“Rather than address lines that are deeply etched into the skin, it is much easier and more effective to address these issues early and prevent them from progressing,” Dr. Zeichner says. “I typically recommend considering a neurotoxin treatment to adult patients when lines start to set in at rest. This may occur at 21 years old in one patient or 41 years old in another. If a line is not there, I do not presume that it will develop any time soon, so I do not recommend treatments to those patients.”
AAFPRS President Phillip R. Langsdon, M.D., agrees that providers should not treat unless there is a condition to be treated.
“My opinion is there is not enough evidence of the efficiency of any kind of supposed prevention or of the safety in treating people that don’t yet have defects to improve. That is why I err on the side of caution,” Dr. Langsdon says. “My feeling regarding Botox [Allergan] is that people should be treated only if they have a condition in which we can see a clinical improvement after treatment. Fillers, we use when a person has a defect or they’re showing the signs of aging. I don’t treat patients thinking I’m going to prevent aging; I treat them to try and reverse the signs of aging with fillers.”
But Dr. Langsdon says there are ways to prevent skin aging using sun protection. He says he’ll treat early signs of aging with medical-grade daily skin exfoliation and superficial chemical peels to rejuvenate skin and stave off skin aging.
“If there’s any use in the term ‘prejuvenation’ it would be in skin protection from the elements and sun exposure,” Dr. Langsdon says.
For further reading: Treating the Young Aesthetic Patient: Evidence-Based Recommendations. Published June 2017 in the Journal of Drugs in Dermatology.3
Drs. González, Langsdon and Zeichner report no relevant disclosurfes. Dr. Fabi is a consultant, speaker, trainer and investigator for Allergan, Galderma, Merz, Valeant, Revance, Evolus and other companies.
1. Trindade de almeida A, Carruthers J, Cox SE, Goldman MP, Wheeler S, Gallagher CJ. Patient satisfaction and safety with aesthetic onabotulinumtoxinA after at least 5 years: a retrospective cross-sectional analysis of 4,402 glabellar treatments. Dermatol Surg. 2015;41 Suppl 1:S19-28.
2. Rivkin A, Binder WJ. Long-term effects of onabotulinumtoxinA on facial lines: a 19-year experience of identical twins. Dermatol Surg. 2015;41 Suppl 1:S64-6.
3. 1. Bonati L, Fabi S. Treating the Young Aesthetic Patient: Evidence-Based Recommendations. J Drugs Dermatol. 2017;16(6 Suppl):s81-83.