It's a tough call for the middle-aged these days, when 60 is proclaimed to be the new 40 and we don't need just to act younger, but to look it, too.
Increasingly, we are becoming willing to do something about it - the latest Mintel survey on attitudes to ageing found that 43 per cent of those surveyed would contemplate a non-surgical procedure to improve their looks.
Last week, Sarah Ferguson – who will turn 60 on Tuesday – spoke with characteristic honesty about the tweakments that she has tried over the years to keep her face looking fresh.
She looked decidedly well at her daughter Princess Eugenie's wedding last year and said: "The happiness was shining out of me because my daughter was getting married. When I'm passionate about anything, my eyes shine. Above all, it was being joyful for Eugenie that made me look good. But I'd had some laser treatment on my face which helped too."
Laser treatment clears pigmentation and sun damage from the skin, and stimulates the growth of new, skin-supporting collagen. Fergie also admitted to a thread lift, the same procedure that Simon Cowell - who also turned 60 this month- has tried where fine threads made from the same material as dissolveable surgical stitches are placed carefully into the skin with long needles, then hoisted to reposition sagging skin tissues back to where they used to be.
Cowell said it "hurt like hell", but thread lifts are a big hit in Hollywood and are becoming increasingly popular in the UK, as a medium term alternative to a face-lift – the results last for a year or two, depending on how aggressively they are done.
But what looks youthful in mid-life? A fresh face with a glowing complexion, well-defined features - and which can still show a full range of emotion. A face with a few lines, for sure - but without the ones that drag it down into perpetual grumpiness. That takes a healthy lifestyle, great skincare… and, for some, a judicious number of tweakments, minor cosmetic medical procedures that can help give a face an ageless look without ending up looking, well, just weird.
"Little and often is the way to go about it," says leading cosmetic doctor Dr Marwa Ali, who practices at The Wellness Clinic in Harrods. "The days of frozen shiny faces are long gone. Now, it's all about subtle, natural results."
"Bear in mind," adds Dr Ali, "that you need to think about treating the ageing face in a multi-dimensional way. There's no one single fix. You need to replace lost volume in the face, improve skin quality, soften pigmentation and tighten the skin and that is going to take a combination of treatments."
So what are the new, subtle tweakments that really make a difference? Here is my selection.
Re-define your jaw - with carefully placed filler
Most of us are happily unaware that we lose bone from our skulls as we age. By the age of 50, this starts to show up, particularly around the corner of the jawline bone. Placing a judicious amount of a firm, injectable dermal filler on, or rather below, the corner of the jaw where it is losing height can improve the jawline dramatically - and no, it won't make you look like Desperate Dan.
Tighten up the eye area - with radiofrequency energy
The quickest and surest remedy for saggy skin around the eyes is a surgical eye lift, but most people aren't up for that. Step forward Dr Sach Mohan, whose 'Ping' treatment uses radiofrequency (RF) energy to tighten up the whole eye area. RF energy effectively 'shrink-wraps' the skin by delivering a heat shock to the collagen within it - I don't like the analogy, but think of flash-frying a steak - and only takes a few minutes.
Boost skin radiance with a 'moisture jab'
The latest way to counteract the dullness and dryness that creeps up on older skin is with sessions of 'injectable moisturiser', a fluid type of hyaluronic acid gel. There are several brands of this; the one people are currently raving about is Profhilo, which not only plumps and smooths the skin from the inside by providing extra moisture where it's needed, but also stimulates the regeneration of collagen and elastin to make ageing skin firmer and bouncier, too.
What looks youthful in mid-life? A fresh face with a glowing complexion, well-defined features - and which can still show a full range of emotion. Photo / 123RF
Soften lines with super-subtle Botox
Honestly, it can be done, and all good practitioners with an artistic eye will be able to do this for you. Using smaller doses of Botox in specific areas will soften existing lines and prevent the development of deep lines, while still allowing movement in the face so that you look natural. The downside of this 'baby dose' of Botox? You'll need re-treatment sooner than if you have a larger dose, probably after three months if you want to maintain results.
Lift the skin all over the face with HIFU skin tightening
Can you tighten the skin without a facelift? Yes, with devices that use high-intensity focused ultrasound (HIFU). Unlike the gentle form of ultrasound used for taking pictures of babies in the womb, HIFU creates pinpricks of heat deep below the surface of the skin, which shrinks existing collagen and stimulates the growth of new collagen which in turn lifts and tightens the face. Can it give the results of a facelift? No - but on the right patient, it can make an appreciable improvement. Brands of HIFU include Ultherapy, which is FDA-cleared and gives more of result, and Ultracel, which is considerably less uncomfortable, so preferred by patients.
Soften pigmentation with IPL or prescription creams
Age spots and pigmentation patches suit no-one. On lighter skin, these are easy to zap with Intense Pulsed Light, which most tweakment clinics will offer. On skin that is olive or darker, it is better to treat pigmentation with targeted skincare, as incautious use of IPL or laser can cause rebound pigmentation that is worse than the original problem. How to find such skincare? Through an online dermatology consultation service called Dermatica, the first in the UK, which will identify your skin issues and provide a prescription product to treat them.
Super-hydrate your skin with an oxygen facial
The older it gets, the drier skin becomes - so anything that rehydrates the skin will pay dividends as plump, hydrated skin cells soften wrinkles and reflect the light better, giving skin a lovely glow. The short-cut way to do this is with a gentle facial treatment called Intraceuticals, which uses a pressurised jet of oxygen to push a hydrating serum deep into the skin. It has been a firm favourite with celebs as a pre-red-carpet booster for a decade, and it's what gave Andie MacDowell (61) an extra glow when she stepped out at her movie premiere in August.
Whiter teeth are one of those markers of youth that our brain acknowledges without having to stop and think about it. To brighten up your smile without going as far as tooth-whitening, you could try a superior tooth-polishing treatment called Airflow, which claims to remove stains that the traditional hygienist's scale-and-polish may leave behind.
