When is Too Early to Start Cosmetic Procedures?

“Is it too early?” is a question I am commonly asked when someone is considering having a procedure to enhance their appearance, such as starting to use a neuromodulator like Botox or having a filler injection or a laser treatment.   My feeling is that there is rarely a time that is “too-early”.  One of my mentors, the esteemed Dr. Ken Arndt, and I wrote about this in a Viewpoint that was published a couple years ago in the journal JAMA Dermatology.

What we discussed was that the etched-in forehead lines, frown lines, and crow’s feet that emerge over time are caused by the repeated contraction of the muscles involved with facial expression.  If these actions are minimized by relaxing the muscles involved, the lines on the face that are interpreted as aging, tiredness, or anger simply do not form.  It is easier to prevent the lines when they are just starting to develop than to attempt to reverse them once they are well established.  So, initiating regular treatment with a neuromodulator early in life, such as in one’s 20’s or 30’s, will have a dramatic effect on the appearance of the face as seen in their 40’s or 50’s.  There will be few if any lines and wrinkles present.  This concept was nicely illustrated by a comparison study between identical 38-year-old twin sisters, one of whom had received botulinum toxin injections regularly in the forehead and between the eyebrows beginning at age 25 and one of whom had received botulinum toxin injections in the same areas but only twice over 7 years.  While forehead and frown lines in the minimally treated twin were visible at rest, they were absent in the regularly treated twin even 4 months after her last treatment. This observation suggests that regular treatment with a neuromodulator like Botox beginning in young adulthood before static lines have become well established can prevent the development of etched-in lines.

The same applies to the effect of injecting soft tissue augmentation fillers into the skin.  Placement of these substances below folds and wrinkles on the face not only smooths the skin and improves facial contour, but studies show that some of the substances used may actually stimulate biologic processes that induce new connective tissue which will last much longer than the filler that was injected.  This supports what we observe clinically- the more a filler is used, the less often it is needed.

The same is true of intermittent exposure to energy sources such as non-ablative fractional lasers.  These treatments not only diminish sun induced freckling and fine lines, but they too stimulate changes in the underlying skin, in particular, the formation of new collagen. Analysis of skin under the microscope after nonablative fractional resurfacing has demonstrated induction of wound healing and replacement of the thermally damaged collagen with new collagen within 3 months. In addition, nonablative fractional resurfacing may also diminish actinic keratoses, which are sun induced precancers.

So, there is rarely a time that is “too early”.  In addition to sun protection and the use of retinoid creams, initiating conservative use of neuromodulators, fillers, and noninvasive energy based treatments, alone or in combination, keeps our patients looking young and their skin healthy.