From Botox to skincare, fillers to anti-ageing boosters, we asked an industry pro about the products and procedures that really work when it comes to treating all manner of skin concerns

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While we're anti 'anti-ageing' (after all, who doesn't want to age?), we also want our skin to stay smooth and supple for as long as possible. So when it comes to looking after ageing or mature skin, what should we really be spending our money on?

From prevention to non-invasive procedures, the range of options now available can prove to be a pretty overwhelming list to choose from. Cue cosmetic doctor Dr Vicky Dondos  to clear our confusion and separate the fact from the fiction when it comes to keeping wrinkles, pigmentation  and dark circle woes at bay. Praised as one of the UK’s ‘best face-perfecting doctors’ by the British press, she’s at the helm of all things anti-ageing and is a pro at making people look younger naturally, subtly and effectively.

A fully qualified medical doctor, Dr Dondos graduated from Guys and St Thomas’s Medical School in London in 1998. Fast-forward 10 years later and not only has she garnered a reputation for being one of the best in the business, well-versed in the art of Botox and fillers, but she also co-founded respected doctor-led beauty practice Medicetics  in 2006 with business partner Dr Geoff Mullan .

No nonsense and refreshingly honest, let her words of wisdom help you weigh up your options and find a regime and solution to tackle your particular skincare concern. We asked Dr Dondos for her top 10 tips for a smoother, revitalised, younger-looking complexion.

1. When should you start an 'anti-ageing' routine?

VD: I think it depends on your definition. In my opinion, what it doesn’t mean is investing in an incredibly expensive collection of anti-ageing products.

I think it’s never too early to start, provided it’s done without obsessing over it. There should never be a time where you shouldn’t be mindful of looking after your skin and doing your best for it. What I tell my patients that often has a real impact is that only 20-30% of skin ageing is genetically determined. You can do so much the earlier you start, but it’s also never too late as well.

2. What are the main anti-ageing myths?

VD: Spending too much money is the first thing that springs to mind with women thinking that they have to invest large amounts. Throwing all your money into fancy ingredients is nonsense. What’s more important is to be consistent. I also talk a lot to my patients about what’s beyond just creams and a skin regimen.

I always refer to the ‘Ss’: sleeping, smiling, stretching (exercise), sugar (less of it) and to keep things simple with a regime that’s consistent and right for your skin type. Sleep trumps everything though - it makes such a big difference. Recent research shows the impact that sleep and stress has on the skin and it is really fascinating. Ultimately, stress causes cortisol levels to increase which in turn causes collagen to break down.

Sleep is the best way to boost collagen production due to the fact that this is the time when the repair process takes place to undo the damage of the day. Hyaluronic acid  production also increases during the night which in turn boosts hydration levels. The studies also showed interestingly that those who were optimistic had higher levels of antioxidants in their blood!

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3. What are the essentials for a youth-boosting skincare routine?

I think there are 5 things that work no matter your age:

1) Sunscreen

Daily sunscreen  should be an essential part of your skin regime from your 20s. I would recommend not using a sunscreen higher than SPF30 and although I’m not completely against sunscreen in moisturisers or in makeup, it is better to have a separate step for this. However, something is better than nothing. There are also so many dual-action ones available now for different skin types.

We prescribe certain types as a treatment for those who suffer from acne for example which also offers sun protection at the same time. SootheUV is another we recommend for calming inflammation which acts as both a moisturiser and strong UV protectant. For over-the-counter, I’d strongly recommend La Roche-Posay.

When seeing clients, I can instantly tell who has been using sunscreen regularly and who hasn’t. Even after a couple of months of using it every day, lines will improve and skin will become more supple and soft. Not only will the skin need to do less to protect itself, but damage will be minimised too.

2) Exfoliation

From exfoliating pads from Cane + Austin , £48 to creams like NeoStrata Bio-Hydrating Face Cream , £37 exfoliation is such an important step in anyone’s skincare regime. It shouldn’t be a once-a-week step though, but done regularly for maintaining a good skin barrier, boosting collagen production and promoting a healthy dermis that is better hydrated. It’s about finding the right product for your skin type.

3) Cleansers

It’s more important to focus on finding and investing in the right cleanser rather than a fancy moisturiser in my opinion. What people don’t stress enough is how important and how tailored it should be to your skin.

In my experience, many skin types can’t handle physical scrubs used too often. So I would recommend using two cleansers and alternating them: 1) an exfoliating cleanser and 2) a calming cleanser.

Never exfoliate twice a day and aim to do it at night. For those who can handle it, NeoStrata Exfoliating Wash , £39 is a good choice. With regards for soothing cleansers, I’d recommend non-detergent ones. In my clinic we recommend Tebiskin too (an Italian skincare range that gives fantastic results for rosacea). The science behind it is amazing and it contains MSM which acts as a great anti-inflammatory. For over-the-counter, Avène and Neutrogena have some great simple cleansers.

Heavily scented cleansers are full of irritants  and I would be a bit weary of foaming cleansers and cleansing brushes too. There are some good ones, but with the current obsession I’m seeing of getting squeaky clean skin, what I would say is to ask yourself how your skin felt after cleansing? This will give you an indication of how much damage you’re doing. Everyone’s skin does feel a bit tight, but the goal should be for it not to.

4) Antioxidants

These are important for boosting skin’s defences. Research shows that although a healthy diet and oral supplements are most definitely of upmost importance, there is also significant gain in using a topical antioxidant too. Reservatrol is a good ingredient, but I usually recommend a combination product, e.g. Neostrata Skin Active Antioxidant Defence Serum , £72 which contains eight different antioxidants and is well formulated.

Additionally, I would also recommend getting regular check-ups when it comes to your skin. One day, I believe it will be like going to the dentist. Your skin goes through changes throughout the year and your regime should be adapted to match its changing requirements.

5) Retinoids

These are vitamin A derivatives  which have a well-established track record for promoting collagen production and preventing its breakdown. It comes in over-the-counter and prescription strength types and the best one depends on your age and skin tolerance.

I would recommend Skinceuticals with regards to over-the-counter options. We also stock non-prescription retinoids at the clinic - Philosophy and Vichy are very good, I’ve been really impressed with them. People are so scared of them in the UK, however they form part of people’s daily regimes on other parts of the continent.

4. What’s the best way to get rid of dark circles and puffy eyes?

VD: These can prove very difficult to treat. The term ‘dark circles’ is such a broad umbrella term too - they can be caused by a range of underlying causes. Fortunately, for most of my clients who come in with this particular concern (when they get to their late 30s in particular), it is due to fat loss on the face specifically around the orbit bone. The dip here affects the way that light hits it, resulting in a dark circle. This can be treated though using fillers placed on the bone to lift it and compensate for the fat loss.

However, dark circles caused by congestion, pigmentation and the blood supply are very hard to treat in comparison - I’m still to come across a product that really works. Creams only work temporarily, the only ones that have an effect in my opinion are the ones that restrict the blood vessels. Using a tea bag is just as effective as creams in this regard.

If the dark circles are caused by hayfever however, I would recommend decongestants to my clients to help with lymphatic drainage as well as nasal sprays and anti-histamines.

Puffy eyes  are incredibly difficult to treat too. There is very little we can do. If the puffiness is worse in the mornings and improves during the day, this could be due to lying flat during the night or some other problem that is restricting drainage around the nose. This is beyond my expertise, so I normally recommend that patients go and see a nutritionist. This is a much better place to put your money than products in my opinion, as looking at the inside is just as important as looking at the outside.

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5. What’s the best way to tackle fine lines and crow’s feet?

VD: For prevention, I would go back to my pick of the five products that really work, in particular sunscreen and retinoids.

As the next step, Botox  is brilliant for crow’s feet. Provided it is done carefully, it can be great at treating the lateral areas of the nose too and is fantastic for the upper face. It works by weakening the muscles and reducing wear and tear around the forehead thereby reducing the formation of wrinkles. The injections take less than five minutes. Immediately after, there may be a gathering of little bumps, then over the next few days lines will start to soften. All in all, the effect lasts for around 4-6 months. The best results are seen after a year or so of treatments. Even when the Botox starts to wear off, wrinkles take longer to form as the skin’s had time to heal itself and rest, meaning that you can stretch treatments and less are needed in the long run too.

For those in their 50s, there also lies the possibility of plasma resurfacing in the form of plasma skin rejuvenation (PSR) and laser treatments. These could also be suitable for those in the 40s too, but just at a lighter energy.

6. How about deeper set wrinkles?

VD: Recommended treatment would be the same as above for fine wrinkles, although you could start to look to fillers too. Fillers are becoming more and more popular in our clinic - I would say that they’re now 50/50 to Botox in terms of how much they are requested.

Volume loss on the face can be so ageing. So we use fillers to try and compensate for fat loss and address drops in the facial contours usually based on photos taken 5-10 years ago. It’s not a means for changing the face, rather for restoring and strengthening the skin. They are particularly good to use in the lower face where the effects of talking and eating are felt the most. They provide fantastic results but subtlety is key in ensuring that they aren’t noticeable.

The fillers that we use take 30-45 minutes to administer, the results are immediate and clients can usually go straight to work afterwards. They may feel a little tender or puffy in the treated areas, however this is often more noticeable to the client than it is to anyone else. Depending on the filler, the results can last up to 18 months.

For frown lines though, Botox is fantastic at targeting those.

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7. Is there anything that works for sagginess and loss of elasticity?

VD: In all honesty, this is really difficult to rectify without the use of a scalpel. However, prevention is key, so I would go back to my five main components for an effective skincare regime detailed earlier as a first step. It’s vital to keep the skin well hydrated and prevent the breakdown of the dermis.

As far as treatments go, radiofrequency is very popular in the clinic. Its principle is to try and trigger and stimulate the skin to produce more collagen. Other treatments which do this include microneedling  (which is also particularly effective against acne scarring), Dermapen, Dermaroller and Skin Boosters - procedures involving a micro injection of hyaluronic acid to hydrate skin. This one in particular is proving popular as it sits in the middle between Botox, fillers and Dermapen. It can be done as a one off or as part of an intensive course. It is particularly good for crow’s feet too as it stimulates and hydrates the area. A Skin Booster treatment around the eyes lasts for approximately 6 months.

8. What would you recommend for tackling pigmentation and brown spots?

VD: This is the second most popular skin complaint in our clinic to wrinkles. It’s so common, but it can be managed. It can be due to a range of different causes whether that be sun exposure as a teenager or hormones as a result of pregnancy or the pill when you’re older. It can often also be caused by inflammation from spots or even hair removal, whether that be from plucking or over-waxing.

I get pretty upset about the claims of some over-the-counter products. They’re not nonsense as they do contain active ingredients, however their concentrations are too low to work. I prefer to use a combination of prescription products as part of an intense 12 week regime. The gold standard is Obagi Nu-Derm - it’s a safe, quick and effective way to get rid of pigmentation. If that doesn’t work than no topical treatment will, so it’s then best to use look to procedures.

One such procedure is intense pulsed light (IPL) for treating superficial pigmentation which when combined with prescription products can offer longer-lasting results. And of course sunscreen, to prevent and maintain the results afterwards!

9. When should you look into plastic surgery, Botox and fillers? Could you do more harm than good if you do it too soon?

VD: This is a difficult question as it’s so personal. Having worked with plastic surgeons, it seems that the best results are seen when you’re young, but I would advise that putting it off isn’t necessarily a bad thing. There is plenty that you can do, but different approaches need to be taken for different areas. I often make referrals to eye surgeons who are able to perform simple, safe procedures that make a huge difference to the face. Non-surgical treatments can hit the wall quite quickly and depending on the situation, I would see no benefit in delaying referral.

When it comes to ‘lifts,’ we need surgeons. However, one thing I would say is important to be mindful of is the stretching the skin - it does affect what you can do afterwards with regards to supporting the dermis and stimulating collagen once you’ve gone through that stage of intervention.

I would judge it by a case by case basis. It’s important to weigh up the impact and look at the reasons for why the patient’s considering it.

When it comes to Botox and fillers, there is no magic number for when it’s best to start. I’d recommend it to my patients who have premature signs of ageing or a massive wrinkle they wanted to get rid of for example. However, that being said, nothing makes me more furious than preventative Botox!

Fillers can be great treatment when in the right hands. I won’t condemn those who use it to achieve that extra mm to improve the ratio of their faces, for me though I’m very conservative in how I apply it. I take a proactive approach and sometimes a little bit of well-placed filler can really make a difference. It depends on your face and the rate at which you age which differs from person to person. It can also vary depending on a person’s body fat percentage. Fillers will have a bigger impact at an earlier age for a fitness fanatic for example, as they don’t have enough of a body fat reserve so when they age, it really shows more.

10. Can using Botox, fillers and anti-ageing products cause your skin to become lazy?

VD: Actually some new research suggests that the opposite is true for fillers. The surgeon behind it has been doing punch biopsies of patients he’s been regularly treating with fillers for the last 10 years or more. After close study of their skin and measuring its quality, he’s seen that the fillers have actually had a positive impact on it thanks to its stimulating effect, making it tighter and denser.

It’s a fine balance in my opinion. Some treatments can cause some inflammation however, if done correctly and at the right intervals, it can have the right impact on the skin.

I wouldn’t say that slowing down the ageing process will make your skin lazy, rather it will help reduce its wear and tear. Plus, it’s completely reversible. Botox doesn’t destroy the muscles, it just weakens them, so if you stopped, you would get full muscle bulk back. I have seen no evidence of sagging or weakening of the skin.

When it comes to anti-ageing products, I would say that there would be damage to the skin if they are stressing it, so keep it simple. Overloading it can cause inflammation and ends up being counter-productive. When it comes to certain ingredients such as antioxidants, these are components we need to keep supplying it in order to boost its defences. The same goes for hyaluronic acid. As we age, our production of it naturally decreases.

In short, the danger is not that skin gets lazier; the danger lies in the damage caused by overloading it and using the wrong products for your skin type .

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