Dr Rozina Ali is an internationally recognised consultant plastic, reconstructive and aesthetic surgeon
with more than three decades of experience understanding the anatomy, tissues and structures that
shape how we look and how we age. In the first of a two-part series on male ageing, she explores
why more men are taking an active interest in looking and ageing well and why male rejuvenation
should go beyond individual treatments to consider the face, eyes, skin, hair and scalp,
understanding what is actually changing before deciding what, if anything, to do about it.
For a long time, aesthetic medicine had been a conversation dominated by women. That is changing.
Men are increasingly prepared to talk about the things they see changing as they age and,
importantly, to do something about them.
What interests me is that these men do not necessarily think of themselves as aesthetic patients.
They are not always arriving with the name of a treatment they have researched or asking to look
ten years younger. More often, they describe what they see: tired or heavy eyes, a softer jawline,
skin that has lost some of its vitality, thinning hair or simply a sense that the person looking back at
them in the mirror looks older than they feel.
I think this represents a healthy change. Ageing is inevitable, but that does not mean we have to be
passive about how we age. My philosophy has always been pro-ageing rather than anti-ageing:
understand what is changing, look after what you have and, if you choose to intervene, do so
intelligently and proportionately.
Start with the issues and the tissues
My plastic surgery specialism is reconstructive microsurgery, so I have spent more than 30 years
thinking about anatomy and blood supply, structures and tissues, form and function, where I can
borrow excess tissue from, how to hide the harvest site, how to best place the additional tissue. That
philosophy underpins my entire aesthetic practice. The face is not simply a layer of skin. It is a
complex three-dimensional structure of bone, fat, muscle, ligaments and skin, and every one of
those layers changes as we age. Regenerating, repositioning, and re-aligning those tissues will
rejuvenate a face, reconstruct a life.
At R&A – Regeneration & Aesthetics, I talk about understanding both your issues and your tissues. Is
the concern primarily excess skin or poor skin quality? Have you lost just volume or also structural
support? Is there laxity? Is muscle activity contributing? Is there genuinely excess tissue?
Understanding which layer, or combination of layers, is responsible for what can be seen is what
allows me to select the right intervention, at this time.
This is particularly important for men who may be relatively new to aesthetics. I want them to
understand what is changing and what their options are.
Why the eyes can change the whole face
The eyes are a good example. They have an extraordinary influence on how rested, energetic and
youthful we appear.
With age, changes around the upper and lower eyelids can make somebody look persistently tired
even when they feel perfectly well. Heavy or lower brows can make you look angry, unfriendly or
unapproachable, never a good look in the workplace or socially.
There are excellent treatments for improving skin and tissue quality, muscle pull, brow position, skin
excess, however no technology or injectable should be expected to solve a problem that is not
understood and cannot therefore be anatomically corrected.
For some, a blepharoplasty may be the most effective and proportionate answer. Being a surgeon
does not mean I think everybody needs surgery; if anything, it makes me very conscious of when
somebody would not benefit, which is why it became incumbent on me to understand and know
what non-surgical options are available and what they can meaningfully achieve. So now I can
consider upper or lower lid blepharoplasty, direct brow lift, temple lift, but also polynucleotides,
PRP, HA facial fillers, Skincare products or technologies such as Radiofrequency or Ultrasound –
that’s surely the comprehensive medical and surgical understanding our aesthetic patients deserve
to have access to. It also means I will be honest when a focused surgical procedure is likely to
produce a more appropriate result than repeatedly trying to compensate for a structural problem
non-surgically.
That is an important part of my philosophy: the right treatment, for the right issue, at the right time.
Looking after male skin
Then there is the skin itself. Men have historically tended to do rather less with their skin than
women, yet it has been exposed to the same decades of sunlight, environmental damage, stress and
lifestyle influences.
As we age, changes in collagen, elastin, hydration and cellular activity affect the skin's texture,
resilience and elasticity. We may see pigmentation, roughness, fine lines and increasing laxity. For
me, the answer is not to erase every line. Lines are part of expression and character, and a
completely smooth face is not synonymous with a younger or healthier-looking one. Ageing is
masculinising- that’s a very beneficial quality in men, however improving skin quality, skin tone,
pigmentation is essential to looking healthy and fit as well as more youthful and energetic.
I am therefore much more interested in improving the quality of the tissue.
That might begin with a sensible skincare strategy and sun protection. Depending on the individual,
we can also consider treatments that support hydration, collagen production, skin quality and tissue
regeneration, or technologies that tighten and support the skin over time.
This is where my “little and often” philosophy becomes particularly relevant. The most long lasting
and authentic rejuvenation is rarely a sudden transformation. Small, carefully chosen regenerative
interventions over time allow us to maintain the characteristics that make somebody recognisably
themselves while supporting the tissues as they age.
Hair is part of the ageing picture too
We should also talk about hair. For many men, thinning hair or a receding hairline is one of the most
visible signs of ageing, and it can have a surprisingly significant effect on how old someone perceives
themselves to look.
Hair loss is also an excellent example of why it is essential to understand the biology of tissues,
before reaching for a treatment. Genetics may play an important role, but hair and scalp health can
also be influenced by a wider range of factors. Internal and external assessment matters.
Testosterone and cortisol levels matter as much as hair density and hair growth phase.
At R&A, I see the scalp as another tissue environment that we can assess and support. For suitable
patients, regenerative approaches may include scalp microneedling, platelet-rich plasma (PRP), LED
light treatment, exosomes, or prescription medication to support scalp and hair health. Hair, skin
and face should not necessarily be thought about as three entirely separate aesthetic problems.
Together they contribute to how healthy, vital and yes, how young somebody appears.
Do you want to look younger, or do you want to look well?
Perhaps the most interesting thing about this changing male aesthetic patient is the outcome many
men actually want. They don’t necessarily want people to notice that they look younger, and they
certainly don’t want people asking what they have had done. They want to look rested, healthy,
sharper and more like the version of themselves they still recognise.
That means effecting subtle, qualitative changes. Sometimes it means improving skin or scalp health.
Sometimes technology or regenerative treatment has a role. Occasionally surgery is the most
effective solution. Judgement and skill are required in equal measure to ensure no more
intervention is offered, than is required. Less is actually more.
But there is another part of this conversation that interests me increasingly. The face, skin and hair
are the things we can see, but they do not exist independently of the body underneath them. As
men move through midlife, changes can also occur in weight, muscle, fat distribution, metabolism,
hormones, energy and wider health. So in the second part of this series, I am moving beyond what
we can see in the mirror. It’s time for a male
