In this episode, Harpreet, Christelle, and Amanda unpack the multifaceted nature of aging — exploring how it impacts not only our physical appearance, but also our emotional well-being and sense of identity. They explain that aging is deeply individual, with genetics playing a significant role in which features change first and how those changes show up over time.

The conversation breaks down the difference between surface-level changes, like skin texture and elasticity, and deeper structural shifts, including volume loss, muscle laxity, and increasing facial asymmetry. By understanding these layered changes, listeners are better equipped to make informed, personalized treatment decisions rather than reacting to what they see in the mirror.

Key Takeaways

1. Aging is a multifaceted process that affects everyone differently.
2. Genetics play a significant role in how and where aging appears first.
3. Surface changes and structural changes in the face require different approaches.
4. Understanding the aging process leads to more informed, personalized treatment decisions.
5. Embracing aging with awareness and self-acceptance is just as important as any aesthetic intervention.

Disclaimer: The Beauty Equation is for informational purposes only and not medical advice. This podcast does not create a doctor–patient relationship. Always consult a qualified healthcare provider before making medical or aesthetic decisions. Information may change as the field evolves.

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About the Hosts:

Dr. Harpreet Lotay is a family physician specializing in aesthetic medicine. She is the founder of Sona MD in Kamloops, BC, and serves as Chief Medical Officer at Bios Wellness Clinics. Known for her artistic approach and comprehensive non-surgical treatments, Dr. Lotay combines medical expertise with an eye for natural results. She is also an educator, a national trainer and holds academic appointments where she shares her knowledge in clinical dermatology and aesthetics. You can get in touch with her on Instagram @hlotaymd

Dr. Christelle Oliver-Dussault is a family physician specializing in aesthetic medicine, women’s health, and psycho-education. She brings a holistic, whole-person perspective to her clinical work, blending science with a deep understanding of the mind-body connection.

She is also the founder of Reclaim The Pink Within, a movement that empowers women to rediscover themselves during life’s most transformative stages. In addition, she is passionate about medical education and mentors the next generation of family physicians through her work with the department of Family Medicine at the University of British Columbia.

You can connect with her on Instagram @drchristellemd

Amanda Manholt is a clinic manager, patient consultant, and co-host of The Beauty Equation Podcast. With over 30 years of experience in beauty, aesthetics, and leadership, she has guided patients and teams alike toward confidence, growth, and empowerment. Known for her ability to connect with people and simplify the often-overwhelming world of aesthetics, Amanda brings a warm, practical, and relatable perspective to every conversation. You can find her on Instagram @crowsfeetandconfidence.

Websites

https://sonamd.ca/

https://www.getyourpinkbackproject.com/

And I think one of the things that we can't escape is

our genetics. So you come from your parents and

that's going to have a significant impact on

how you age, which parts of you show age first. And

it's different for every person, but there are certain things that run in certain

families and we've touched on that in the past on our own

experiences, but that's one thing that you

can't change. So in terms of

the, you know, the things that we can't change that that we'll see. I find

in, from my experience, that it's oftentimes those deeper changes, those deeper

structures that you will really see, the ones where they're less affected by

sun exposure. I wanna start with that idea of genetics

and that every person is different and unique. So

even in our teens when we're pretty robust,

pretty healthy, and objectively young, we all

have an Achilles heel, something that we've

inherited that will age us faster than the rest.

Welcome back to The Beauty Equation. In the last episode, we talked

about that unsettling feeling when your face doesn't quite line up

with how you feel inside. And today we're going to talk about

why. Because when women notice change and they go in

to see the doctor or their professional, they are often given really

vague answers like it's collagen loss, it's gravity,

it's aging. But those explanations don't

always match the experience. And aging isn't just one thing

and it doesn't happen evenly. So you have changes

in structure, you have differences in your skin, hormones,

fat pads, muscle tone, and they're all shifting at different

speeds for different people. And when those changes show up on your

face, it doesn't just feel physical, it feels emotional

and it affects your identity. So today we're going to

explain what's actually changing clearly without any

drama, not to create fear, but to replace confusion

with understanding. So you can stop blaming yourself

and start making better decisions. I

love that. Yeah. And I think one of the things that

we can't escape is our genetics. So

you come from your parents and that's going to

have a significant impact on

how you age, which parts of you show age first.

And it's different for every person, but there are certain

things that run in certain families. And we've touched on that in the past on

our own experiences, but that's one thing

that you can't change. So in terms

of the, you know, the things that we can't change that we'll see,

I find in, from my experience, that it's oftentimes those deeper

changes, those deeper structures that you will really see, the ones

where they're less affected by sun exposure.

Um, so where do you want to start? Well, I want to

start with that idea of genetics and that every person is different and

unique. So, you know, even in our

teens when we're pretty robust, pretty healthy, and, you know,

objectively young, we all have an

Achilles heel, something that we've inherited

that will speed up the— how,

like, that will age us faster than the rest, you know. So you

might be— you might have skin that's exceptionally sort

of sensitive to UV and that tends to wrinkle in a certain

way. And your friends might be able to tolerate more sun

exposure than you and genetically you can't. So for those people,

you know, skin interventions are gonna be some of the first things they get

into. Other people, their family

structure might be such that they have smaller chins.

So when we look at how human beings age, we, you know,

let's start with babies. They have little small chins, right?

But then so do 90-year-olds. So it's like we grow this chin

into adolescence and we get a nice jawline

and then it sort of regresses, right? And, well, some of us get a nice

jawline. Some of us have never had a nice jawline.

That's right. It's less nice. Yeah. So that's what I mean.

So if you had a small one to begin with, right, you're going to age

that lower part of your face faster. So, so that's, that's something

that's always interesting when we see our younger patients to kind of go like, how

can we You know, if they're somewhat interested, how can we change their

aging trajectory or make it a little bit less, less

stark, I guess. Yeah. 'Cause for some who does have that smaller

chin, we've talked in previous episode about bone

resorption. So that shrinking of the bone happens as you get

older. It's a slow process that accelerates over time

and becomes much more visible after menopause.

But if you already don't have much bone there, your

aging is going to show up in your lower face, in your chin, around your

mouth much quicker. And there's nothing in your

lifestyle, no amount of calcium and physical activity

that you can do that will improve that. That's just one of those

cards that you've been dealt. Yeah. What about

asymmetry? I feel like facial asymmetry is an interesting

thing. So some people are very bothered by the fact

that they feel like like their lips, for example,

like one side's fuller, one side's smaller. And then, you know, when they go

and actually see their photos that we do, they realize, oh, one

cheek's bigger, one cheek smaller, one eye's bigger, one eye's less, more

closed. And then they're like, oh my gosh. And

it seems to like everybody has some amount of facial

asymmetry. It would be weird if we were completely

mirror images. We would actually look bad.

Yeah, and we— it kind of alien. It's not normal,

right? If you haven't had the chance to Google that,

Google symmetrical photos of like, um, they've done it

for Britney Spears, other stars that we deem very

attractive people. I think there's one of Halle Berry as well. And

when you see how they look so symmetrical, they just— they look eerie. They

don't look quite right. Weird. Really weird. And I feel

like it's exacerbated once we get into mid,

mid-age, because as we start to have more bone reabsorption and the

fat pads shrink, then that those asymmetries become even

more noticeable. So sometimes they do. People will say, oh my God,

all of a sudden I'm, I'm not even when you're sort of like,

show me a picture of when you were 20 and you can see it, but

they have never seen it. Yeah. Yeah. So I think

asymmetries can become much more prominent. The hollows more hollow.

And I think that's where the fat pad shrinking

makes a big difference too. Because then you're seeing what was the. Bone,

um, that you may not have seen before. Um,

yeah. One of the other things that— oh, go ahead.

Oh no, go ahead. That's it. Muscle laxity is

something that we've touched on previously as well too. I don't think we

talked about it. Do you do face yoga? Yeah, like

we will talk about it. Like it's—

I don't know how many— everyone's talking about weightlifting these days and I know it's

good for you, right? Just enjoy it. So I'm going to stick to my Pilates.

But your muscles will get weaker with time. Yes.

And with that, they won't work as well.

And that applies to your face. We have so many muscles in our face that

are responsible for facial expression, and

some of them become much more lax

and don't have the ability to

lift as they used to. And some become

really strong. Yeah. As I flex the lower

platysma bands, the ones that pull everything down get

intensely strong. Yeah. And that's something that can be quite genetic

too. So I think you and I have talked about, Amanda, both our

families having this. So in my family, a lot of the women, you'll have

that like turkey neck. Um, and

I'm a pelican. Yeah, the women in my family are all quite

petite, but in their photos they'll look like they're overweight just because

of that like muscle that is so strong. And I know, Harpreet, I don't know

how much you've been putting into my neck and how often we do it. It's

just a very— it's just never enough, right? It's never enough.

Seriously, most muscles are strong,

but you. Don'T want to get too much in there and, you know, then their

head falls over. I'm just kidding. No, no, there, there—

yes, there's a There's a proper dose,

but you're— yeah, you're absolutely right. So all of the muscles

that pull our face down seem to become more— become

stronger for various reasons. And then the muscles that

tend to lift have a harder job of lifting our

cheeks up. Right. And there are some treatments that sort

of zero in on that. Emsculpt is one of them. They have

Emphase for the face that sort of targets that.

I think the data that's— we're still understanding the role of that

completely, but definitely muscle loss is a marker of

aging for sure. Then there's, you know,

thinking about photos, you know,

I, when I was back in my day,

when we didn't have a phone, when we didn't have a camera on us

all the time, at all times. Yeah, we weren't

taking pictures daily and at every event and of our

food and all of these things. Right.

I think photos, lighting, you know,

it can really amplify the distress, you know,

like heaven forbid my front camera turns on when I'm, you know,

we've all had that happen where you get that angle where you're thinking, oh

my God. I look like Jack the Pug. Yeah. I mean, even

the availability of reflective surfaces,

right? Like mirrors, right? They weren't that

common 50, 70 years ago. Think about that,

right? We just didn't see ourselves as often, but now

through Zoom or through, you know, photos or whatever,

we just see ourselves all the time. I actually had a gal

in consult this week say that she was going to just drape all the

mirrors in her house. She's like, maybe that's what I need to do. Like, you

know, just put scarves over all of the mirrors. I'm like,

it's an option. Yeah. I don't know, but you know what?

We, it's, um, aging

is just, it's a, uh, I don't know how to say this, but

it's a continuous thing, right? It's going to move on. Time moves

on. We can't stop that completely. And, you know,

um, Uh, you know, Catherine O'Hara and that, uh, what was that show

that she was in? Uh, Schitt's

Creek, right? Do you remember that time where she said, take lots of photos of

yourself? Like your photos of yourself when you're young?

Yeah, true. I mean, at every age, I should take photos of myself now

because when I'm 80, right? So I think we do kind

of have to learn to appreciate where we're at and

appreciate what we do have. And at the same

time, like today's episode's really about understanding, right?

Because we don't know why we see these changes, but

there's, we still have lots of good stuff, right? Gotta

remember that. There's a few people actually, there's someone who works in our

clinic who for her aging journey, her big thing has been,

she's very slim and always feels like she's,

getting— looking gaunt. Um, and the other day

I feel like I look like a cancer patient, and she's not sick, she's just

the way she's really, really active. And some people that

can happen. So she's someone who has these like beautiful cheekbones,

right? But below her cheekbones doesn't have much fat. So

like 20s and 30s, you know, everyone's envy. Then you get into the

40s, that, that fat underneath your

cheekbone just keeps going and going, and that hollowness

made her look ill. And we did a treatment on

her recently, and when she looked and started crying, she's like,

I don't look sick anymore. Oh, that's lovely.

And it's, it's, that's very

individual, whereas other people, they have a lot of fullness in their cheeks and that,

that would never happen to them. Yeah, yeah, exactly. Yeah, I'm like,

oh, Everyone is different. I don't have any fullness here.

You've lost some volume in your cheeks below your cheekbone, but the

way your bone sits and your fat pads sit, you don't have that

sickly appearance that. Um, I just get

nice jowls. Thanks. Thanks to my genetic profile.

And, and it's, it's, yeah, I don't know.

It's, it's, it, it definitely hits that identity. Firmly.

Um. I start to see more of

my grandmother in my face, which

I loved my grandmother. She raised me, but I

don't know that I'm ready to look quite like that.

Yeah. And then I think, oh, I'm just being vain, but

it definitely can be jarring

when it starts to happen. But it kind of happens to all of us.

Yeah. So we talked a little bit about like genetic sort of

predispositions, but let's talk about something that's universal. I'm

going to just kind of go over for people or listeners, like

what is— what does happen holistically to your face?

And, you know, for one person it's going to be the skin is going to

be a weak spot. For another, it's going to be those neck

depressors. For another, it's going to be a weak chin. For another,

it might be that they're not very robust in the

face or have fat in their face to start with. But globally, this

is what happens. You start to lose collagen in your skin,

right? So in your 20s, you're going to lose about 1% per year, and

it just keeps going. So that elasticity and snapback starts to

decline. And then depending on your lifestyle too, you're going to

have dyspigmentation or sort of dullness of the skin

start to show up. And UV damage can also show up

as enlarging of— enlarging the pores. And

then a watchiness to the skin, and you can also start to develop

some creepiness as well. So those start— things start

to happen. And then in your 40s, sort

of late 30s, you start to see some

fat resorption. So a lot of people in their 20s will have

chubby cheeks and not like that sort of adolescent look. By

their 30s and sort of mid-40s, they have a more sculpted

look. And I would say women look really good in their early

40s, many of them, right? They're like They look good.

They're holding their own. So, but they've got a bit of a sculpted look.

And then the fat pads start to resorb beyond what looks good and

you start to get hollowing underneath the eyes. You might get

some hollowing in the temples, especially our runners. We start to see

that they tend to lose fat interestingly in their temples.

Just another reason not to run. Yeah. And that sort of

up and down bouncing, repetitive sort of pulling on

the skin is not good for it either. I'll put that out there. But if

it's good for your headspace. You can keep doing it. Yes, absolutely.

We'll give you some tools to reverse the running, the positive effects of the

running. Yeah. No shame to runners out there. I'm just not going to do it.

But I think you're awesome. Go, go, go. Yeah.

Yeah. So you start to see that volume loss, then you start to see changes

periorally, right? So you get these textural changes around your upper

lip where you get lip lines starting, the lips start to get

slimmer and slimmer, the chin starts to absorb. And

the midface starts to sort of fall into the face,

right? So that's what we start to see. Then when you marry that with

that continuing collagen loss, you start to

see more jowling and sort of hanging of the skin sort of below the

jawline. So, so

that, that is sort of encapsulates what people can

expect to experience. Of course, we have tools and

depending on your genetics, 1 or 2 or 3 of those things is going to

be something that ages you a little bit a little bit more quickly, and it's

going to be the thing that we might target first to keep you looking

like yourself. So that was a

really good recap. Yeah, thanks. And

then just to finish, as your bone shrinks, your skin doesn't, so you're gonna get

those folds and that sagging. Totally.

You're so right in saying what we target first will

depend on your genetics and your anatomy, um, because

oftentimes we can get a sense of what's going to start to show

up first and that the order in which we discuss treatments may

change on the person. And I would add to that what bothers

the person the most. Yes. Yeah. Yeah. I had one

recently and we didn't end up doing any treatment,

but this person came in with the expectation of getting a

Botox treatment, but when she went through what really bothered

her and we looked at photos, she actually didn't need any Botox. She's someone

who had a lot of volume loss in her big midface

hollowness and was concerned about, you know, just tired eyes and

a bit of heaviness between kind of the tip, the sides of the nose

and the corners of the mouth. And she actually had

some expressive lines, but not really any lines at rest. And it's really— it was

really more volume depletion. And I could see as we were

talking, she was quite disappointed because she in her head thought, well, the

Botox is going to fix the issue here. And, you know, with

understanding, she realized that that wasn't the treatment for her. And oftentimes when

those— like the when expect— treatment

expectations aren't met with what they were

hoping, it can take some time to understand what we

discussed. And we ended up deciding that we

would check in in a couple weeks and just see if there was more information

she wanted, because it can be overwhelming to take it all in. Like, you

described it so well, their heartbeat, but it's a lot when you're not doing this

every day to wrap. Your head around it all.

Yes, yes. But when you understand the difference between surface

changes and structural ones, between perception

and reality, it becomes much easier to make decisions

that actually serve you. So I think

if these conversations are helping you see things differently, we'd

love for you to subscribe. Yeah.

I hope you enjoyed today's episode. It was really about helping

you gain a bit of clarity as to what happens.

And realizing that this process is gonna happen,

but we have tools to slow it down,

even when we know that there are some periods in your life where that might

speed up. And our next episode, we're gonna talk about

the different approaches that we have and how,

you know, we can make these decisions and make

treatment plans without any urgency, without any pressure,

so that you are happy with the outcome and you don't

have regret from your treatment options.

And really, it's something that will sometimes require more

than one conversation, and that is okay.

Yes. Until next time. Take care.

Bye for now. Bye-bye.