool of the trade. It's also individualised, working on reforming pre-existing contours.
In a talk at Clinic 42 in Epsom he espoused the view that sometimes surgery is the only answer for people (read women largely) who are unhappy with their no-longer so superficial signs of aging. Deflation, he said, was the main concern of many clients, because that sagging look was ageing and there was only so much that could be done to combat it, short of surgery.
"Do what you can to preserve your elastin and collagen," he advised, adding that appearance medicine could do much, but in the end a facelift would achieve more. And it should last for up to 10 years.
Ahead, he said, would be more use of stem cells and putting people's own fat in as fillers rather than synthetics. Injection rhinoplasty was also on the way and could be used, for instance, to create stronger nose bridges (something some Asians hanker for).
And if you're wondering what the theory on Madonna is, New York magazine draws attention to her "Mount Rushmore cheekbones, the angular jawline, the smoothed forehead, the plumped skin, the heartlike shape of the face" which make her look preternaturally young. It also questions whether she may have had a little help to stay wrinkle-free.
Writer Jonathan Van Meter says: "Looking at Madonna, I kept thinking of the British expression for reconditioning a saddle: having it 'restuffed'."
Referring to several celebrities who share the same look, he goes on: "It's possible (though in some cases before-and-after pictures would seem to suggest otherwise) that this face is occurring entirely naturally - after all, these are women who are famous for being beautiful. The point is that there is a noticeable aesthetic shift happening in the face, and that's dovetailing with quantum leaps in plastic surgery and dermatology."
Demi Moore, Michelle Pfeiffer, Liz Hurley and Naomi Campbell are all suggested as having "new, new faces".
The perfect face has plumped-up, youthful cheeks, possible thanks to fillers, to mimic the "baby fat" of women in their teens and early twenties.
"It's impossible to pinpoint exactly when or how a new aesthetic is born, but it seems clear that once we became obsessed with the baby face of the teenage girl, the world of dermatology came up with more and better ways for us to achieve the plumpness of youth," writes Van Meter.
The article quotes Liz Rosenberg, Madonna's publicist, as saying: "Whatever Madonna has had done - and I really don't know - she looks truly amazing."
She may have youthful contours, but how many 50-year-old virgins can the world swallow?
