From All or Nothing to Age-Appropriate: How Modern Aesthetics Changed the Conversation About Ageing

When Ruby Wax spoke openly about her facelift on I'm A Celebrity, it struck a chord with me. Here was a woman of 72, comfortable in her own skin, happy to talk about the work she'd had done and not remotely apologetic about it. That kind of honesty would have been almost unthinkable a couple of decades ago, when cosmetic procedures were something you denied to your dying breath, even when your best friend was telling you she could tell.

For me, the clip was a useful reminder of how far the industry has travelled. Not so long ago, aesthetics really was all or nothing. You either aged without any intervention at all, or you had a surgical facelift and hoped nobody would notice. There wasn't much in between. Today the picture looks completely different, and that shift matters for anyone thinking about how they want to age.

This is a piece about that change. About why the taboo has softened, why "subtle" has become the goal rather than "dramatic", and why a patient starting their skin health properly in their thirties or forties may well arrive at 72 in a very different place from the generation before them.

When aesthetics meant surgery or nothing at all

For a long time, the only reliable way to address real skin laxity was to have it surgically corrected. A facelift removes and repositions tissue, tightens the underlying structures and trims away excess skin. It can produce a genuine, lasting result, and for the right person at the right stage it still has its place. Ruby Wax looks wonderful, and part of that is her character and her confidence, which no treatment can bottle.

The trouble with the old model wasn't the surgery itself. It was that there was so little else on offer. If you weren't ready for an operation, or you didn't want one, your options were limited to good skincare and hope. That created a strange all-or-nothing dynamic. People waited until things had progressed a long way, then had one significant intervention, often quite late, and often all at once.

It also fed the secrecy. When the only treatment available was a major one, admitting to it felt like a bigger confession. That's why so many of those conversations happened behind closed doors, or not at all. The idea that you could talk about your skin the way you'd talk about going to the dentist simply hadn't arrived yet.

The shift towards skin health and prevention

What changed everything was a move away from chasing lines and towards supporting the skin itself. The modern approach is far more interested in the quality of the tissue than in any single wrinkle. That means collagen, elastin, hydration and the overall health of the skin, the things that actually determine how a face ages over time.

Collagen gives skin its structure and firmness. Elastin allows it to stretch and recoil. Both decline steadily from our mid-twenties onwards, and the rate at which they're lost has a great deal to do with how the face eventually softens, hollows and drops. Rather than waiting for that process to reach the point where surgery is the only answer, today's treatments aim to slow it down and keep prompting the skin to renew itself along the way.

I often frame it this way to my patients: the aim isn't to change your face, it's to look after it. That's a different mindset entirely. It's less about correction and more about maintenance, the same principle we already accept for our teeth, our fitness and our general health. Start early, do a little consistently, and you avoid the situation where everything needs fixing at once.

Why prevention beats correction

The earlier you begin supporting collagen and elastin, the more you have to work with. It's much easier to maintain volume and firmness than to rebuild them from a low base. A patient who begins regenerative and device-led treatments in their forties is protecting a foundation that's still relatively strong, which is why the results tend to look so natural. Nothing changes dramatically from one month to the next. The skin simply holds its condition for longer.

This is also why age-appropriate treatment has become such an important idea. A woman in her thirties needs something quite different from a woman in her sixties. Good practice matches the intervention to the stage of life and the actual condition of the skin, rather than applying the same fix to everyone.

Device-led treatments doing the heavy lifting

The biggest single change has been the arrival of energy-based devices that can tighten skin and stimulate collagen without surgery. These sit at the centre of the modern approach, and they're a large part of why I believe some of today's patients may never feel the need for a facelift at all.

Radiofrequency microneedling is a good example. At our clinics this is delivered with Morpheus8, which combines fine needles with radiofrequency energy to heat the deeper layers of the skin. That controlled heat triggers a healing response, prompting fresh collagen and elastin and gradually firming and refining the skin over the following weeks and months. It's particularly useful for early laxity along the jawline and lower face, the areas that used to send people straight towards surgery.

Fractional laser resurfacing works on a similar principle from a different angle. Devices such as the Secret Pro create tiny channels in the skin that stimulate renewal and improve texture, tone and firmness as the skin repairs. BBL Hero and MOXI address pigmentation, redness and overall skin quality, which matters because even a well-supported face looks older when the surface is uneven or sun-damaged. Ageing isn't only about sagging. It's about the whole condition of the skin, and these treatments target the parts that lines and fillers never could.

The point isn't that any one device replaces a facelift on a like-for-like basis. It's that used together, and used consistently over years, they keep the skin in far better condition than the previous generation ever managed. The lift is maintained gradually and holistically rather than restored in a single operation.

The rise of regenerative treatments

Alongside the devices, a whole category of injectable treatments now works with the skin's own biology rather than simply filling or freezing it. These are often described as regenerative, because they encourage the skin to repair and rebuild.

Profhilo is one of the best known. It's a stabilised form of hyaluronic acid that spreads through the tissue and stimulates collagen and elastin while deeply hydrating the skin. It doesn't add volume in the way a traditional filler does. Instead it improves the quality and firmness of the skin itself, which is exactly the kind of subtle, foundational result the modern approach is built around.

Polynucleotides take this further. Derived from purified DNA fragments, they act as a biological signal that helps repair tissue, improve elasticity and calm inflammation. Skin boosters, PRP using the patient's own platelets, and microneedling all belong to the same family of treatments that prioritise skin health over dramatic change. None of them alters the shape of the face. They simply help it stay healthy and resilient for longer.

Anti-wrinkle injections and dermal fillers still have their place, of course, but the way they're used has changed too. The goal now is to soften and support expression, not to erase it. Preserving the way a face moves is part of looking natural, and part of looking like yourself. A frozen, filled, over-treated look is exactly what the current generation of doctors is trying to avoid.

Ageing on your own terms

Perhaps the most meaningful change is one of attitude. The taboo Ruby Wax helped to break down has given way to something healthier: the idea that you get to choose. Some people will want very little. Some will build a considered plan over many years. Others may still opt for surgery when the time is right, and there's nothing wrong with that.

What's different is that no one is boxed into all or nothing any more. You can start gently, adjust as you go, and make decisions that suit your face and your stage of life. The best outcomes come from a proper conversation about what's realistic and appropriate, not from a fixed menu applied to everyone. That's the whole philosophy behind the doctor-led approach at Wellface.

Common questions about modern anti-ageing treatments

Can device-led treatments really replace a facelift?

Not exactly, and it's worth being honest about that. A facelift addresses significant laxity by physically repositioning tissue, and no non-surgical treatment reproduces that in a single step. What device-led and regenerative treatments do is keep the skin in far better condition over time, so that many people either delay surgery considerably or find they never feel they need it. The results build gradually and look natural because nothing is being dramatically altered.

When should I start thinking about prevention?

There's no single right age, but the general principle is that starting earlier gives you more to work with. Collagen and elastin begin to decline from our mid-twenties, so many patients start introducing skin health treatments in their thirties and forties, before laxity becomes pronounced. It's much easier to maintain firmness than to rebuild it once it's been lost.

Will these treatments make me look done?

That's precisely what the modern approach is designed to avoid. Regenerative treatments like Profhilo and polynucleotides improve the quality of your own skin rather than adding volume or changing shape. Anti-wrinkle injections and fillers, when used carefully, soften and support rather than freeze. Preserving your expression is central to looking natural and like yourself.

How much downtime is involved?

It varies by treatment. Many injectable skin treatments cause only mild redness or small bumps that settle within a day or two. Device-led treatments such as radiofrequency microneedling or laser resurfacing may involve a few days of redness and some social downtime depending on the intensity. I'll talk you through exactly what to expect before you commit, so there are no surprises.

Do I need a whole plan, or can I have a single treatment?

Either is fine. Some people come in for one specific treatment and are perfectly happy. Others prefer to build a longer-term plan that combines skin health, regenerative and device-led treatments over the years. The right answer depends on your skin, your goals and your stage of life, which is why the first step is always a proper consultation rather than a set package.

Talk it through with me at Wellface

If Ruby Wax's honesty has you thinking about how you'd like to age, the best next step is a conversation. Every face is different, and the treatments that will genuinely suit you depend on your skin, your history and what you actually want, not on what worked for someone else. A doctor-led consultation gives you an honest assessment and a plan that fits your stage of life rather than a one-size-fits-all fix.

Wellface has branches in Cobham, Esher and Wimbledon, and I and the wider team would be glad to help you understand your options, from regenerative injectables to device-led skin tightening. Get in touch to book a consultation with me and start a considered approach to your skin, on your own terms and at your own pace.