Take any group of midlife women and it doesn’t take long for conversation to turn to our changing skin: who’s getting tweakments, who’s actually remembering to take collagen every day and how we’re feeling about the ageing process on any given day.
We learned so much from Ellie’s skinterrogation so we thought we’d round up the best nuggets. Read on to find out what to do about fine lines — and which skincare treatment Ellie recommends over all others...
Does collagen really improve skin?
“Collagen supplements don’t exert their effect by depositing into the skin. The mechanism is thought to be through upregulating signalling pathways that then upregulate the making of proteins like collagen and elastin in the skin. So far the evidence points at collagen supplements improving hydration and so far they have been shown to be beneficial for joints. They haven’t been proven to improve wrinkles yet but perhaps watch this space, the body of evidence is growing.”
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What can I do if I'm suddenly getting dry skin around the eyes?
“I wouldn’t use an eye cream as most are formulated with ingredients to de-puff. I would use a barrier repairing moisturiser like Avene Cicalfate+, Erborian barrier repair, or La Roche Posay Cicaplast Baume B5, or Byoma barrier repair. For whatever reason, things have got a bit irritated and needs to be brought back to baseline and then can start on eye creams again.”
“Solar lentigines develop with cumulative sun exposure and so usually would expect to see them in 40s onwards. The best treatment for them in terms of skin care are sunscreen, vitamin A derivatives, antioxidants can be helpful. Then really energy based devices, IPL (intense pulsed light) and certain pigment lasers eg PICO can be helpful.”
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If I'm still prone to acne and oily skin in menopause, what should I use on my skin?
“I would use an SPF like Heliocare oil free gel - it has UVA and UVB protection and melts into the skin quite nicely. La Roche Posay have a fluid that is easy to absorb in. Erborian have a redness barrier supporting range that is designed for sensitive skin. La Roche Posay Toleriane range, Bioderma and Avene Tolerance range are good for sensitive skin.”
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How should I treat milia in menopause?
“Tretinoin is probably the most effective as it increases skin cell turnover and reduces milia from forming. I get milia, they can’t be popped but can be extracted with a needle (of course a sterile needle).”
How can I improve my menopause skin on a high street budget?
Sunscreen to reduce collagen degradation
"A huge study looking at thousands of patients found that daily sunscreen with SPF and UVA protection for four years improved the appearance of the skin by 24%...so there is a reversible element to wearing daily sunscreen, moisturiser and cleanser.
Cleanser
To wash off pollution, sunscreen etc.
Moisturiser
As it helps to ensure the skin barrier (our skin shield) is kept lovely and healthy.
Vitamin A derivatives
Retinol and retinal are available over the counter. Long term use helps to improve the skin thickness (6-9 months). Retinal has a more direct impact on the retinoic acid receptors in our skin over retinol. Tretinoin is prescribed in the UK but that has the most direct effect and as it is a drug therapy and it has huge amounts of evidence to support its use to help improve skin cell turnover, structure, thickness and reduce pigmentation.
An antioxidant
Vitamin C or vitamin E, ferulic acid, or resveratrol, green tea polyphenols."
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If we only use one cream on our skin, what should we pick?
"The elusive magic one stop cream! Sun screen is the best cream to reduce collagen degradation, reduce pigmentation, reduce DNA damage and risk of skin cancer and with long term use (4 years), the skin can be 24% younger. The best ingredients are sunscreen, vitamin A (retinol, retinal and tretinoin (on prescription) and an antioxidant (L-ascorbic acid form of vitmain C has the most evidence)."
Many women don't know where to start when it comes to switching up skincare in midlife
What can I do about dark circles becoming more prominent?
“Dark under circles can be because of volume loss, genetics, lack of sleep, sluggish lymphatics... it entirely depends on the cause. Overall skincare can help a little, vitamin A derivatives like retinol, retinal or prescription tretinoin can help thicken up the skin but take at least 6-9 months for this benefit. Some use polynucleotides (salmon sperm facial) to improve the texture of the skin in this area. Some non-ablative lasers can be helpful to improve the skin quality. Eye creams with ingredients like caffeine have a temporary de-puffing benefit but not long term results. Hyaluronic acid filler to the mid face can help with volume loss in the mid face that can exaggerate dark under eyes. I am not generally a fan of tear trough filler as a universal solution for dark under eyes as this can contribute to the lymphatic fluid building up and can make things puffy and even worse.”
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How should I prep my skin differently if my makeup is suddenly sitting in my fine lines?
“Don’t switch up everything all at once, the worst is when your skin reacts and then you’re not sure what’s caused the problem. It’s more likely that your skin has changed over time, and skin changes season to season. I would prep my skin better. You may need a moisturiser that is slightly richer, or to use less exfoliating acid toners/peels if that’s relevant. There is a lot of focus on healthy skin barriers and if your skin barrier is happy then you can start introducing ingredients to optimise things even further. Cleanser, moisturiser and sunscreen are my essentials.”
I keep hearing about peptide plumping - what is it?
“I love a peptide cream, I use it as my moisturiser. There are different types of peptides, signalling peptides, carrier peptides. The signalling peptides generally signal our deeper skin cells to make more collagen and elastin and that’s how the marketing of peptide plumping came about. Overall i see them as helpful in skincare and they are often lovely moisturisers. I like the Paula's Choice peptide gel, Medik8 liquid peptides and peptide cream (these are what I use), Cerave have one, Inkey list, Naturium so many!”
Could my HRT be causing acne?
“Sometimes it just happens when you first start HRT because of the fluctuation and then settles down and depends on the form of your HRT. It is relatively common to get hormonal acne in in pre and perimenopause.”
Can vitiligo flare up in menopause?
“Vitiligo can’t be prevented. One thing to be aware of is that vitiligo can go to sites of trauma ( a process called koebnerisation) so to be aware of any energy based devices that may cause trauma to the skin, may bring on vitiligo in those areas. The treatments for vitiligo have improved. Newly approved NHS cream that is a JAK inhibitor called Opzelura that is very helpful for facial vitiligo.”
What can I do about how fast weight loss has aged my face and neck?
“Jowls and necks in the context of what used to be called ‘Ozempic face’ is quite common. Vitamin A derivatives (retinol, retinal and tretinoin (tretinoin on prescription) can help build up collagen but takes a long time of at least 6-9 months of consistent use. Botulinum toxin can be helpful along the jawline and the neck (platysmal bands in the neck). Hyaluronic acid fillers can be helpful to try and restore some of the volume loss but I would be very careful with practitioner and clinic selection. Energy based devices like radiofrequency microneedling and ultrasound based devices can have some benefit. Skin boosters are having a bit of a moment to improve skin texture and build up collagen. I think the difference is relatively subtle and gradual. By far the biggest change would come from surgery.”
I burned my skin with a new product and after a month, it’s still red and flaky. Help!
“Don't worry! It happens to the best of us! Zero therapy is the key. Strip everything back. Use a gentle sensitive skin cleanser, moisturiser, one that is designed for barrier repair. no antioxidants, no exfoliating acid ingredients, no vitamin A derivatives. It will get back to your baseline. Then introduce ingredients very slowly one by one every week once your skin has completely recovered.”
Many midlife women feel overwhelmed by the array of skin treatments on offer
Why am I noticing dark spots and my skin texture changing in menopause?
“It depends what the dark spots are. If they are sun spots, or melasma, or harmless brown growths called seborrhoeic keratoses... Skin texture for sure changes! Our skin gets more dry as we lose more water from the surface of our skin and we can retain moisture as efficiently, we can develop spots or hormonal acne as our oestrogen levels decline and we have unopposed androgens (male circulating hormone) that can stimulate our oil glands to produce more oil and contribute to acne on the lower third of the face."
"The products that are the most helpful are a cleanser, moisturiser and sunscreen. Then added extra would be vitamin A to repair skin over night (retinol, retinal or tretinoin) and an antioxidant in the mornings for protection from oxidative stress (vitamin C, vitamin E, resveratrol etc). Vitamin C in the form of L ascorbic acid can be a little irritant as the PH of this is quite acidic, but there are other formulations of vitamin C that are less irritant. I would prioritise the others first and then add in vitamin C once tolerability improves. Energy based devices like IPL (intense pulsed light) is helpful for sun damage changes to the skin but dark changes can become darker temporarily as a result of treatment”.
What can I do about prominent undereye veins?
“Under eye veins become more visible as we lose collagen and volume in the area with age and having pale skin for sure makes it more noticeable. Skincare can help a little, vitamin A derivatives like retinol, retinal or prescription tretinoin can help thicken up the skin but takes at least 6-9 months for this benefit. Some use polynucleotides (salmon sperm facial) to improve the texture of the skin in this area. The peri(around) orbital (eye) veins can be treated with certain vascular lasers. Sometimes hyaluronic acid fillers can be used in the mid-face to improve certain aspects of volume loss...so there are things that can be done! And of course sunscreen to reduce collagen degradation.”
I’ve just turned 40 and starting to notice fine lines. What should I look for in a moisturiser?
“A good moisturiser is one that has the right combination of emollients (skin softening ingredients), humectants (ingredients that draw water in) and occlusives (that keep moisture in the skin). So examples of good humectants are hyaluronic acid and glycerin, occlusives are things like petrolatum or shea butter, and good emollients are things like ceramides and fatty acids.”
“I think RF and LED can be a little helpful, there is emerging evidence for LED therapy. In clinic LED outperforms the at-home devices but the devices are getting better and better. Clinic radiofrequency microneedling can have some positive impact. Ultrasound tightening in clinic can have some lifting benefit. Collagen supplements have shown to be helpful in terms of skin hydration but i don't think that is going to be the thing to give you a snatched jawline!
"Vitamin A derivatives (retinol, retinal and tretinoin (tretinoin on prescription) can help build up collagen but it takes a long time of at least 6-9 months of consistent use. Botulinum toxin can be helpful along the jawline and the neck (platysmal bands in the neck). Overall you can have a small contribution from each of these modalities but combining procedures with good evidence based skin care will be what makes a noticeable difference. Oh and of course sunscreen to reduce collagen degradation.”
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If I were to invest in one clinic treatment once or twice a year, what would be your suggestion?
Botulinum toxin!
Dr Ellie Rashid is a practising consultant dermatologist at OneWelbeck Skin Health and Allergy, holds a key leadership position at a top London NHS hospital, and is an honorary senior lecturer at King’s College London. She has a PhD in regenerative dermatology and is dedicated to helping people achieve healthy skin through honest, evidence-based education. You can follow her on Instagram @drellierashid.
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