With So Many Options To Choose From, Do Do The Order of My Treatments Matter?

When it comes to Medical Aesthetics, do the order of my treatments matter?

Biostimulators, Botox, Lasers, Skin Tightening, Microneedling, Peels, the list goes on... With so many options to choose from when it comes to non-surgical aesthetics, how do you know what treatment you should start with, and more importantly, does it even matter?

At Skin Worthy Toronto our specialty is comprehensive treatment plans that account for the 5 facial layers. Not only do we assess the aging process of these layers, we seek to optimize parts of these layers for more harmony and balance in the face.  We call this assessment the 5,4,3,2,1, and the plan that comes from this is what we call your Beauty Evolution which can be done over 2-12 months depending on your needs and timelines.

Now to get back to answering the question "do the order of my treatments matter?" - yes, the order of cosmetic treatments matter and there is actually a typical standard that most experienced providers follow. However, like most guidelines, there are exceptions that arise when we encounter unique anatomical variations (we'll get to that later).

When you look at the face through the 5 facial layers, typically the safest, most effective approach is to treat from the deepest layer outward, so  from bone to skin.

The 5 Facial Layers

Each layer ages differently and supports the layers above it. Treating them out of sequence, with a provider who doesn’t understand your unique anatomy can lead to unnatural results, overfilling, or short-lived outcomes.

The Typical Treatment Guidelines in order of first to last:

1. Bone (Structural Support)

Purpose: Restore projection and facial framework

Common treatments:

• Structural dermal fillers (jawline, chin, temples)

• Biostimulators placed at periosteum

Why first: Bone loss is what causes sagging everywhere else.

2. Deep Fat (Volume & Lift)

Purpose: Rebuild lost support and youthful contours

Common treatments:

• Deep-plane fillers (cheek fat pads)

• Regenerative injectables (e.g., Sculptra)

Why next: Deep fat loss creates hollows and descent of tissues.

3. Muscle (Movement & Tension)

Purpose: Balance facial expression and prevent wrinkle formation

Common treatments:

• Neuromodulators (Nuceiva, Botox, Dyport)

• Functional muscle relaxation or reshaping

Why now: Muscle activity affects how fillers and skin behave.

4. Superficial Fat (Refinement)

Purpose: Fine contouring and softness

Common treatments:

• Superficial fillers

• Micro-droplet techniques

Caution: This is where overfilling often happens if deeper layers weren’t addressed.

5. Skin (Quality & Texture)

Purpose: Improve tone, texture, elasticity, and glow

Common treatments:

• Lasers & energy devices

• Microneedling / RF

• PRP

• Medical-grade skincare

• Chemical peels

Why last: Skin treatments work best when the structure underneath is supported.

If this order is followed, generally we can see optimal outcomes, with minimal complications.

However as stated previously, there are some exceptions to this rule once we assess a face that has unique needs. Some of these common exceptions that we adjust for include:

1. Nuceiva/Botox/Dysport First. Neuromodulators can often help relax the muscles prior to placing filler, so that filler has a chance to integrate without repetitive muscular contractions, especially in a patient who has under-developed bone structure where the muscle dominates.

2. Combining Treatments: Skin tightening using RF micro needing (Morpheus8) and a biostimulator such as Sculptra (The Sculptor) can create thicker, tighter more elastic tissues in a patient who has a lot of laxity. Once skin integrity is improved, filler often settles better in more supportive skin and can even at times require less HA based filler in their plan.

3. Skin treatments such Dermal Infusions, Combination Therapies like Clear and Bright, and a proper skin care protocol to improve skin health is sometimes absolutely necessary before placing fillers or doing more advanced skin toning or resurfacing. Using advanced skin or laser therapies or even injecting dermal fillers into unhealthy, inflamed skin with acne/rosacea can cause lead to poor healing, infection or scarring.

What Can Happen If A Provider Ignores Guidelines or Fails To Recognize These "Exceptions"

Medical treatments require medical assessment. Clinic hopping and going to inexperienced or unqualified providers may be appealing in the short run, but certainly not in the long game. What can happen?

• Puffy or heavy-looking faces

• Overfilled cheeks or nasolabial folds

• Skin laxity that worsens after filler

• Shorter-lasting results

• “Chasing” aging signs instead of correcting causes

• Poor outcomes, infection or worsening of skin conditions

• Poor filler integration, lumpy, unnatural results

At Skin Worthy our goal is to educate our patients on their anatomy, advise on best treatment options and devise a curated and deliberate plan that will help them achieve elevated results all while feeling heard and supported on their journey. Sounds like something you might be interested in? Click here for more on our Beauty Evolutions.