First Consensus on Primary Prevention and Early Intervention in Aesthetic Medicine

September 2017 | Volume 16 | Issue 9 | Original Article | 846 | Copyright © September 2017

Marina Landau MD,a Chytra V. Anand MD,b Thierry Besins MD,c Yates Yen Yu Chao MD,d Sabrina Guillen Fabi MD FAAD FAACS,e Uliana Gout MD,f Martina Kerscher MD PhD,g Tatjana Pavicic MD,h Peter Hsien Li Peng MD,i Berthold Rzany MD ScM,j Gerhard Sattler MD,k Tunk Tiryaki MD,l Heidi A. Waldorf MD,m and Andre Braz MDn

aWolfson Medical Center, Dermatology, Holon, Israel bKosmoderma Skin & Hair Clinics, Bangalore, India cCentre Esthétique Saint George, Nice, France dChao Institute of Aesthetic Medicine, Taipei, Taiwan eCosmetic-Laser Dermatology, San Diego, California and Department of Dermatology, University of California, San Diego, CA fLondon Aesthetic Medicine, London, United Kingdom gUniversity of Hamburg, Hamburg, Germany hPrivate Practice, Munich, Germany iP-Skin Professional Clinic, Kaohsiung, Taiwan jRZANY & HUND, Berlin, Germany kRosenparkklinik, Darmstadt, Germany lCELLEST Plastic Surgery Clinic, Istanbul, Turkey mWaldorf Dermatology Aesthetics, Nanuet, New York and Department of Dermatology, Mount Sinai Hospital, New York, NY nClínica Dr. André Braz Serviços Médicos, Rio de Janeiro, Brazil

BACKGROUND: Facial aging is a complex interplay of extrinsic and intrinsic factors leading to progressive changes in the skin, subcutaneous tissue, and bone. Clinical experience suggests that early aesthetic intervention may slow the signs of aging, but treatment in the absence of symptoms or with minimal signs of aging has not yet been properly addressed. OBJECTIVES: To provide treatment recommendations for primary prevention and early intervention in individuals with no or minimal signs of aging. METHODS: Fourteen specialists in aesthetic medicine convened over a full-day meeting under the guidance of a certified moderator. RESULTS: Tailored treatment recommendations have been provided for prevention and early intervention of fine wrinkles, static lines and folds, irregular pigmentation, laxity, and subcutaneous volume loss by protecting the epidermis, stimulating neocollagenesis, reducing hyperkinetic musculature, and reinforcing supporting structures. CONCLUSION: Preventive measures and early therapeutic interventions that may alter the course of facial aging were defined. Further studies are needed to support these recommendations with the best possible evidence.

J Drugs Dermatol. 2017;16(9):846-854.


Over the last two decades, a greater understanding of the complex interplay of intrinsic and extrinsic factors leading to progressive changes in the face over time has led to revolutionary changes in the approach to rejuvenation. The current treatment paradigm favors a multimodal approach targeting multiple tissue layers—from epidermis to bone—for optimal results.1 Clinical experience suggests that early intervention may slow the progression of the aging process and prevent the need for substantial restorative treatment in later years. However, preventive measures in the absence of many signs or symptoms have only rarely been addressed in the literature,2-4 and there are no guidelines for identification of early indicators or the potential bene ts of targeting facial changes before they occur. This consensus report examines the evidence for primary prevention and early intervention in individuals with no or minimal signs of aging and provides comprehensive recommendations for treatment.


In March 2016, fourteen specialists across the globe from the fields of plastic surgery, dermatology, and clinical epidemiology convened to discuss guidelines for primary prevention and early intervention in aesthetic medicine. Group members differentiated between individuals without any visible signs