Yes, you can be too old for Botox in your 40s! These are the signs tweakments won't work and you need a facelift

Being told 'you're better off getting surgery' is definitely not what you want to hear when, fed up with the signs of facial sag that appear in midlife, you've finally plucked up the courage to dabble in some of those minimally invasive 'tweakments'. Tweakments that are now so popular that the UK market is worth £3.6 billion annually.

The use of injectables (such as Botox and filler) has increased 7000 per cent in two decades. And with ever more 'miraculous' non-surgical cosmetic solutions hitting the market you'd be forgiven for thinking that there is now a scalpel-free treatment to prevent and correct every aesthetic niggle you might have. 

You may even, not unreasonably, think this class of procedure will do away with the 'need' for more traditional plastic surgery. Certainly, this was suggested widely in the early days of minimally invasive treatments. Alas, this isn't always the case and for some people surgery - whether a face or eye-lift - will be the only effective solution.

Inge van Lotringen explains why sometimes 'tweakments' aren't enough, and to get the result you want you may have to go under the knife

It may be the reason why upper eyelid blepharoplasty is one of the most in-demand surgical treatments (Jennifer Coolidge, 62, Matt Damon, 53, and even Taylor Swift, 34 are rumoured to have had it done). And facelifts are having a moment too (Brad Pitt, 60, is said to have just had one) - described by US Elle recently as 'kind of great right now' and attracting patients in their 40's.

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The reality is, no matter how much you might love your tweakments, there comes a point when skin gets too lax, and its underlying supporting tissues (fat and bone) too withered, for scalpel-free tweaks (like cushioning fillers or high heat-induced skin-tautening) to make a demonstrable difference.

'Determining this requires an honest doctor's eye, but think very thin, dry, crepey skin that's lost its 'spring,' says surgeon and cosmetic physician Dr Apul Parikh. The age when this happens can vary a lot, but can be due to ageing, poor genetics, or lifestyle factors such as smoking or sudden weight loss. 

That's when a modern facelift, which works on the superficial as well as the deep tissue layers of the face or neck, is the only thing that can reposition and tighten all your 'moving parts' satisfactorily, restoring fresh-faced perkiness and volume all in one go.

'It's upsetting for people to hear, but preferable to wasting thousands on tweakments that won't work,'says Parikh.

Eyes tend to get beyond non-surgical help soonest. Plenty of people who've had toxin for years to give brows a lift, and so open tired-looking or hooded eyes (this, by the way, works for some, but not all – it depends on the strength of your forehead muscles) find the trick suddenly doesn't work anymore when they hit their mid forties to early fifties.

'Again, this happens when skin gets too lax,' says Parikh. Basically, the incremental toxin-induced muscle lift can no longer prop too-saggy lids up.

With 'lifting' heat-based treatments like plasma and radiofrequency microneedling showing signs of risking long-term damage to eye area skin, an upper lid blepharoplasty, which surgically removes a strip of skin from the lid surprisingly quickly (the procedure is half an hour and the downtime a week) seems the more sensible choice. 

'It has, by far, the most visible and predictable outcome,' says oculoplastic surgeon Dr Rachna Murthy. 'And it's the only safe option if you have a history of eye conditions like dry eye.'

For under-eyes, filler injections can 'successfully correct dark circles caused by hollowing and thin skin, but if there are fat bulges, loose skin, or permanent puffiness, lower lid surgery is the only effective and long-term solution,' says Murthy.

Tweakments cost between a few hundred and a few thousand pounds, but have to be repeated every few months or annually to maintain mostly quite subtle results. Surgery results last ten years or longer and can be far more evident. 

But they come with significant downtime, risks, and a price tag – an upper blepharoplasty costs roughly £7000 while a facelift is well upwards of £20,000. Given, though, that a decade of tweakments easily sets you back £30,000, surgery, while hugely expensive, can actually prove the more cost-effective option. 

A good facelift will also give a much more natural result than the weirdly-shaped and unnaturally taut faces associated with an endemic over-use of fillers and toxin.

So when your cosmetic doctor is honest enough to tell you that the tweakments ship has sailed, don't be offended - instead be grateful they have integrity and won't sell you a pup.

Race you to it!

Dyson 'disrupted' the styling tool market with its popular (and very expensive) take on the hairdryer, and is set to do the same with its styling products, The Chitosan Formulations Post-Style Serum, £49 (dyson.co.uk), boasts a mushroom-derived molecule that holds your style without crunchiness or weight, while controlling frizz and repairing damage. 

My icon of the week: Celine Dion

Music legend Celine Dion performs on the Eiffel Tower during the opening ceremony of the Paris 2024 Olympic Games

The singer likes her make up as dramatic as her music. At the Olympics her look was Charlotte Tilbury: the diva's eyes were turned into beacons with Luxury Palette in The Queen of Glow and Hollywood Exagger-Eyes Liner Duo, while lips and cheeks were peachy with Matte Blush Beauty Wand in Pillow Talk and K.I.S.S.I.N.G topped with Lipstick in Nude Kate.

Cosmetic Craving

Jules Von Hep has made it his mission in life to help women (and men) see the beauty in themselves and stop criticising their physique.

A hugely in-demand tanning expert and 'confidence cheerleader', he's extended his self-tanning range Isle of Paradise with a selection of body products that simply radiate joy and will bring a glow to your limbs. Scented and packaged so as 'to release happy hormones', the Brilliantly Bright Body Polish, has skincare ingredients vitamin C, niacinamide and hyaluronic acid and, at £18 (boots.com), is a fraction of the price of comparable body boosters.