Top tips for treating middle aged patients - Hamilton Fraser


Last year, 50,000 more over-55s underwent cosmetic procedures than they did in 2017, according to a recent report from the American Society of Plastic Surgeons. But why are middle aged patients increasingly looking to have cosmetic surgery? There are a number of factors that could be contributing to this rise, including greater financial freedom, the need for a confidence boost, or people wanting to ‘reinvent’ themselves at mid-life.

Hamilton Fraser Cosmetic Insurance’s latest annual survey also supports a rise in the number of patients seeking non-surgical treatments for aging, with 2019 survey results showing that 81.13 per cent of practitioners surveyed stated that this was the most common treatment type requested by patients. Another 66.16 per cent of practitioners reported that preventative aging treatments were the second most common treatment request they received.

Common treatment areas

Consultant plastic surgeon, Naveen Cavale, from The British Association of Aesthetic Plastic Surgeons (BAAPS) says, “The demand for subtle, understated anti-ageing procedures such as eyelid surgery, face lifts and fat transfer remain largely unchanged, while more ‘conspicuous’ treatments such as tummy tucks and nose jobs are dropping dramatically.”

With this in mind, the facial zone is one of the most areas common for cosmetic treatments in the over 50s. Epidermal thinning and variations in collagen cause the skin to age and lose elasticity, and this is particularly noticeable during the menopause, as oestrogen stimulates collagen and oil production. Gravity is also a factor, as the pull of the facial muscles causes the formation of wrinkles and lines. Popular treatments for the face include:

Dermal filler

Dermal filler is used to treat lines created by lost collagen and fat and is therefore an ideal treatment for middle aged patients. Prime locations for the injections are two sets of parentheses: the pair of lines that extend down from the nose to the corners of the mouth, known as the nasolabial folds, and another pair that extends down from the corners of the mouth to the chin, known as marionette lines.

Botulinum toxin

Botulinum toxin is most commonly used to treat the expression lines of the forehead and between the brows. It works by partially immobilising the muscles that form expression lines so the skin smooths out, although some deep expression lines may not go away completely. It is a popular treatment option for frown lines and crow’s feet.

Hamilton Fraser Cosmetic Insurance’s 2019 survey results also found that both dermal fillers (87.64 per cent) and botulinum toxin (89.59 per cent) were the most popular treatment methods used by practitioners in 2019.


As people age, they often develop pigmentation marks on the skin, including freckles and liver spots, which are generally caused by sun damage. With laser treatment, the uppermost layers are stripped away, along with wrinkles and pigmentation. The energy from some ‘non-ablative’ resurfacing lasers passes through the outer layer of the skin to work at a deeper level, in the dermis, to stimulate inflammation, which leads to collagen formation.

Skin needs time to recover after most laser treatments. It can take a couple of weeks to heal, depending on the type and extent of the treatment. The non-ablative treatments tend to heal a bit faster.

There are a number of considerations that an aesthetic practitioner should keep in mind when treating middle aged patients.

Patient selection

As discussed, there are many reasons why patients may turn to cosmetic surgery for the ageing face , but researchers have suggested there are two major categories of motivation for surgery: internal and external.

Internal: Internally motivated patients are generally more committed to physical change and therefore make better patients. They are also usually more satisfied with the outcome of treatments.

External: Externally motivated patients are hoping to change not only their bodies, but also their lives, sometimes to please others, and as a result are often dissatisfied with the outcome if their lives do not change as they imagined following treatments.

Patients may fall in to the ‘external’ category if, for example, they are being motivated by the desire to please someone else, such as their partner; they exhibit underlying psychiatric disorders such as depression, personality disorder or body dysmorphic disorder (BDD); or they may have unrealistic expectations of what can be achieved through cosmetic intervention.

When considering your patient’s request for cosmetic enhancement, it is important to bear in mind the factors that can predict a good or poor psychosocial outcome from cosmetic treatment. You can read more on patient selection here.

Just because a patient has reached middle age does not mean that issues such as body dysmorphic disorder no longer apply. As with any patient it is extremely important to understand their motivations for wanting a cosmetic procedure and to ensure that you carry out a full assessment and educate your patient about the treatment, any side effects and provide full recovery details. Documenting the whole process from consent to aftercare is a vital part of the treatment process, the importance of which should not be underestimated.

When treating middle aged patients, it is incredibly important to understand the principles of ageing and facial anatomy in order to manage patient expectations. Certain patient requests and requirements may not be suitable, however you may be able to suggest alternative treatments which would provide them with a much better final result that is suitable for their skin type and age. For example, treating middle aged patients is largely determined by the natural profile of the face and how features can be best enhanced, rather than excessively manipulated.

Sometimes practitioners may find themselves in a scenario where it is simply not possible to achieve the results a patient is requesting. If this happens to you, then make sure that you are honest, open and explain the reasons why. This can help you to avoid a potential dissatisfaction or claim after the treatment has taken place. Read more about understanding when and how to say no to a patient here.

Careful patient selection and understanding their motivations for treatment can really help to lay the foundations for a smooth treatment process, for both you and your patient, whether they are gen Z, millennials, middle aged or older!

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