Reading a face: the four dimensions before any intervention
Before any aesthetic treatment at 23MD, the face is read in four dimensions: skin, structure, movement and personality. We call this the 4D Approach. It exists because a concern you can see on the surface is usually shaped by what is happening underneath, and a treatment aimed only at the surface tends to give a result that does not last or does not look like you.
What is the 4D Approach?
The 4D Approach is the assessment framework behind every aesthetic consultation at 23MD. Four readings come before any intervention:
- Skin: quality, tone, texture, hydration and pigmentation. The surface shows how well cells, collagen and circulation are working underneath.
- Structure: bone, fat compartments and ligaments. This is the architecture that sets proportion and balance, and that changes most with age.
- Movement: expression, muscle activity and resting tone. How a face moves is as defining as how it looks at rest.
- Personality: who you are, how you see yourself and what looks like you. Treatment that ignores this tends to look "done".
Behind all four sit your hormonal and metabolic health and how well your skin repairs itself. They are not a separate dimension; they shape every one of the four. You can read more in why hormones are read before the skin is treated.
Why does facial ageing need more than one treatment?
Because the face ages in layers, not just at the surface. A 2020 review in Aesthetic Surgery Journal describes ageing from the "inside out": the facial bones remodel, fat pads shrink or shift, muscle tone changes, and the skin weakens and thins [1]. A line or a hollow you notice is often the visible end of changes in several of these layers at once.
Hormones add to this. A 2025 clinical review estimates that women lose about 30% of their skin collagen in the first five years after menopause, a loss linked more closely to the length of oestrogen deficiency than to age itself [2]. Two women of the same age can have very different skin for this reason.
That is why the assessment looks at all four dimensions every time. A treatment that addresses only the surface may produce a result that the other layers undermine within months.
What happens if a dimension is skipped?
In our experience, most disappointing results come from treating one layer in isolation. Some examples:
- Filler without reading structure and skin. Filler placed without accounting for thinning skin and shifting fat can look heavy, or appear to move from where it was placed.
- Resurfacing on inflamed skin. Treating skin that is actively inflamed raises the risk of complications, including scarring and pigmentation changes, so inflammation is settled first.
- Regenerative treatments without the wider picture. When metabolic or hormonal health is out of balance, treatments that rely on the skin's own repair may not perform as well.
Each of these is preventable with a full assessment first. It is also why there are treatments 23MD declines.
What does the 23MD assessment involve?
Every new aesthetic patient at 23MD receives the full assessment before any treatment. It takes about 45 to 60 minutes, and it is not optional: you cannot have treatment at 23MD without it.
It covers your concerns and goals, your medical and treatment history, a close reading of skin, structure and movement at rest and in expression, and a conversation about what you want to look like, and what you don't. Where hormonal or metabolic health may be affecting your skin, this is discussed and, if useful, our wellness team is involved. The result is a written plan that sets out which treatments, in which order, and why. More on what we ask at the consultation.
Who is this for?
- For anyone considering aesthetic treatment, whether it is a first visit or a tenth.
- For people who have had treatment elsewhere and felt the result didn't look like them.
Book an aesthetic consultation with Dr Kersh
If you would like your face read as a whole before deciding on any treatment, a consultation with Dr Suha Kersh and the 23MD team is the starting point. Results vary, and your doctor will discuss the benefits and risks of any option with you.
Speak to our team on WhatsApp: London or Dubai.
This article is for general information and is not a substitute for an individual consultation.
Sources
- Swift A, Liew S, Weinkle S, Garcia JK, Silberberg MB. The facial aging process from the "inside out". Aesthetic Surgery Journal. 2021;41(10):1107–1119.
- DeGiovanni C. Managing menopausal skin: a clinician's review. EMJ Dermatology. 2025.
