I spent years in this profession thinking about ageing as a problem to be solved. Not consciously, and not in those terms — but in practice, that was the frame. Every patient who came in presented a version of the ageing problem, and my role was to identify the problem’s components and address them with appropriate tools. That is a reasonable clinical model.
The shift came gradually. It had something to do with turning 50, something to do with training for Hyrox at an age when several people I knew were beginning to wind down their physical ambitions, and something to do with a Japanese concept that I’d read about and largely dismissed in my 30s and then returned to in my 40s with different eyes.
The concept is wabi-sabi. Not as an aesthetic category — the appreciation of imperfection in ceramics and gardens — but as a philosophy of time.
What wabi-sabi actually means, biologically
Wabi-sabi is the Japanese recognition that impermanence and incompleteness are intrinsic to the nature of things — and that this is not a deficiency but the very quality that generates beauty and meaning.
Applied to ageing, the shift it produces is this: stopping the evaluation of the older face and body as a degraded version of the younger one.
This is not a small thing. The entire anti-ageing industry — including my own practice, partly — operates on the implicit premise that the younger state is the reference, and that deviation from it is loss. The language reinforces this: restoration, rejuvenation, turning back the clock. Every treatment is measured by how closely it returns the patient to an earlier version.
What wabi-sabi offers is a different reference point: not the face at 30, but the face at its present stage as a complete, appropriate, and interesting thing in itself. The lines that are there because of decades of expression. The structural changes that reflect the physiology of a specific life lived in a specific body.
I don’t think this means abandoning clinical medicine or deciding that ageing is entirely natural and should be left alone. I haven’t adopted that position. I still treat. I still believe in the tools available to support structural health as people age. But the framework has changed: I am no longer trying to restore patients to a previous version. I am trying to help them be the most functional, healthy version of their current biological stage.
The clinical consequence of this shift
The practical consequence in practice is that I have become much more interested in physiology than in appearance. If a patient comes in at 55 wanting to look like she did at 35, the honest clinical answer is that this is not achievable, and pursuing it produces the overfilled, frozen, or structurally incongruent results I see in patients who have been treated by practitioners unwilling to say so.
The useful clinical answer is: your face at 55 can be the best version of your face at 55. Structurally supported. Hormonally appropriate. Properly protected from further sun damage. Rested. Vitally connected to the body it belongs to.
This is a different goal. It produces different results. And in my experience, it produces patients who are more satisfied with their outcomes — because the goal was achievable and the pursuit of it was reasonable.
What I’ve observed about how Asian women relate to ageing
This conversation is specifically inflected in Asian cultural contexts, and it’s worth naming directly.
In many East and Southeast Asian families, ageing is privately feared and publicly minimised. The conversation about looking older happens in whispers. Anti-ageing procedures are pursued covertly — the cultural stigma around “getting work done” exists alongside the universal desire to look well. Women manage this contradiction by not quite admitting to either the fear or the treatment.
What is also present — more than in Western cultural conversations about ageing — is a deep tradition of respect for elders and the understanding that age carries wisdom and authority. The elder woman in Chinese, Malay, and Indian cultural contexts has a social standing that is not available to younger women. This is not always acknowledged as a benefit; the emphasis on youth for women’s attractiveness overwhelms it in practice. But the cultural resource is there.
The mental shift I’m describing draws on both elements: taking the anti-ageing measures that genuinely support health and function, while releasing the goal of appearing young in favour of the goal of appearing well — which is different.
The practical expression
I’ve stopped framing consultations as age reversal. I frame them as structural health optimisation for this body, at this stage.
The questions I now ask at the start of a consultation: How do you feel in your body? What do you want to be able to do that you’re finding harder? What would “looking well” actually mean to you?
These are different questions from “what bothers you most about your appearance?” They produce different answers and different treatment plans.
I also invest in my own ongoing physical capacity in a way I didn’t in my 30s — not despite ageing, but because of it. The Hyrox training. The BJJ. The strength work. These are not ways of fighting ageing. They are ways of inhabiting my age as fully as possible. The body I’m building at 51 is not the body I had at 30. It’s better suited to the life I’m actually living — more capable in specific ways, more deliberately developed, less casually assumed.
What neuroscience says about this kind of reframing
The way you think about ageing measurably affects how you age. This is not wishful thinking — it is a documented phenomenon.
Becca Levy’s work at Yale has repeatedly demonstrated that individuals with more positive self-perceptions of ageing live an average of 7.5 years longer than those with negative self-perceptions, after controlling for health status, socioeconomic factors, and functional health [1]. The mechanism involves psychological stress, health behaviours, physiological markers including cardiovascular biomarkers, and the self-fulfilling quality of believing that decline is inevitable.
The belief that older age brings diminishment produces the physiological conditions that accelerate diminishment. The belief that it brings different capacities and possibilities produces a different biological environment.
This is why the mental shift is not self-help. It is medicine.
The older I get, the more I find that the patients who age most interestingly are not the ones who have had the most treatments. They are the ones who have found the most to be interested in.
There’s something in that.
References
[1] Levy, B. R., et al. (2002). Longevity increased by positive self-perceptions of aging. Journal of Personality and Social Psychology, 83(2), 261–270. https://doi.org/10.1037/0022-3514.83.2.261 [VERIFY — confirm before publishing]
[2] Westerhof, G. J., & Barrett, A. E. (2005). Age identity and subjective well-being: A comparison of the United States and Germany. The Journals of Gerontology: Series B, 60(3), S129–S136. [VERIFY — confirm before publishing]
[3] Kinsella, K., & Wan, H. (2009). An Aging World: 2008. U.S. Census Bureau, International Population Reports, P95/09-1. [VERIFY — confirm before publishing]