I’ve always believed that how we care for ourselves is a form of communication. It’s how we tell our bodies that we’re paying attention.

For the past three months, I’ve been in a very intentional conversation with my skin. The person I have to thank for that is Dr. Amir Karam.

If you follow the world of aesthetic medicine, you likely already know Dr. Karam. He’s a board-certified facial plastic surgeon known for results that are beautifully natural. The kind that whisper, not shout. While he’s widely celebrated for his surgical artistry, especially his Vertical Restore facelift, what really drew me to his work is his philosophy around skinspan.

Skinspan is the idea that we can extend the health, resilience, and vitality of our skin over time. Not just how it looks today, but how well it functions for the long haul. For women navigating midlife, this matters more than we’ve been taught to believe.

As many of you know, perimenopause can feel like a plot twist for your skin. One day your routine works. The next, you’re staring in the mirror wondering who quietly rearranged the furniture.

According to Dr. Karam, this is not your imagination. As estrogen declines, collagen production can drop by as much as 30 percent in the first five years after menopause.

Which brings me to my own experiment.

For the last 90 days, I’ve committed to Dr. Karam’s KaramMD Trifecta skincare system. No hopping around. No impulse buys. Just consistency. The results have been undeniable. My skin feels stronger, the texture is smoother, and there’s a clarity and brightness I honestly had not seen in years.

(And while I’m not quite ready for my own before/after photoshoot, Dr. Karam graciously shared this image of one of his own Vertical Restore patients (both photos taken after surgery). The photo on the left was pre-Trifecta, and the photo on the right after 8 months of Trifecta use.) 🤯

The system is built around what Dr. Karam calls the 3 C’s: Commitment, Consistency, and Continuity. Simple. Sustainable. And, in my opinion, the real secret sauce for midlife skin.

But skincare is only part of the story.

To truly understand how our faces change as we age, we also have to understand what’s happening beneath the surface. I had the opportunity to sit down with Dr. Karam to go deeper on both, and I’m excited to share that conversation with you.

This is for every woman who is tired of the hype and ready for a grounded, honest conversation about what it actually takes to look and feel your best in midlife.

Dr. Karam, many women in their midlife notice changes like sagging skin, volume loss, and texture shifts during perimenopause. Can you explain how hormonal changes during this phase impact skin aging, and what women can realistically expect?

“Perimenopause is one of the most pivotal transitions in a woman’s skin life. As estrogen declines, collagen production drops sharply. This is when women commonly notice increased laxity, thinning skin, more fine lines, and loss of facial fullness. These changes are normal and biological. They are not a sign that someone is doing something wrong.”

What’s the most important shift women should make in their skincare philosophy during this time?

“The key is early recognition. You can’t rely on your skin’s old reserves anymore. This is the moment to shift toward intentional, consistent, clinically effective skincare. The good news is that with the right approach, women can maintain healthy, youthful-looking skin well into later decades. Hormonal changes make aging more visible, but they don’t make it inevitable.”

You talk about skinspan, not just lifespan. What does that mean to you?

“I love the term skinspan because it mirrors what we talk about in longevity. It’s not just about living longer. It’s about living better. Skin is the same. The goal is to preserve the quality of your skin for as long as possible.

To extend your skinspan, focus on the fundamentals—the things that actually move the needle: daily sun protection, consistent use of proven actives and lifestyle changes such as anti-inflammatory nutrition and restorative sleep.

Clinically, the biggest differentiator I see though is not which products women use, but whether they follow the 3 C’s:

Why is consistency more important than intensity?

“Gentle, effective formulations used consistently will outperform aggressive approaches used sporadically every time. Stopping and starting disrupts the cellular process. What you do daily matters far more than what you do occasionally.”

When it comes to sagging and laxity, can skincare and non-surgical treatments really make a difference?

“It’s crucial to understand the difference between skin problems and shape problems. They are two separate aging processes. Non-surgical treatments like lasers, microneedling, and peels improve skin quality only. They do not lift deeper structures or correct true laxity. Once laxity becomes significant, no non-surgical treatment can replace what surgery accomplishes. They serve different purposes, and both have a place in aging well.”

When should women start thinking about surgery? What are the signs?

“There are three clear signs that surgery may be the more effective path:

A good rule of thumb: If the issue is sagging, heaviness, or loss of contour—it’s structural, and surgery is the right solution. If it’s discoloration or fine texture changes—skincare and resurfacing can help.”

Your Vertical Restore facelift is known for natural results. How is it different?

“The Vertical Restore facelift lifts the entire facial fascia vertically, including the brow, midface, jawline, and neck, in a unified and anatomically natural direction. It restores youthful shape at the root. The goal is not to create a new face, but to restore you to yourself.”

How do you help patients decide on the right path?

“My approach is transparent. I evaluate anatomy, goals, readiness for downtime, age and hormonal stage. Women in perimenopause often benefit from a balanced approach: foundational skincare + selective nonsurgical treatments + surgical intervention when shape changes become apparent.

The key is honesty and expectation setting. I will never tell a patient a nonsurgical option can replace a facelift—because it can’t. But nonsurgical tools absolutely complement surgery when used correctly.”

How does skincare support surgical outcomes?

“Healthy skin is half of a youthful face. I can restore shape surgically, but I cannot surgically improve skin quality. When skin is healthy before surgery, it heals better and scars better. After surgery, results last longer when skin continues producing collagen and is protected from inflammation and sun damage.

This is why I strongly encourage every surgical patient to be on a science-backed routine like the KaramMD Trifecta. Surgery restores shape, but skincare preserves quality—and that combination is what creates the most natural, beautiful, long-lasting results.”

What’s your advice for women overwhelmed by marketing claims?

“Trust biology, not marketing. If something claims to lift like a facelift, it’s not honest. Stick to proven ingredients like retinoids, vitamin C, and peptides. Simplicity wins. You don’t need a 10-step routine. You need the right actives used consistently. Understanding how aging actually works gives women their power back.”

My conversation with Dr. Karam reinforced that aging well is not about choosing skincare or surgery. It’s about understanding how they work together over time.

For those curious about my experience with the KaramMD Trifecta, I can genuinely say it has been a game-changer for my skin quality. It embodies the 3 C’s in a simple, elegant system that I can actually maintain.

And on that note, Dr. Karam is generously extending a discount to this In the Saddle community! If you were thinking about starting a new skincare routine in 2026, this is your chance. 👇

Now through the end of the year, you can use code INTHESADDLE20 for 20% off at KaramMDskin.com 🤌

I implore you to finally let go of the idea that your best skin is behind you. With an honest, skinspan informed approach, it may very well be right around the corner. 😄

Challenging long-held fears, new research found that for women with BRCA1/2 mutation (previvors, meaning they had undergone risk reducing surgery), MHT was actually associated with a lower risk of breast cancer. Even more striking, there were zero cases of breast cancer among women being treated with the combination of conjugated estrogen and bazedoxifene (Duavee), opening the door for safer symptom management. (News-Medical.net)

Get ready for a new name in the world of weight loss drugs: retatrutide. In a new Phase 3 trial, Lilly's "triple agonist" delivered up to 71 lbs of weight loss on average, but the real surprise was its impact on osteoarthritis, with some participants becoming completely pain-free. This dual-action benefit could be a game-changer for those struggling with both obesity and joint pain. (PR Newswire)

We know the shingles vaccine is crucial for adults over 50, but new research suggests it might do more than prevent a painful rash—it could also slow dementia progression. A large study found that in adults already living with dementia, the vaccine was linked to a nearly 30% lower risk of dying from the disease, suggesting it has therapeutic as well as preventive benefits for brain health. (CNN)

This week’s group chat edit, I’m highlighting 3 products on my stocking stuffer list for the holidays this season! 🤶🎄

🥇: Pique Sun Goddess Matcha

I love an afternoon pick me up, and I have been opting for matcha more and more! With EGCG to firm and brighten skin from within, and L-theanine to promote calm and balance, this 100% organic, ceremonial-grade matcha is a lovely way to curb those 3pm sugar and hunger cravings.

🥈: Goop Sex Oil

For my patients who have a hard time getting out of their heads for intimacy, I love recommending this product. Discrete on a nightstand or in a bathroom, the oil feels—and smells—so good. And it’s formulated to sink into the skin, moisturize, and provide just the right amount of slip without dripping onto sheets.

🥉: Boom Boom Nasal Sticks

Recovering Afrin addicts, take note. Winter around here comes with chronic nasal congestion, and I love throwing these pocket-sized sticks in a purse, a school backpack or on my desk before any call where I want to sound less like a mouth breather .👃