Middle-aged women are prone to skin aging manifestations such as wrinkles, laxity and hyperpigmentation due to factors including physiological function decline and hormone level fluctuation. Such problems often induce or exacerbate appearance anxiety, which in turn affects physical and mental health as well as quality of life. This paper systematically sorts out the multi-dimensional physiological, social and psychological causes of appearance anxiety caused by skin aging in middle-aged women. Combined with the latest clinical research and practical experience, comprehensive clinical countermeasures are proposed from the aspects of dermatological intervention, psychological counseling, lifestyle adjustment and construction of social support system, aiming at providing diagnostic and treatment ideas for clinicians, helping to middle-aged women alleviate appearance anxiety and achieve dual physical and mental health.