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January 27, 2026
Dr Tim Pearce
As we age, we tend to get a mismatch between our appearance and our emotions. Many patients will sit in a consultation with an aesthetic clinician and explain that their primary concern is that their face does not match with how they feel emotionally.
This causes a challenge to their identity, and they may experience problems interacting with others who perceive their mood incorrectly due to the ageing effects on their face, and the impact this has on their expressions. They may claim that people always think they look depressed, grumpy, or angry, but they are in fact very happy in themselves, and have come to you for help.
In this blog, Dr Tim Pearce will explain why he thinks the most important desire for his aesthetic patients is that they look on the outside the way they feel on the inside; they want to look positive. He will share the ten locations on the face which play havoc with creating negative expressions as we age and explores how you can remove your patients’ negative aura.
Dr Tim will be discussing more medical aesthetic training tips as part of his upcoming webinar series, so if you’re looking to increase your CPD-certified learning and want to learn more skills to make you a better practitioner, then step one is to register for the free webinars by Dr Tim.
Does ageing make the face look more negative?
As aesthetic clinicians, this is where we can start to understand that you cannot design a medically justifiable treatment plan without taking your patient’s psychology into consideration. In doing so, you are deciding whether appearance is part of health, or not.
The face has two primary functions, firstly for mastication and the human requirement for nourishment, and secondly for communication, both verbally and through physical expression of emotions, which aids interaction with others. Ageing can distort the messages that we transmit non-verbally, affecting our relationship with those around us and our ability to collaborate effectively. Correcting the ageing effects on the face is not simply a vanity exercise.
The following ten points are identified as signs of ageing, but they also give individuals a negative aura. Isn’t it a shame that ageing does not make us all look happy, but in fact makes us look sad?
- Frown lines – This is a commonly treated complaint, with frowning having a known negative interpretation, patients do not want frown lines when their face is at rest.
- Descent of the lateral eyebrow – This manifestation with heaviness at the side of the eyebrows, and in combination with frowning, is associated with expressing a sense of concern. This happens more readily as we age because the brow naturally descends.
- Omega sign – This is a combination of the above which creates an Omega (Ω) shape in the forehead and is often associated with feelings of grief, sadness, or depression.
- Tear troughs – Tear troughs can make an individual look angry, as well as tired. This is easily noted when you tilt your own face forwards and downwards – which is an aggressive posture – this change in facial angle and lighting normally highlights the tear trough, so you can see how a prominent tear trough face on could be interpreted as aggression, but it is likely a depleted fat pad.
- Hypertonic inferomedial orbicularis oculi muscle – In this presentation, the eyes are slightly narrowing; this is also associated with aggression. However, it can be caused by loss of a fat pad at the lateral lid-cheek junction between the eye and the cheek. This can be restored through volumisation with dermal fillers.
- Naso-labial snarl – When the facial muscles pull up the naso-labial line, it casts a shadow that creates the appearance of a snarl, this can display a sense of disgust or anger on the face. This happens as volume is lost in the mid-face.
- Pursed lips – This is a common reaction or expression seen in children and is associated with anger, but with ageing the lips can become pursed as they lose volume and the hypertonic orbicularis oris muscle compounds the negative appearance.
- Down turned mouth – This is the classic upside-down smile that causes shadowing from the lines that form at the oral commissures, made worse by increased tone in the depressor anguli oris (DAO) muscle which pulls the sides downwards. Often interpreted as a look of grumpiness or sadness.
- Chin crease – In a sulking or petulant child, there is a tendency to rotate the chin upwards and the lip down, this creates a crease along the top of the chin. In adults, as we age, this can become a permanent line which then gives off the same negative expression of being in a sulk.
- Jowl – Heaviness in the jowl and mid-face can also be associated with the appearance of sulking.
Making happy patients with filler injections
People unconsciously make the wrong assessment of others due to ageing. The job of a healthcare practitioner practising medical aesthetics is to help make your patients healthy and feel better on the inside, improving their confidence so they can engage more confidently with others. This can be achieved by improving their appearance to soften negatives expressions. The outside of your patient will then match their inside.
If you want to see some great cases studies which demonstrate the real transformations you can make which remove a negative aura from a patient’s face, then check out Dr Tim on a recent episode of the Aesthetic Mastery Show.
Here’s a sneak peek at one of them. This patient received no botulinum toxin treatment and was only treated with volumising dermal fillers to the forehead, glabellar crease, lateral frontal fat pad, temples, and tear troughs. What a dramatic change this shows, turning a negative appearance into a much happier-looking patient.
Check out the video on 10 injection points to remove patients’ negative aura for the full treatment plan and a second case study.
Aesthetics Mastery Show
Catch up with detailed injection techniques and his product choices for treating older lips by watching Dr Tim Pearce discussing the restoration of older lips on the Aesthetic Mastery Show.
Further resources
If you want to increase your confidence in delivering safe and effective dermal filler treatments, you might consider Dr Tim Pearce’s eLearning courses:
Are you still anxious about delivering cosmetic injectables safely?
If you want to learn more about mastering medical aesthetic treatments and complications or conquering the anxiety of where to place your needle, then register for the next Dr Tim webinar.
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Dr Tim Pearce eLearning
Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.
Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.
Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.
