Dermatologists Reveal the Ideal Age to Start Different Types of Cosmetic Treatments to Delay Signs of Aging

Prejuvenation is the notion that partaking in aesthetic tweaks early can delay signs of aging. Learn about when to start which anti-aging treatments based on your age.

During lockdown, as nonessential medical practices shuttered and annual aesthetics meetings got pushed back, many cosmetic doctors—yearning for new ways to connect and educate—found themselves on Instagram Lives for the very first time. Since reopening, several have continued to frequent the platform, rigging up their ring lights on the regular to brainstorm with colleagues and answer questions from tuned-in followers. 

Dr. Evan Rieder, a board-certified dermatologist and psychiatrist in New York City, recently hosted a Live with board-certified Philadelphia dermatologist Dr. Nazanin Saedi—as part of Dr. Rieder’s now weekly series, All Skins Considered—to tackle the topic of prejuvenation, or the notion that partaking in select aesthetic tweaks early on, and having them done routinely, can delay the classic signs of aging, allowing us to “avoid heavy lifting later in life,” says Dr. Saedi.

Much knowledge was dropped during their 30-minute tête-à-tête, starting with this pearl: the term prejuvenation was coined by Boston dermatologist Dr. Kenneth A. Arndt. In a paper he published on the phenomenon in 2013, he explores how introducing neuromodulators, fillers, and energy-based treatments in the 20s and 30s—as a complement to a steady regimen of proven topicals—can help keep skin smooth, spotless, and healthy into midlife. His philosophy—now widely embraced by dermatologists everywhere—can be neatly broken down into these six steps, listed in order of prejuvenation priority.

The six steps of prejuvenation

1. Starting in your teens and 20s: sun protection and antioxidants

While prejuvenation is technically aimed at those in their teens, 20s, and 30s, sun protection should be a lifelong pursuit. “Since sun damage is insidious and cumulative, daily prevention is best,” says Dr. Mary Lupo, a board-certified dermatologist in New Orleans. While she doesn’t push any one particular brand of sunscreen, she urges patients to use a product with an SPF of 40 or higher and to store it with their toothpaste so application becomes as routine as teeth brushing. 

“The old adage typically holds,” adds Dr. Rieder: the best sunscreen is the one you will wear every day, all year long. Hats, sun-protective clothing, sunglasses, and shade are equally crucial elements of sun protection.

By your 20s, it’s time to incorporate a free-radical-quenching antioxidant serum, layering it under your sunscreen in order to amplify its protective powers. “I usually have people use something vitamin C–based right after cleansing in the morning so that it’s the first product on the skin, unless there is a topical prescription medication that takes precedence,” Dr. Rieder adds. Dr. Saedi commonly recommends MaeLove Glow Maker—with vitamins C and E plus ferulic acid and hyaluronic acid—to younger patients, saying that it’s “amazingly effective, for $26.”

2. Starting in your teens and 20s: retinoids 

Plenty of people get acquainted with retinoids in their teens, when acne first strikes—and the skin-smartest among them cultivate a forever relationship with the wonder drugs. By normalizing basic skin functions—cell turnover, collagen synthesis, pigment production—these vitamin A–based creams can improve everything from pimples to wrinkles and discoloration. “Teens actually do better [with retinoids] than older patients, because their skin is a bit oilier,” Dr. Lupo says. (Retinoids are notoriously desiccating, as you’ve probably heard.) 

If your (enviably clear) skin didn’t require a retinoid intervention in your teens, consider adopting one in your 20s, to keep skin plump and smooth. Our experts say mild-mannered Differin Gel and La Roche Posay Adapalene Gel, both drugstore formulas, are ideal for beginners. When skin calls for something stronger, Dr. Rieder turns to Altreno, a prescription tretinoin lotion that he’s found to be the “most tolerable” of the bunch. 

With any retinoid, it’s essential to ease into it, using a pea-size drop only once or twice a week to start, gradually upping the frequency as your skin adjusts. For prejuvenation patients with dry or sensitive skin, Dr. Lupo advises trying “mask therapy”—letting the retinoid sit for only three to five minutes before washing it off with cool water, patting skin dry, and applying moisturizer.

Related: 5 Innovative Treatments That Are Helping Us Stop Aging Before We Age

3. Starting in your mid-20s to mid-30s: neuromodulators

In Dr. Arndt’s aforementioned paper, he argues convincingly for introducing muscle-relaxing toxins, like Botox and Xeomin, no later than the third decade of life, noting that “the pattern of lines observed with a smiling expression in young adulthood predicts the unique pattern of facial wrinkling that will be seen without expression years later.” He goes on to say that “if the action of the muscles of facial expression is diminished, the lines on the face that are interpreted as aging, tiredness, or anger will simply not form. Initiating regular treatment with a neuromodulator in an individual’s 20s or 30s will have a dramatic effect on the appearance of the face as seen in the person’s 40s or 50s. There will be few, if any, lines of facial expression present.”

That’s assuming you keep it up, of course, having baby doses of toxin injected, across the upper face, a few times a year. 

Whether you take the plunge at 26 or 34 really depends on your individual skin type and how fast you’re aging. “It’s always best to start toxin before lines get etched in,” explains Dr. Lupo. “But if you have more sun damage, that will be earlier than if you have better skin quality.”

There’s really “no firm timeline” for the inaugural needle poke, adds Dr. Rieder, “but most of my prejuvenation botulinum [toxin] patients are in their mid-20s” and starting to see the earliest evidence of forehead creases, crow’s-feet, or elevens lines, which are often the first to dig in.

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4. Starting in your early 30s: resurfacing procedures

For the prejuvenation set, “the goal [with resurfacing tools] is a superficial exfoliation—essentially like a retinoid on steroids,” says Dr. Rieder. “We’re taking away sun damage and causing the outer layers of the skin to be removed.” As surface cells slough off, they carry with them excess pigment, leaving the skin more even-toned and radiant. Laser and light energy can also ramp up collagen growth in the skin’s deeper layers, to keep skin thick and lineless. 

Dr. Rieder leans on the Fraxel laser, since it “gives excellent and predictable results, typically in a single session,” he says. It’s also been shown to boost skin health by destroying precancerous cells. The device can be dialed up or down, to deliver more or less improvement (and consequential recovery time). Since prejuvenation patients rarely have extensive sun damage, Dr. Saedi tends to toggle between the Clear + Brilliant (think: mini Fraxel) and the picosecond laser. Both options help with mild texture issues and discoloration and involve little to no downtime, requiring multiple rounds for best results.

Light chemical peels can also be used to subtly refine the skin—and they cost a lot less than laser treatments. Our experts typically choose peels over devices for patients with acne—salicylic acid cuts through oil to clear pores—and heat-sensitive melasma, which tends to worsen when zapped. “Glycolic acid peels are excellent for melasma,” notes Dr. Saedi.  

5. Starting in your late 20s to early 30s: hyaluronic acid fillers

“The concept of prejuvenation with fillers is somewhat difficult, if your definition is strict—intervening before signs of aging show—because I think most people would not want to put fillers in their face until they begin seeing those signs, and I would agree with that sentiment,” Dr. Rieder says. He uses injectable fillers judiciously and only for those with the very earliest signs of aging, which typically creep in by the late 20s or early 30s, he notes, “though there is some variability.”

Hyaluronic acid (HA) fillers are ideal for prejuvenation seekers because they’re temporary and reversible. They’ve also been shown to spark collagen synthesis, allowing them to keep skin smooth beyond the life of the gel itself. 

According to our doctors, the most popular filling zones for younger patients include the lips, under-eyes, and cheeks. “Next is the chin, if it’s recessed,” Dr. Lupo says. The intent is usually to enhance, create balance, and improve light reflection rather than restore skin or fight lines. There are always exceptions, of course: “We don’t really see volume loss until later, in the 30s or 40s,” says Dr. Saedi. “But if someone smiles a lot and they have more prominent nasolabial folds, they may come in wanting to soften those.” In such cases, she’ll inject a fine, flexible HA, like Restylane Refyne or Defyne, directly into the area in order to downplay folds.

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6. Starting in your mid- to late 30s: skin tightening treatments

This step is somewhat surprising, mainly because tightening treatments are famously unpleasant and their results can be rather underwhelming. They’re pretty pricey too—on the order of several thousand dollars. All in all, they’re a tough sell to prejuvenators who have no sagging in sight. “Often, people do need to begin to see the subtle signs of laxity before going down this road,” says Dr. Rieder. This generally happens in the 30s, he adds, but “it’s really patient-dependent, with genetics playing a substantial role.”

Radiofrequency (Thermage, Tempsure) and ultrasound (Ultherapy and Sofwave) energies are commonly used to heat the skin’s deeper layers, for a firming effect. According to Dr. Rieder, “the cost and discomfort of ultrasound can be more substantial than [with] radiofrequency,” but in terms of efficacy, head-to-head studies haven’t shown a difference between the two. Both technologies take at least three months to produce a visible change—and neither is a home run (or even a single) for every patient. “Results aren’t striking with either,” Dr. Saedi says, “but young patients don’t really need too much [in the way of tightening].” 

For those willing to play the long game, getting a tightening treatment every few years can help head off sagging. Bear in mind though: the effects of certain preventive measures can be invisible in the moment. Sunscreen and antioxidants don’t deliver a wow with every application, but they are proven to stave off wrinkles and sunspots, so we’re loyal all the same. Tightening treatments require that same leap of faith—and the conviction that your future face is worth the investment.