Just As Well, The Women's Health Podcast - Skin in Your 30s, 40s & Beyond: What Really Works with Dr Sophie Shotter

Episode Date: April 21, 2026

What does your skin actually need — and what’s just hype? In this episode, Claire Sanderson sits down with Dr Sophie Shotter, award-winning aesthetic doctor and President of the British College of Aesthetic Medicine, to break down what really works when it comes to skin health. From your 20s through to your 50s and beyond, Sophie explains how your skin changes, why your 40s can feel like a “cliff edge,” and what you can do to protect it. They cover: The 4 essential skincare steps everyone needs The ingredients to avoid (even in expensive products) Why your skin barrier might be damaged The truth about Botox, fillers & skin boosters What to ask before choosing a clinic Budget-friendly skincare that actually works They also discuss the impact of lifestyle factors such as stress, sleep, alcohol and diet, and how these influence not just how your skin looks, but how it functions. A practical, honest and expert-led conversation about aging well — and looking like the best version of yourself. Learn more about your ad choices. Visit megaphone.fm/adchoices

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Honey, forget about the lasagna. Let's celebrate. 19 plus Ontario only. Please play responsibly. Concern about your gambling or that of someone close to you. Call 1866-531.2600 or visit connetso. Hi, I'm Gemma Atkinson and I'm Claire Sanderson and Claire has just recorded another episode of just as well. I was gutted. I was supposed to be joining this chat. I was very excited but London traffic had other ideas for me.

It did so you were being a show busy type person and you were on TV this morning and trying to get across from White City and we're stuck in gridlock. Yes. Which is a shame for you because it was a really really interesting chat. So Dr Sophie Schotter is the president of the British College of Aesthetic Medicine. She's a multi-award-winning ascetic doctor and the ascetic doctor that I go to for my various treatments. And I speak about it openly, full, completely transparent of the work I have done to preserve my skin health. And we talked about all aspects of skin health. We talked about how your skin changes throughout the decades. So we even talked about pre-teen because I spoke about my daughter, Nell, who's 10 and already has a skincare routine. Good for her.

Because she's, well, maybe not, because Sophie has other opinions about these young girls who could end up compromising their skin barrier. Really? Because they're overusing products because they're seeing them on YouTube, etc. So she talks about that and also what you should do to your skin in your 20s, your 30s,

and then your 40s, which is the age group you and I are, really are the battleground here for your skin. Because we start ageing far more quickly our hormones are all over the place or collagen depletes. Yeah, your estrogen receptors are... It's downhill. So she talks about what you can do

in your 30s in preparation for that decade, but then also what you can do in your 40s and beyond to have the healthier skin you can. The wonderful thing about Sophie and I've been going to her for years, she's not an ascetic doctor

that wants to augment how you look or change how you look. You do see these women that go a bit too far on the fillers, a bit too far on the Botox. That's what puts me off. It frightens me that if I did it, it would go wrong. Yeah, and we talk about that.

We talk about the red flags you should look for when you're checking out a clinic and considering a clinic. We talk about the questions you should ask and the answers that you should receive before considering going to that clinic. Yeah, and then we also talk about for someone like yourself who maybe is considering a treatment, but nervous. Yeah. the ones that would be the stepping stone into aesthetic medicine.

And we talk a lot about the treatments becoming available now, skin boosters. They're injectables, but they are to encourage your own skin health. They're almost like injectable moisturiser. So it's not freezing your face. It's not filling your face, so it looks a different shape.

It's not changing how the face you were born with. It's making you look like you had a good, night's sleep. What about cost and stuff? Does she give options? Yeah. Obviously, a lot of people, I see some like treatments and they want like close to six, seven hundred quid and you're like, what? I could go on holiday for that. Yeah, absolutely. So I ask her about skin care and what you can do on your various budgets and she gave some great tips, really practical tips, which I hadn't heard before. And I'm not going to share it because I urge people to listen about what to look out for on the supermarket shelf or on your high street.

shelf. So, and she said there are products available and there are ways to signpost these products. I'm best to tell you, but I'm not going to. No, yeah, I'm going to listen. There are ways to look out for products on the supermarket shelves and also what ingredients you should actively avoid. Fragrance was one of them. And I know your own skincare range, gem and tonic. Yes.

We're fragrance free. For the moisturiser for that reason. Because I was told fragrance moisturiser. Body stuff's not as bad, but on your face, this shouldn't be. So she said avoid fragrance, but she also gave the name of other ingredients that you should avoid. That's interesting. And if it's towards the top of the list, especially avoid. And I asked, well, is it the case that you're more commonly going to find those in your cheaper products

and actually the more expensive higher end doctor-led products won't have them? She said not necessarily. So it's, but she also recommends if you do have a little bit of money to spend and you want to invest, she recommends the brands that you should go for then. that there's a lot of top tips and there are many top tips. Oh, well, we all need the tips, especially when it comes to our skin. So enjoy Claire's chat with Dr Sophie Schotter for just as well. Today I'm talking to Dr Sophie Schotter,

an award-winning ascetic doctor and president of the British College of Aesthetic Medicine. We're diving deep into everything's skin, how it changes throughout the decades, and what lifestyle factors, stress, alcohol, central heating, or secretly sabotaging our complexions. We'll also discuss the seismic shift happening in aesthetics right now. Women are moving away from fillers and frozen faces and are instead asking for something completely different,

hydration, glow and actual skin health. We'll talk about the new generation of treatments that improve rather than change. What questions you should be asking your practitioner and which ingredients to avoid? And if you're on a budget, what's actually worth spending your money on? Plus, what does the future of skincare look like? Let's find out. welcome to Jess as well Dr Sophie Shorter. Thank you so much for having me.

I love that you're here today, Sophie, because we've known each other for years and full transparency, you do my treatment, which we can talk about. So I feel like I know you on a very personal and professional level. But for those listening, tell us about your journey to becoming the multi-award winning doctor you are today. Thank you.

And your very prestigious role as the president of the British College of Aesthetic Medicine. So I've been in aesthetics since 2012, I think, and I left to set up my own clinic, left the NHS in 2014. I loved my time in the NHS. I did a lot of anaesthetics and intensive care, but I knew that that wasn't really where my heart lay anymore. And what I really enjoyed was bringing people smiles back. I got to make people feel better and to deliver a level of care that I could be really proud of. And so from there, it started with just me and a clinic in Kent and now quite a big team, two clinics, one in London and one in Kent.

And as you said, this year in September, I took over as president of the British College of Aesthetic Medicine. And we're a charity aimed at really campaigning for better regulation, educating the public and representing our members who are all doctors and dentists in this field. So what are the most common complaints, conditions that you see in your clinics in Kent and in London? So my patients are patients who come in wanting to look weller for want of a better word, just as well. You know, it's about people looking like the best version of themselves. They may come in having noticed more fine lines and wrinkles. A lot of the time it's about just. generally feeling like their face has changed, maybe not quite being able to put their finger on

it, but wanting to look like the best version of themselves. Not like they look 10 years younger than they are. They just want to look well. And that's, that's been a big shift, I'd say, across the years. There's been a lot of change, which I know will come on to. But very often, it's just this more general perception rather than saying, I want that line to be gone. do you often see there's a gap between what people ask for and what they actually need? Oh, definitely. And I think nowadays we have a much more educated consumer than we once did. There's so much information now, whether that's because people in the media talk about it like you,

or whether it's social media that means there's more information accessible. It still means people can come in and ask for one treatment that's maybe had great, marketing, but actually what they really need is something else. So there's sometimes a misconception about what certain treatments can achieve. So what the place of different treatments are. And also about the fact that just because something's talked about everywhere, that doesn't necessarily mean it's the best thing for everything. And again, that goes with your friend.

If your friend's had a treatment that's been great for them, it doesn't mean it will be great for you. Because all of our skins are different and it changes. Dramatically throughout the decade. So let's talk about what is happening to our skin from our 20s, 30s, 40s, the battleground years, I'm there now firmly in the perimenopause. My rosacea has got notably worse in this decade

and then 50s and beyond. How is our skin changing? So changes start in our, even potentially from 18 onwards. And through our 20s, our levels of elastin, of halaronic acid. acid and of collagen all start to decline, but you're probably not really seeing it yet. Unless you're someone who really sun worships, smokes, maybe really struggles with lifestyle, maybe then you start to see it. But for most of us, we think we're pretty comfortable with our skin in our

20s, even if the changes are happening beneath. Through our 30s, we often start to see those first signs crop up, but we still look pretty good. You might have a few more fine lines and wrinkles. You're skin texture may be starting to change and you might explore what treatments could help. But as you say, 40s tends to be the big battleground for women. Tends to be when we start to notice those accelerated changes and within the first five years of perimenopause, we lose about 30% of our collagen. So, you know, so many women describe it as this real cliff edge moment. And no matter what they do, they struggle to keep up with a change in their skin during this decade.

So that can be things like the skin thinning, more fine lines and wrinkles, pigmentation suddenly showing even though they're using sunscreen every day, more dryness, dehydration. And as you said, you've noticed with your rosacea, because all of these changes are impacting on our skin barrier health, skin conditions like rosacea can suddenly appear or become worse. And then in our 50s and beyond, we're still aging at a quicker rate than we were premenopause.

So we still have more of a battle on our hands than we did beforehand. And I say battle, you know, I think ageing is a huge privilege. But for me, it's about skin health because we know that healthy skin in women, our skin is covered in estrogen receptors, our skin cells. And estrogen is really good for our skin. It helps it to function at its best. So when we then are estrogen deficient in those postmenopause years, that's not associated with healthy skin,

which is why skin becomes so fragile as we get older. So for me, it's not just about how the skin looks, but it's about how healthy it is. And we'll come on to that because there has been a shift away from aesthetics to skin health in the treatments that you've done for me, which we'll go through. So is there a decade where intervention

becomes the most sufficient. So is it the 30s that women needs to really start focusing on their skin and looking at treatments and their lifestyle in order to set themselves up to be in a better place by the time they hit the 40s? Yeah, for sure. And I think it's the same in every aspect of our life with if you can go into those perimenopauseeers prepared,

then you will cope with them better. And that's the same for skin. It can be optimising your skincare routine, really thinking about your lifestyle and what you're putting your skin through. And then treatments are kind of the icing on the cake. I always say it's like having a personal trainer. What you do at home and your solo exercise routine is the most important thing. And your trainer is the icing on the cake. And the same goes with skincare.

Skin care is your solo exercise routine and I'm your personal trainer. But skincare can be quite confusing, can't it? There's even for someone like myself whom I'm obsessed with skincare and feel I'm quite well read on the topic just through the content we put in in the woman's health, there are certain brands that I get so confused that am I supposed to be using that peptide, that acid,

that in what order am I supposed to be using those? And actually for my rosacea prone skin, it can do more harm than good. Absolutely. I sometimes feel like I need to put the most gentle thing ever on my skin. It's a minefield out there. It is.

And this is where too much information can also be a bad thing. And I think I see a lot of confused patients about skincare. And I would say it never hurts to have some help on your skincare routine. Talk to an expert and have something tailored to you. And you're completely right. If you're struggling with rosacea or any sensitive skin condition, acne as well, I would always say less is going to be more and it's not about piling on more and more active ingredients because you will make your skin worse rather than better. But of course, when you look at what you see online, it's so easy to fall into the trap of thinking it's all going to help. Yeah.

Yeah, and I have fallen into that trap. Yeah. And then you can, then the skin becomes more sore and more red. But it is an easy trap to fall into. Yeah. And I think it's, you know, there's so much information and misinformation out there. So you need to be careful we get your information from. So let's look at lifestyle culprits then, stress.

Yeah, huge. It's endemic, isn't it? In society, we're all stressed, especially women in their 40s, I would argue, because we're juggling so many plates, spinning so many plates at this age. But how does it impact the skin? and what does that damage look like? It's huge. It's, as you said, I do think women in our 40s,

it's, you know, you've got the physical stress of your hormones changing. Often we've got aging parents, we've got young children, we've got careers. There's so many balls in the air. But stress is associated with high levels of something called cortisol. And cortisol impacts your skin.

It particularly can degrade collagen and elastin. And it can also, So for some people contribute towards more breakouts as well. But that kind of accelerated skin barrier breakdown is stress linked. Interesting, you said cortisol there because a lot of high intensity exercise or endurance exercise, you know, a lot of people are signing up for marathons in their 40s as a bucketless moment. But that increases cortisol in your body. Can that impact your skin?

So, yes. but I would say cortisol is healthy. We need it if we're in fight or flight mode. So there are situations where cortisol is not bad for you. What becomes bad is if it's chronic. So think about we need cortisol if we're being chased for a forest by a bear. And then we get up our tree and we're safe and the bear's gone. Our cortisol comes back down.

But if in our modern lives we have so much stress, but we're not being chased by a bear, but our body thinks it is because we're constantly on this hamster wheel thinking about all the things going on that is unhealthy for us because we are not actually under threat of life so this chronic cortisol increase is the bad thing for us hit training i think can be great for so many people but i for example have been guilty of overdoing it so i now train differently i i don't do hit training because um for me with a high stress lifestyle adding in hit in there

I just got injured all the time. I felt awful. Pathie, I got. Yeah. And so I know some people, it really works for, but again, it goes down to this is so different between all of us. And hit training, I think if you haven't got much other stress in your life, if you are one of those people, great. It might do really well for you. But for people like you or me who are probably running on a lot of cortisol a lot of the time, it's not great.

Yeah, somebody explained it to me once, a very high profile personal trainer. He said your lifestyle, you're already operating on a lift shaft at level seven of cortisol. You do not want to put more cortisol on top of that and go up to 10. Exactly. Yeah. Alcohol, it's not really good for anything, is it? No. How does that show in your skin?

Yeah, I think alcohol, it's a tricky one. It's so pro-inflammatory for the whole body. And we now also know if you're like me and you've spent so much time, working on your gut microbiome. When I then understood what alcohol does to my gut microbiome, I drink so rarely now because I want to protect the hard work I've done. And we all know that our gut health also impacts our skin health. So alcohol is very pro-inflammatory for your whole system. And the skin is no exclusion to that. So we often see links with skin diseases like rosacea. And just generally redness, puffiness, it's also sure.

sugar. So alcohol is essentially sugar and sugar makes all of your proteins in your skin, your collagen, your elastin, more brittle, they snap. So we do notice accelerated aging as well. Which brings me on to my next one, which is diet. You've mentioned sugar there. What other culprits are in our modern diet which are attacking our skin health? Sugar's the big one where there are real relationships with the skin proteins, but you can also have really positive impacts by having an antioxidant rich diet, ensuring you've got enough protein intake in your diet, again, that's going to impact your skin. You know, ultra-processed foods, I'm always going to say, are a no-no and trans fats and so

on, even though maybe the effect on skin is less specific, although again, they're quite pro-inflammatory. You know, I think those from a systems-wide perspective are things we should all be minimizing. For me personally it's heat that aggravates my rosacea and that can be consuming heat as well, consuming chilies, not just being in a warm environment. That's quite a common trigger, spicy food for things like rosacea. And dairy? Yeah. Yeah.

So much dairy. Dairy, again, especially if people are sensitive, it can lead to breakouts. It can lead to skin barrier problems. So I would say with all of these things, it's whatever's triggering inflammation in your system. So if dairy is a trigger that's making you. inflamed it's going to have an impact on your skin. Where do you stand on supplements? Collagen, everyone's taking collagen.

I love collagen. Yeah, I'm a big fan. Bovine, marine. So both are good. I think, so I work quite closely with absolute collagen and I've been really impressed by them. It came about really organically. But they're a marine collagen supplement brand.

And the way our relationship started was them sending me a clinical study that they had done with over 30,000 data points showing the benefits of their product and, you know, all independently done in Princeton. So an incredibly robust study. So marine can have great benefits. Bovine can also have really good benefits. There are studies linking bovine to increased bone density as well for women, which is obviously a positive. I actually take both. But I think it's one of those things you can really do to help your whole body from the inside out. I know Gemma, who normally co-hosts with me, is vegetarian. She said she will eat fish now and again if she knows where it's come from and it's

being ethically sourced, but she takes bovine collagen. That's the one that works for her. Yeah, that's really interesting. And I will often find that with people that when it comes to something that's really good from a health standpoint for them, they will flex. and especially if there's good provenance and traceability of where it's come from. Yeah. I mean, I take collagen every day.

I also take creatine every day. Does creatine have any skin benefits? Because it seems to benefit women every other way. Yeah. Nothing that has been clinically proven yet. But I think creatine in midlife for women is a huge one. And just the data is it's probably now the most evidence-based supplement we've got. every doctor we've had on this podcast has raved about creatine.

It's the one thing we all should be adding to our day today. So we're in the depths of winter at the moment and the central heating has come on. And I've noticed that my skin has gotten worse with the central heating. If it's not central heating, it's air conditioning, city pollution. How does this all impact our skin? And what can we do to maybe help it, not react to these stresses. It's hard and a lot of the time it's about trying to predict as much as you can.

You know, we all roughly know what time of year the weather's going to change. You are going to need richer ingredients through the winter. So in winter when the central heating goes on, you have that big shift in temperature from outside to inside. But you also have more transepidermal water loss through your skin, your skin, because the environment with the heating on tends to be drier. So using maybe more lipid-based moisturizers is really good. Keeping those on, especially at night, so that you lose less water.

And then often in the summer, we just need to go a little bit more gently. You don't need as many rich products, but going with a lighterweight hydrator tends to be a really good choice for most people. And pollution, antioxidants. vitamin C is amazing for sun. So through the summer, I'll always tell people go for a good vitamin C product. But through when you're thinking about pollution, I'll often go for a broader antioxidant product that has more in it than just a vitamin C.

And again, thinking about how you're cleansing when you're worried about pollution is really important. Because if, you know, you and I are in central London today, those are the days where you should double cleanse. Yeah. You know, it's for me, it's really about getting. getting those contaminants out of my pores and making sure my skin is squeaky clean at the end of the day. And what do you think an optimal cleanser is a balm or a foam wash?

I think it depends on the skin. Yeah. So I think balm cleansers are lovely. And I mean, I love VerdeLab, have an amazing one that's so nice to use. Mimetics as well, I think is really nice at the moment. So I like to, for my skin, which is quite balanced, I'll tend to use balm first, get my makeup off, get the oils off the top of my skin, and then I will use a wash-on, wash-off cream cleanser.

So that kind of, I feel, gives me a little bit more of a proper clean, but it's not having to take my makeup off. But again, if you've got an oily skin, a foaming cleanser or a cleanser with a little bit of an acid in it could be really good as well. Sleep. Oh, huge. Yeah, it's, and it becomes. harder to come by as we age.

There's all sorts of reasons why women, especially 40s and belong, beyond complain about getting to sleep. But if I have one or two nights that I haven't slept, you can see it and you can see it in someone's space. Equally, you can see if someone's had a good night's sleep as well. But what is happening to the skin? What damage is happening to the skin when we're having compromised sleep?

So there was actually a study done on, showed faces to random people. and it showed people who had been sleep deprived and those who were well rested. And it was the same people but all mixed up. And the ones who were sleep deprived were perceived as less attractive than the ones who were well rested. So it's also been shown what a difference it makes on how we look. But there are many things. Sleep is the time when we restore and we recharge and our skin is such an active organ.

And if you're not giving it the time to repair itself, then you are going to accumulate more skin damage. I think a lot of people tend to notice their skin looks duller, maybe the texture's less good when they're, when they're tired, when they've not had enough sleep. And a really big one is also that while we're asleep, our eyes microblink and that microblinking drains fluid from around our eyes. And so we look less puffy, whereas when you're sleep deprived, you have more fluid retention and you look a bit puffier.

It can be fixed if you catch up on the sleep. Yeah. Because if you are sleep deprived, you tend to adopt maybe not so healthy lifestyle habits the following day. You're looking for the biscuits and the carbs, you know, the processed carbs for energy, etc. Exactly. Making poorer choices with everything else. So it's the same with drinking water. Yeah.

It's, yeah, if I'm feeling well, I'll drink loads of water. But if you're sleep deprived, you're enough to just drinking coffee. Yeah, and coffee's a dehydrator and. Yeah, I mean, I'm all for a little bit of coffee, but too much, you're completely right. What is too much? Again, it depends on the individual. You can actually test genetically to see how sensitive people are to coffee. So I'm kind of a normal responder.

I mean, at the moment, I'm pregnant, so I'm literally having one cup a day and that's it. But before that, I was a two cups, but all before 12 o'clock. But if someone's very caffeine sensitive, that might be too much. equally there are a small amount of people who genuinely can have an espresso after dinner and it not affect their sleep. So I think for most people, keeping it in the earlier half of the day

and two to three, but also timing with exercise, caffeine pre-workout is really good for you. But too much of it later in the day, not great. So let's talk about this shift in the treatments that people are coming to your clinic for. So I've been coming to see you it must be five years, do you think?

And I've had all sorts. I have had filler. I haven't had it for a long time, but I have had filler, Botox. But we've transitioned to do more sort of skin health treatments recently. I had one called Skin VEve recently, which is explain what Skin VEV is.

So Skin VEve is a real skin hydrator. So it's different from other skin boosters, but it boosts levels of something called Aquaporin 3. in our skin cells, which is a long word, but it allows these channels to be created in the skin cells that allow water and glycerol in. So you end up with all this hydration. So you're seeing more of that in your clinic now,

women who just want to look the best version of themselves rather than a different version of themselves. Yeah, I would say my patients never wanted to look different. And, you know, when we talk about changing faces with muscle relaxing injections, fillers, a lot of that is choice unfortunately. But I think what's changed for me is that once upon a time, they were the only tools we had, really.

And a lot of people, especially with filler, they were so happy with what it did for them that they wanted more and more and more. And that's not the right thing. For me, the way I like to think about it is we are ageing on every level from our skin to our bone. And so when I see a face, I will look at what's changed and we'll think about what we need to address that.

So fillers still have a big place in my practice, but I combine them more with other things. So if I think someone's got some bone loss going on or some fat loss, I will very likely use filler. But if their skin isn't in a good place, why bother? The skin, the canvas has to look great. And that's what when we look at other people, we think they look healthy.

We make judgments rightly or wrongly without meaning to. the moment we look at someone, their skin tells us a story. And so for me, that's where it all starts. So I find nowadays compared to maybe 10 years ago, my treatment plans are much more multifaceted. I will talk to everyone about skincare. I'll touch on lifestyle. And then we'll talk about different steps of a treatment program.

And it's just about not overusing any one tool. And a lot of the treatments we're doing now, skin vive, other skin injectables, it's about skin health. And really, like I said earlier, skin is our body's biggest organ. And what we understand now is it's not just that how healthy you are on the inside shows on your skin, it's also the other way around. How healthy your skin is will impact how you age internally. And there are now links with signs of aging on the skin to Parkinson's, Alzheimer's, cardiovascular disease, osteoporosis. The list goes on. So that is my key focus.

Let's get people's skin healthy. So we've mentioned skin V. What other treatments are being commonly asked for or you are mostly using at the moment? So there's an amazing product called Sunacos, which I really love. And Sunacos is a mixture of hyaluronic acid and amino acids. And that one's all about collagen stimulation, but many different types of collagen.

You can use it even around the eye, which is great. energy devices like softwave radio frequency microneedling when used properly. Again, amazing. Then we have an amazing thing called MCT, which stands for metacel technology. But thinking about regenerative treatments, if you've heard about PRP, platelet-rich plasma, this involves us taking blood from someone's arm and creating this golden liquid full of your own platelets, which can really stimulate wound. healing, tissue healing. And this machine that we have allows us to amplify that into this supercharged exosome

solution. And exosomes, everyone's talking about them at the moment, but these are your own. They're not from a plant. They're certainly not from another human. They're not from an animal. They're yours. And they can be released, they can be injected into you so that your cells go, oh, I need to stimulate more of this healing response.

And so you get some really amazing results. great for hair loss, great for skin quality. So we're really shifting more and more towards these treatments that have these regenerative benefits. So I had microneedling and I at the time thought it was revelatory. But now I fear that my skin would be too sensitive for it. Is that, can treatments which you've had historically not work for you as you age and your skin change?

Absolutely, which is why it's so important if you're having treatments to work with someone who you can have those conversations with. It's not just, oh, you did that 18 months ago, we should do that again. It might not be the right thing for you anymore. And I always, the moment we penetrate the skin barrier, so microneedling, radio frequency, microneedling, lasers, I will always look at optimising skin health first. For someone who is curious but has not yet dabbled in aesthetic, injectables and I'm nervous about looking done, you know, quote marks. What would be your recommendation?

What's a sort of an entry point treatment to go for? I always think you can't go wrong with skin boosters looking after your skin and optimising your skin ecosystem, your skin environment. So things like skin boosters, for some people, microneedling could be a good choice. But really, again, focusing on a skin treatment. So what's a skin booster? Something like skin v. Skinve or sooner cost profiloh.

Exactly. These ones, they're all great skin boosters. They all work slightly differently. You mentioned in your role as the president of the College of, sorry, remind me, it's the College of Aesthetic Medicine. Sorry, yeah, British College of Aesthetic Medicine is set up to help tackle the cowboy practitioners that are out there. And you hear horror stories of people getting Botox when they go and get their hair done. and you often see people with very overinflated lips that I had a lunch with someone fairly recently

and she said she'd had her Botox and I felt like saying, yes, I can see because her face was doing this sort of very strange crinkle around here like it looked unnatural and I think she'd had her Botox put in the wrong place. So what essential question should someone be asking before they dive into having a treatment? So for me, these treatments should be being done by doctors, dentists and nurses. And again, we have to remember that all muscle relaxing injections like Botox are prescription treatments.

So one of the things is that you have to be seen in person face to face by your prescriber. And not all nurses are prescribers. So I think it's really important people realise that and aren't afraid to ask. who is prescribing for you. Don't be afraid to ask what products people use. There's, again, a wild west of products out there. I think people knowing how much experience someone has got. But for me, that goes beyond years,

because you can have one person who injects twice a month and has been doing it for 10 years, and you can have someone else who's doing it five days a week, but has only been injecting for a year. And their experience will probably be equivalent. insurance and also just asking about you know it's great when things go right but what happens when things go wrong how how experienced are you in dealing with those things and someone who is ethical and honest will always give you all of that information transparently insurance making sure that

you are you you have cover should you ever need it so there's a lot of facets and I think it can be overwhelming and one thing we've done at BCAM is recently launched a media campaign called vet it before you get it and if you go onto the BCAM website you can download a list of questions and you could send it to the clinic in advance because sometimes you'll be sitting in front of a professional like me and you might forget what you wanted to ask or you might be too intimidated to ask and this guides you to get the right information but you can just send it on email beforehand and ask them to send it back to you. So what are the real red flags that if people come across them, it's best just to walk away? I think for me, this being done by non-health care

practitioners is a red flag. Even though it's not illegal in the UK, it worries me so much. You're having things injected in your face. The premises it's being done in, like you said, hair dresses, people having it done in their kitchens, sheds in backyards, it should be in a clinical environment. It should feel like, yes, it can be a nice clinical environment, but it should be clean, it should feel safe. And I think if someone isn't transparent with you about their qualifications, you find a lot of people being very fluffy,

and you can read it and think, I think they're a nurse, but they haven't actually said that. And it can be really hard. to unpick. So anything where you feel you're not having entire transparency and I always say

if something feels not quite right in your gut walk out if someone is pressurising you and to have treatment on the day walk out. Yeah.

If they're trying to upsell in a way that makes you uncomfortable. Exactly. Yeah. On the flip side of that how do you deal with patients who come in

and maybe I've had too much work done. Yeah. You know, you do see them walking around Harley Street sometimes. These women who have had so much done and, in my opinion, probably have a bit of body dysmorphia going on or absolutely not seen in the mirror what we're seeing. How do you deal with that? An honest conversation.

You know, it can be very difficult for people because they see their face in the mirror every day and they maybe lose sights of how different they look. it's something we call perception drift and so I think an honest conversation is really important and sometimes when you show people good photography and we have a really good tool we can use for that that can just help to open people's eyes as to why something isn't looking quite right and ultimately if someone's aesthetic isn't aligned with my own I'm not afraid to say no I will explain why and I will try to guide them to what I think they need. But, you know, I'm not afraid to turn someone away if I don't think they're understanding what I need them to.

So let's talk about skincare products and also budget priorities because you can spend an absolute fortune on skincare or you can spend 10 pounds. There's so much available out there. But are there ingredients that people should actively avoid? The big ones for me are things that are known to be irritant. So alcohol d-nats is a big one. And it will surprise you, even on some really reputable products,

you'll find it high up on the ingredients list. And fragrance is one to be careful of. And it can be listed as perfume. It can be listed as fragrance. Sometimes it's things like citronoul, linenol. And so it can be really hard to unpick, but these things can be really irritant. Now, a healthy skin may, like a balanced skin,

may not have any problem, although it can still cause microirotation, but if you suffer from rosacea, these things can cause you huge triggers. So I always say have a look on the ingredients list. The higher up the list something is, the more of it there is in the product. But they're my big ones that I will always say,

be really careful of. And it's not necessarily the case that you'd more commonly find them in cheaper products. Not always. I mean, sometimes for sure, but I've seen them on the labels of quite expensive products. What are your skincare non-negotiables, things that everyone should be doing regardless of skin type?

So really simple. A cleanser, an antioxidant, some form of hydrator and a sunscreen. If you can have those four steps in your routine, you'll do well. Everyone thinks, oh, I need a retinal, I need a retinal. You might not. It's a typhinoid could do you more harm than good if you've got a very unstable skin barrier.

There are great alternatives like peptides for some people. But for me, those four core pillars, and there is an antioxidant and a hydrator for every skin type, even skin types that have struggled with sunscreen because maybe they have an olier skin, there's a sunscreen that will suit you. And if you can get those four steps on, you've got the foundations. Is there a difference between a mineral sunscreen and the other one? Chemical? Yes.

Yeah. What are the difference? Are one better than the other? They're both good. And I think a lot of bad stuff has been said about chemical sunscreen. I really like them. Depends on the individual. But if you have a...

So the difference is a mineral sunscreen will contain things like zinc oxide, titanium dioxide, that reflect the UV radiation off the skin. Whereas chemical filters absorb the UV radiation and turn it into heat. but some chemical sunscreens have been associated with problems most of those are now not used in the UK anymore and they can be more irritant for sensitive skins again so if you have a skin problem I will tend to say towards mineral sunscreens but there are some great chemical products on the market

and the benefit of them is they're often a little bit more sophisticated in texture and formulation so you can find a sunscreen to achieve everything from matifying and oily skin to helping to suppress redness. So let's talk about budget. There are some really expensive doctor-led skincare brands out there today, seemingly supported by amazing research done in some Swiss clinic somewhere. And does it really correlate the more you spend, the better it will be? No.

Sometimes there are some amazing products that are investment products. I will say I have never found a product. that's, I mean, I'm talking above, but I'll say above £500, but actually what I recommend is much lower than that, that I've thought that's worth the spend. So there's... That's a lot of money for most people to spend.

Exactly. So I, most of my skincare routines, and I always think a transparent conversation around budget is so important because it means you can get the right stuff. There are great places in a routine where you can save money, things like your cleanser. Cereve, for example, £12 £1.5. I think you can pick it up in most high street stores, great cleansers, and they've got one for everyone. But then there are other places, like maybe your antioxidants, where you could spend a little bit more.

And there are some really great kind of mid-price point brands like Murad, which are again really accessible. I love their vitusy glycolic, for example. They've got some really good products, but they're not in the multiple hundreds of pounds. No, they're not. And then you can go up to, yes, there are some products I really rate that are more expensive. Oh, just things like revision skincare. They've got an amazing, they've got one called DJ Daily Boosting serum, which actually changes your cellular energy in your skin cells.

But it's investment. Their vitamin C products are amazing. Clinical skin is another brand, many people, won't have heard of. They've got some that are sub a hundred pounds, but some that are quite a lot more that are still worth the investment if you've got the budget. But that doesn't mean it's got to be what's right for you and what's sustainable. So I think having a frank conversation working within someone's budget and again making sure it's appropriate for skin type and hitting all those. So for me, I'm never afraid to talk about actually what's manageable for you.

Is it £50 a month? Is it £100 a month? Is it even less than that? Because if we know I can help you cherry pick where to invest. I would agree with you on revision. I'm very lucky to have sampled revision and it was amazing. Yeah. I also like skin suiticles.

Yeah. I think that's a brand. It is. Albeit it can be quite confusing. Yeah. The different... It's a big range. Yes.

What to use. But what if someone is in the... Because £50 a month is a lot for someone. to spend on their skin. And there are going to be most people listening to this podcast today who fall into that category. And even then it would be a stretch and a sacrifice. So are there any truly high streak brands? You mentioned Seravi.

Yeah. Any others? La Roche Pose. Again, a really good one. And what you won't get is the real punch of active ingredients that you do with some of the more medical brands. but you're going to get good entry level, you're going to get reliable skin care. Medicaid is pretty widely available now.

And again, some of their products are more expensive, but many of them are really reasonable. Curell is another one that I, again, some great products in there. I think you can nowadays go into most high street shops and pick up good skincare with those simple rules about the ingredients I said. The more premium products like revision that I talked about, their budget goes on research rather than marketing, which is why most people listening won't have heard of them.

And their packaging is quite simple. Exactly. I think of Revision. And that's what I was, when you go into your average drugstore, high street shop, the ones that have got that simpler, almost slightly more medical looking packaging are the ones I would gravitate towards. Oxygenetics is amazing. Yeah. Great skin friendly foundations as well. Yeah.

Yeah. What's the price point in oxygenetics? It's not. I think it's about 55 or something like that for a foundation that will last quite a while. But it looks like, you know, nivia or something. You know, it just looks like you could pick it up in Tesco. Yeah. Yeah. Yeah. And those ones, I always think, look at those ones that look a little bit when you're in a boot store or wherever you like to go for skincare, just if you look at that seravet type packaging that's really simple, looks quite clinical. that's often a really good place to start. Those ones that look of it simpler and don't have the really flashy marketing. Are there any overhyped ingredients?

You know, things that come into fashion. I think every ingredient has its place. I think the big one that we touched on earlier, everyone, retinol is the most science-backed anti-aging ingredient. But that still doesn't mean everyone should have it. So in a way I think it is overhyped because that message has got out, oh I must have it, I must have it, I must have it.

But actually for some people it does more harm than good. And the number of skin barriers I've had to fix after overuse of a retinoid. So, you know, there's none that when an ingredient is talked about, it's usually for a really good reason. But that's the one where I still get the most people coming and say, I really need to be on one. And I'm like, no, you don't. Because there's different percentages as well.

Exactly. And you can get really intense retinoid. You just start at the lowest percentage you can and work up. And there's new EU regulations coming in as well, which will affect us in the UK as well, about what retinoids can be sold over the counter and without prescription. And it will drop what's widely available to make it more safe.

Because I think one of the reasons why my skin barrier is terrible is that I have just chopped and changed and used too many products over the years. Because in my role, I'm very lucky I get to try things. or maybe unlucky because I'm the sucker for it. It must be good. I think I fall into that cab. It must be good because it's expensive. Yeah, yeah, yeah, yeah.

It's not necessarily. No, and I think that is a, when I've looked after any journalists over the years where they've had a skin condition, it's the first thing I've said is try and give more of it to your friends and family to try. Yeah. And give yourself, give your skin a chance to have a consistent routine for a while,

just find its balance. Yeah. So I think that's a really common myth as well that people think, oh, I should change my skincare regularly. You actually don't necessarily need to beyond making those seasonal adjustments that I said. So let's talk about the future of skincare and aesthetics. It's science fiction now, even to what it was 10 years ago.

And I've been at Woman's Health nine years, so I've seen it evolve enormously in that time. Where's it going to go? What does the future look like? What excites you? I think, you know, a huge, trend at the moment in skin is skinimalism. And actually that whole less is more, which I'm really pleased to see. And into that feeds things like skin v, these things that prime your skin and make

them healthier without you having to use as many products, without you having to use as much makeup. And I think that's something we'll only see more and more of. And that real focus on as I skin longevity, like, you know, we're all talking about longevity in a wellness capacity. but actually in a skin capacity as our body's biggest organ I think that's going to be another conversation that just grows and grows as well.

I have a 10-year-old daughter who's already using skincare she's seen on YouTube or whatever there's certain brands that these tweens are obsessed with bubble is one of them there's another one I can't remember

Bioma is another one and their packaging are all pastel colours and bubble gum colours and they're not actually cheap these products because you go into boots and they're still 20, 25 pounds each for 10 year olds, it's ridiculous.

And I think, well, I was 10, goodness me. I might have taken a little doll by my mother's nivir or something. And I do worry about how young girls are getting into skin kick. Could they potentially be causing themselves damage? You know, they're compromising their barrier. For sure. When you look at, I mean, there was a big worry a few years ago about how, how widely drunk elephant products were being used by young teenagers.

That's another one. Yeah. So for me, I don't think 10 is a bad age to understand skin a little bit more because hormones are about to shift. And right now at 10, they're probably not playing a role yet. You have a preteen who is going to take your advice and listen to you. And if you can teach them to cleanse and then to put on a sunscreen, that's a really great habit to get into.

And then when their hormones hit, they'll already have that habit in grains and may then get less skin problems like acne that could affect their confidence through their teens. So I'm not against preteens and teenagers using skincare if it's done like that. But when you're talking about getting into complicated routines, they don't need it. If you have a skin diagnosis like acne, you might need more complex routines. but a healthy skin at this age just doesn't. It needs a little bit of simple care, teaching them to look after it, but not bombarding it with active ingredients.

And absolutely there's a big surge in young people with skin barrier problems as a result. And similarly, get women in their 20s, should they be considering the injectable skin boosters or is it too early really for them to be going down that path? So I think it's got to be on a case-by-case basis. There are some people in their early to mid-20s who I've seen with quite advanced skin damage

from smoking, sunbed use, and we might want to do things on them. But I often think when you're around 25, starting to really think about your skincare routine, great. Think about things like just normal microneedling, maybe having some really light chemical peals so you can start taking good care of your skin, but you don't necessarily need to jump into injectables at that stage.

Lifestyle factors. fluctuating weight is a big thing at the moment. So lots of people are taking a Zempic, Wagovi, some aglittides, they're all under the same umbrella, some of Mungaro, some are brand names. Losing a lot of weight very quickly, some of them rebounding out of it

because they can't afford to continue paying the several hundred pounds a month. These injections cost. There's a lot of talk about a Zempic face. Yeah. You know, women lose weight too quickly and they lose the fat pads. Are you seeing much of that in your clinic?

Loads. And how are you helping women? I think the best thing is when women come in and tell me they've started taking it. And then we can help them proactively by things like SkinVeeve early on. And then when they've started to lose a bit of volume, we can help restore that, but maybe through something collagen stimulating as well. So working with them along their journey, and that's where it's quite different from surgery.

because if you're thinking about surgery post weight loss, you have to have been at your target weight for a period of time, stably before you have surgery. But with non-surgical options, being proactive and having them along the way will get you the best results. But the key is, for me, don't lose weight too quickly. Keep as tempting as it can be. Just don't do it.

Stick to a slow and steady pace. Do it for a longer period of time. Maintaining adequate protein intake, because again, so many people are not eating enough when they're doing it. They're using it as a way of starving themselves. And really thinking about that long-term maintenance because the data on these drugs for maintenance of weight loss isn't good. If you come off the medication,

the majority of patients regain the weight pretty quickly. So I think it's a really important piece of the puzzle to think about. If you aren't going to be able to afford to keep on those medications, then you are likely to regain. And that's, again, not just weight loss, but rapid weight gains, not great for the skin as well. And I think for me, I just hope that with time, they're maybe used a bit more responsibly than they are at the moment. I think that worries me. The number of people I've come across who are using them and then they don't have high BMIs.

They're using them to not eat enough. And I think that's worrying. And I don't know how we come back from that at the moment. Let's go back to the future then. Are there any treatments or technologies on the horizon that you've heard at some conference in Monaco or something that you think is going to be a game changer? So there's one that I think it is available in the UK, but not so widely yet that I think is really different. It's called Rexanage, which is really changing how, again, your skin cells work on a cellular energetic level with some really amazing results. So that's really going back to thinking about cellular health rather than just how the skin looks.

and how the skin looks is a consequence of you dealing with your skin cells becoming healthier. I'm always watching what's coming and what's new, but I'm also really hesitant to jump on every new bandwagon because trends aren't necessarily always a good thing, and I always want to see really great science and safety data before something launches. There is an amazing cellulite treatment in the States that I've been watching for a few years. I don't know when it's coming over here. But that I think is exciting because cellulite is something that's so,

such a common issue for women, but so hard to treat. That's called re-sonic. So I'm always watching and waiting with a slightly cynical eye as well. I just want to make sure that everything that I bring in is going to achieve results that people expect, but also do so safely. Yeah, it must be tricky and a huge responsibility to decide. what you were going to bring into your clinic because women, someone may have saved up

for months or years to have this treatment. It's a huge thing for them, a huge investment. And you have a responsibility to ensure that they get value for money, but in a safe way. Exactly. And that's why, you know, there are treatments where, like Softwave, where I was the first in the UK offering it. Tell me what Softwave is.

Softwave is an ultra-send. sound-based skin tightening treatment, but very different from things like haifu or ultherapy. It works in a different way. For tightening, I think it's amazing. I am one of the first two clinics in the UK to have Candela's new radio frequency microneedling platform, which again is a real advance and revelation. But I've run the clinical studies for Europe on it, or I'm running them at the moment. So I have adopted these things early, but they already have a lot of data from having been

in the States for a while. So for me, there's always that balance between, okay, I want to see that they're safe. I want to be able to speak to colleagues who have used it for a while. Make sure that their patients have been happy. Make sure that they've not had big problems from something. Because as you say, it is a huge responsibility. People are trusting me with their confidence, their appearance, their appearance and making a big investment in it. So what's your hope for how women approach ageing and skincare in the next decade?

because I'd hate to get to get to a point where we all look a bit alien-like because we look so young. Yeah. You know, there's a tipping point, isn't it? Yeah. So what's your hope for women in how we approach these things? I think, you know, we have to remember that ageing is a privilege. Yeah. Age is not a bad thing.

And in every other way, the wisdom we get, the way we know ourselves, the way we can trust ourselves, the position we're in our lives, is for most people so much better than it was when we were younger. And really it is and shouldn't be about wanting to look like or be like we were in our 20s or 30s. And that homogeneity that we've seen for a while with young faces and overfilled, I don't want to see that with everyone who's taking proactive approaches to ageing. I think if we think about things on a real skin health level,

but also really appreciate that ageing is a beautiful thing and a privilege to be on that journey, then it can be done beautifully and the results we can achieve can be done beautifully and how we treat you might shift over time. It's not about eradicating every line, every wrinkle or having the most, I hate the word, that snatched jawline out there.

It's about looking and feeling like the best version of you and I hope we embrace that more. Right, let's move on to our quickfire questions then. So we finish every pod, these quick fire questions. So Jema and I are inviting ourselves around for dinner at everyone's house. What are you going to cook us? Oh, so I will probably do, at this time, if you're a really lovely soup for starter,

veggie, something delicious. And then for Maine, I mean, I do, I know a lot of people don't eat red meat these days. I do love a little bit of red meat. I cook a great steak. so I'm going to do steak. And then for dessert, I'm always more focused towards fruit things, really light. So maybe something like a really nice Pavlova or something like that. Lovely.

So you go into a desert island for a year on your own and you can take one thing. What is it? Sunscreen. Yes, good answer. Coffee or wine in your normal state, maybe not at the moment, but in your normal coffee. Coffee. Coffee. Yeah. The last thing that made you belly laugh.

At my hendu, which was just a couple of days ago, there was just this absolutely incredible magician. And it was both a jawdrop and an absolute belly laugh. Really phenomenal. Cool. This is not like a cheesy magician then. No, like he's called the mentalist. A guy called Neb, he was mind-blowing.

I have to look him back. Yeah. And then finally, what's one thing people listening or watching today can do to make themselves feel a little bit better? sleep enough. Like, go to bed that little bit earlier than you normally would. It changes everything. Not just what we talked about skin earlier, about how you feel, your mood, your ability to cope with the stresses of the day.

It's free and it's easy. Lovely. Well, Sophie, thank you so much for coming to see you today. And congratulating on your lovely news as well. And good luck with your wedding, which I know is... A couple of weeks. A couple of weeks. Wow.

Thank you for coming here today and thank you for being on just as well. Thank you.