At the party given to show Bryan Adams's photographs of musicians and singers at the Roemischer Hof in Berlin, the guests walked along a brilliantly illuminated red carpet lined by at least 40 press photographers armed with flashlights. One of the most striking feature of the German film, TV and media stars attending was the smooth skins and white teeth of the men and women. Barely a wrinkle or pigmented patch, other than my own, was visible on the stars' waxy smooth skin.

Skin becomes thinner with age, drier, less elastic and disfigured by a variety of pigmented and brown patches. The more the person has been exposed to the sun, the thinner the skin will become and the more likely that it may ultimately be as dried out and cracked as a parched river bed in an African drought.

In the next 15 years a third of the population will be over 55 and, as a result, the already booming market for products that are designed to disguise ageing will inevitably multiply. Already there is a huge increase in demand for aesthetic plastic surgery - cosmetic surgery to help to give an impression of youth.

Women are about ten times as likely as men to want aesthetic plastic surgery, but men are catching up. Last year 36 per cent more men wanted a nose job than in 2006, 18 per cent more opted for liposuction, 10 per cent more had their eyelids lifted and bags removed, and 21 per cent more men wanted a facelift.

Pigmented patches on the face are often as unsightly and ageing as the brown patches that a leaking pipe makes on a white ceiling. It is always important for patients to see their doctors first so that they can exclude any serious cause for the pigmentation, including a melanoma or lesser forms of skin cancer.

Once reassured that the blotches and patches are not sinister, it is reasonable for people to treat themselves before resorting to dermatologists or surgeons. In the past five years there has been a fourfold increase in the sale of moisturisers, sunscreens, anti-ageing lotions and other products. Procter & Gamble has catered for this market with a new line under the Olay name. Its team have been working on variations in the distribution of skin pigment (melanin), hyperpigmentation and other skin blemishes and blotches. The trials look promising.

Dr Christopher Rowland Payne, a dermatologist at the London Clinic, recently said that, with an experienced doctor, removing flat brown pigmented patches is relatively straightforward if liquid nitrogen is used briefly to freeze the skin with a light touch on three occasions. If the freezing is too hard it may produce post-inflammatory discolouration. Special care must be taken for people with darker skins as they are more likely to develop post- inflammatory pigmentation if the doctor is heavy handed. Brown patches often flourish on the natural shelves of the face, such as the forehead, brows and cheekbones.

The patches that are raised, and can be felt, are often seborrhoeic warts. These may be better removed by being scooped out rather than any other way. Rings under the eyes are disfiguring and a worry. In children, and sometimes in adults, they may denote no more than tiredness. In those with an asthmatic tendency the skin may be finer and dark shadows more likely. Rubbing the eyes at any age may make it worse and, as the skin of those with asthma/ eczema itches more readily, pigmentation is easily made worse. The skin may then acquire an earthen, lacklustre hue. In older people the skin is also thinner so that underlying darker tissue shows through. Sometimes in the elderly the orbital fat pushes forward and the fat beneath the cheek may drop downwards. Fillers may be an answer.

The demand for minor cosmetic procedures such as laser therapy, botulinum toxin injections (botox), chemical peels and microdermabrasion is also steadily increasing at an even faster rate than requests for aesthetic plastic surgery. However, the initial treatment for hyperpigmentation or blemishes should be skin protection and care.

Q&A: HERNIAS AND HONEYMOONS

A reader writes that he had heard recently that Wayne Rooney was going on his honeymoon, but has not yet had his hernia repaired. Is this safe?

The golden rule when treating a hernia is to have it repaired as soon as possible. If the hernia is straightforward it is not an emergency. But no one can predict when a complication such as strangulation of the hernia might occur. If this happens, and the hernia can't be pushed back, immediate surgery is necessary. A hernia is the protrusion of the peritoneum, the strong lining to the abdominal cavity that provides the sac that contains the abdominal contents, through a weakness in the layers of the abdominal wall. A lump can be felt under the skin. If the protrusion is nipped, (strangulated) by the rim of the weakness in the abdominal wall through which the hernia has appeared, gangrene may result.

Is Rooney taking a risk? Yes, but not a big one. He and his doctors will be well aware of the symptoms of strangulation and will have taken this into account. It is the small hernias that are most likely to strangulate. Playing football puts a great strain on the abdominal wall that reveals any weaknesses. Footballers can rejoice that hernia repair is now quicker. At the British Hernia Centre a local anaesthetic is used, a small incision is made over the hernial bulge, the protruding peritoneum is pushed back to where it belongs and a piece of inert and sterile mesh is placed over the gap in the abdominal wall defences. The mesh is held in place by the abdominal wall itself without stitching. The mesh becomes totally incorporated into the repaired wall that is stronger than ever. Footballers are usually back on the pitch in a fortnight.

The British Hernia Centre, Hendon: 020-8201 7000

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