The Power To Tweak (...or Not!)

Dr. Kumar on aging boldly, fixing what bugs you, and skipping the rest!

I have no desire to look 20. Or 30. Or even 40, if I’m being honest. What I do want is the freedom to tweak what I want (or not), fix what actually bothers me (or not), and celebrate the rest without apology. That’s what midlife is about: choice, not chasing.

So I sat down with Dr. Anisha Kumar, a facial plastic and reconstructive surgeon, and a straight-shooting real girl when it comes to aging. She doesn’t flinch when we bring up the questions women wonder about but often don’t ask out loud. Together, we dug into what’s worth paying attention to in your 40s, 50s, and beyond, what you can skip, and how to own your face without losing yourself in the process.

---

1. Let’s start with you. Tell us a little about your philosophy. What guides you when you’re working with midlife women who want to look and feel their best?

Dr. Kumar: My approach starts with putting the mirror in my patient’s hands and asking, “What’s bothering YOU?” You know your face better than anyone, and understanding your specific concerns is essential. Patients often turn this around and ask, “But what do YOU think I need?” - and I’m always happy to share my professional assessment. However, what I’ve learned over the years is that for you to truly love your results, we need to address what’s most important to you personally, not just what I observe from a clinical perspective.

2. For many of us, our 40s and 50s bring gravity doing its dirty work on the face and neck. What non-surgical routines or treatments do you recommend trying first before even thinking about surgery?

Dr. Kumar: Gravity certainly isn’t working in our favor, but we have a solid arsenal of science-backed options! I provide my patients with a complete range of treatments, from minimally invasive to more dramatic interventions. Here’s the medical reality: there’s always a trade-off. More extensive treatments typically create more dramatic, longer-lasting results.

Our evidence-based toolkit includes neurotoxin injections (Botox is just one brand name!), strategic filler injections, laser treatments, and a consistent, effective skincare routine. Everything I recommend must be backed by solid research because treatments need to deliver real results, not just follow trends.

The key to successful non-surgical treatments is consistency. These treatments can be highly effective, but they work best when tailored to your individual anatomy and specific facial concerns and maintained over time.

3. Menopause hormones and skin texture - how do they intersect, and what simple, smart steps can women take to keep their skin healthy and resilient?

Dr. Kumar: It’s essential to understand the science of what’s happening to your skin over the decades so we can all make informed decisions about skincare and treatments.

The reality is that we lose 1% of our total collagen every single year starting at age 25. This isn’t speculation - it’s well-documented biology. Here’s how we can address this strategically at different life stages.

In your late 20s and 30s, Vitamin A products (retinol or tretinoin) should be a cornerstone of your routine. The research strongly supports these ingredients - they stimulate collagen production and increase skin cell cycle turnover, essentially accelerating your skin’s natural renewal process.

In your 40s and 50s, continuing with nightly Vitamin A use remains important, but now we need to address structural changes occurring in your skin. The epidermis (top layer) loses its ordered structure and becomes thinner, while the dermis (deeper layer) loses its water-binding capacity. This results in rougher texture and the formation of fine lines. Adding hyaluronic acid serum for hydration and increasing moisturization becomes crucial during this phase.

In your 60s, the science shows further changes. Your skin produces fewer lipids, leading to increased dryness. Collagen and hyaluronic acid content continue declining, so your skin feels rougher while becoming more fragile. At this stage, prioritizing gentle, sensitive skincare routines with maximum moisturization is essential to support your skin barrier function.

4. For women considering surgery, what should they know about risks, recovery, and finding a surgeon who respects their individuality - not just trends or “one-size-fits-all” faces?

Dr. Kumar: Before considering surgery, it’s essential that all your questions are answered thoroughly by your surgeon. I’m currently writing a comprehensive post about the 10 critical questions every patient should ask their surgeon-- knowledge truly empowers better decision-making. Stay tuned!

Finding the right surgeon requires careful consideration. You need someone whose philosophy aligns with yours and whose approach feels comfortable to you, beyond just impressive before-and-after photos. Getting consultations or second opinions with other providers is always a smart option. Don’t settle until you feel genuinely comfortable and ready to proceed!

What’s often underestimated is the importance of the surgeon-patient relationship. This partnership doesn’t end when you leave the operating room. Surgery outcomes and healing can be unpredictable, and having a surgeon who will work with you as a team to address any issues that arise after surgery is invaluable.

5. What small, underrated tweaks or treatments do you think pack the biggest punch - the things women often overlook but can make us feel instantly better?

Dr. Kumar: The data consistently shows that targeted, smaller interventions often deliver the most significant impact. Results vary based on individual anatomy, but many patients experience remarkable rejuvenation from neurotoxin injections like Botox and strategically placed filler injections. These treatments can help you look like a refreshed version of yourself, and results fully develop within two weeks - no extended waiting periods.

The most underrated treatment, however, is a proper skincare routine backed by legitimate research studies. While it may not seem as exciting as injectables, think of evidence-based skincare as a long-term investment in your skin health. You won’t see dramatic overnight changes, but a consistent regimen using proven ingredients will deliver measurable improvements over time. The scientific literature strongly supports this approach - consistency with research-backed products produces real results.

6. A lot of us are balancing budget, health concerns, and time. How do you advise women to prioritize treatments or maintenance without getting overwhelmed (or oversold)?

Dr. Kumar: My clinical approach involves having patients rank order their concerns and issues from most to least bothersome. This prioritization method cuts through the noise and helps focus your resources where they’ll make the biggest impact for your specific goals. I can then provide evidence-based guidance on which treatments or maintenance protocols will most effectively address your top priorities.

Unfortunately, the beauty industry is saturated with misinformation and aggressive marketing tactics. This is one of the main reasons I started “Real Talk with Your Plastics BFF” - to provide evidence-based recommendations and make legitimate medical knowledge accessible to everyone who needs it!

Here’s a fundamental principle I share with all my patients: price does not correlate with effectiveness. The research doesn’t support cost as an indicator of quality or results. For example, investing in a high-quality medical-grade sunscreen will be significantly more effective for anti-aging than purchasing expensive designer makeup with minimal SPF. The scientific literature consistently shows that prevention is more effective than correction.

Bonus Question (because we’re Real Girls): What’s one myth about plastic surgery or aging you wish we’d all stop believing - and what’s the truth you’d replace it with?

Dr. Kumar: The most persistent myth is that any treatment can permanently stop the aging process.

Here’s the medical reality: we can temporarily “turn back the clock” with various treatments and procedures, but biological aging continues. This means that while rejuvenation treatments can deliver excellent, long-lasting results, they are not permanent solutions. Understanding this fundamental principle is crucial for maintaining realistic expectations and making informed decisions about your aesthetic investments.

---

At the end of the day, it’s not about turning back the clock. It’s about owning our damn timeline - and choosing how we want to show up in it.

So, Real Girls: what’s your philosophy? Tweak, embrace as-is, or a little bit of both? Drop your take in the comments or DM me at realgirlsguide55.com.

You can find Dr. Kumar on at www.dranishakumar.com, on Instagram at @dranishakumar, and on her Substack where she writes as Real Talk With Your Plastics BFF. Send her a DM and let her know what other questions you have and what topics she should teach us about next!

We’ve earned every wrinkle. Might as well make more laugh lines together.
Let’s connect: Instagram | Facebook | LinkedIn