When the Face in the Mirror Doesn't Match How You Feel

By Ida Bell, NP-C • Natural Results. Honest Conversations.

There is a sentence I hear from women all the time. "I just don't feel as old as I look." Sometimes they say it differently. They tell me they were fine with their appearance until they saw a photograph of themselves. Or they caught their reflection in a mirror and, for a second, were surprised by the person looking back at them. They just don't feel like the face they're seeing reflects the person they still feel themselves to be. After more than a decade in cosmetic dermatology, I've realized that this is where many conversations about aging actually begin. Not with a wrinkle. With recognition.

When Did That Happen?

‍ ‍Aging happens gradually. We don't wake up one morning with a completely different face, although I've had plenty of patients tell me it certainly feels that way. The face changes in layers. Skin changes. Collagen declines. Fat shifts. The facial skeleton continues to remodel, with bone resorption occurring in areas that once provided structural support. Hormones, genetics, sun exposure, weight changes, lifestyle and simply the passage of time all contribute. And because these things don't happen at exactly the same rate, there isn't one treatment that simply "fixes aging."

That's one of the first things I want patients to understand. Someone may come into my office pointing to her nasolabial folds. Another points to her jowls. Someone else pulls the skin beside her ears backward with both hands and asks me what I can do about this. What she sees is the thing that bothers her. What I see is the entire face. Those are two very different perspectives.

Aesthetic Medicine Is Still Medicine

Aesthetic treatments may be associated with beauty, but I have never viewed what I do as simply providing a beauty service. Aesthetic medicine is medicine. Every treatment requires an understanding of anatomy, aging, facial structure, skin, safety and the individual sitting in front of me. My job isn't to look at someone's face and figure out how many things I can change. It's to figure out what makes sense. Sometimes that's Botox. Sometimes it's filler, a biostimulator or a laser. Sometimes the treatment someone is asking for isn't going to accomplish what she wants. Sometimes surgery is the more appropriate conversation. And sometimes my recommendation is to leave something alone.

Knowing how to perform a treatment is important.

Knowing when not to perform it is just as important.

You Don't Need to Fix Your Face

This is where aesthetic medicine can get complicated. I make my living treating faces, and I genuinely love what I do. I've seen aesthetic treatments make people incredibly happy. I've watched patients look in the mirror and recognize something in themselves that they felt they had lost. I believe there is value in that. But I don't believe every sign of aging needs to be corrected. That’s not even possible. You don't need Botox because you turned forty. You don't need filler because you've lost volume. And you haven't failed at aging if you've never had a cosmetic treatment in your life.

There are qualities that make a person beautiful that I could never put into a syringe.

At the same time, I don't think there's anything wrong with looking in the mirror and thinking, I'd like a little help. Both things can be true.

Natural Doesn't Mean Doing Nothing

I talk a lot about natural results. To me, "natural" doesn't mean refusing aesthetic treatment. It means that treatment should respect the face that was already there. I don't want to create a different person. I don't want every woman to have the same lips, the same cheeks or the same version of an "ideal" face. And I certainly don't think every aging face needs to be "balanced." I want the woman sitting in my chair to still look like herself. Rested, refreshed, healthier-looking skin or some of the volume aging has taken away. But still herself.

That's a very different goal from trying to make a sixty-five-year-old look twenty-five. Not possible anyway. And that's okay. My goal is to help her look her best at sixty-five.

The Conversation I Think We're Missing

Cosmetic Dermatology/Aesthetic medicine has changed enormously during my career. We have remarkable treatments available to us, and I'm grateful for them. But somewhere between social media, before-and-after photographs, trends and an industry built around selling treatments, I think we've made some conversations about aging unnecessarily complicated. We talk a lot about what we can do. I think we should talk more about what we should do. And occasionally, what we should leave alone.

That's really why I created this space - and why I'm writing Saving Face. I want to talk about aesthetic medicine from the perspective of someone who practices it every day, believes in it, and is also willing to question it. We'll talk about Botox and filler. Lasers and skin. Facial aging. What actually happens underneath the surface. What treatments can realistically accomplish and what they can't. But I also want to talk about the person behind the face. Many times what a patient wants isn’t simply to look younger. She wants the face in the mirror to reflect how she feels.

And that's where the honest conversation begins.