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The Skincare Pyramid emphasizes Dr. Gohara’s 360-degree approach to anti-aging, starting with a base of preventive care steps, building up to treatment options for reversal of specific skin concerns.

The pyramid is built on the concept that having a daily, foundational skincare regimen to prevent signs of aging is paramount. This includes use of gentle, hydrating, non-soap cleaners, antioxidants, SPF 30+, vitamin A derivatives, and moisturizers.

“I tell my patients, if you had a twin with your exact DNA, and you start this type of skin regimen, while he or she doesn’t, you’re going to ward off the signs of aging much longer,” says Dr. Gohara.


Dr. Gohara says the skincare pyramid handout enhances the patient experience with their practice visit. Here she explains how.

“This piece of paper is a great tool. It makes you sit down with the patient, eye to eye; you engage them, talk to them, draw and illustrate for them. You are relaying the same information that you would have relayed otherwise, but the manner in which you are doing it allows the patient to feel that you’re going the extra mile and truly caring for them. It takes five minutes, we are not talking hours. Setting the stage and doing some basic explaining reinforces the idea that our goal is to optimize outcome, not to sell the next latest and greatest thing. It shows patients that there is some thought that goes into your recommendations, and builds patient rapport,” says Dr. Gohara.

In showing the pyramid handout (at the bottom of the article) to patients, it becomes easy to discuss steps that should be followed in a good morning and nighttime routine. The sheet also provides a take-home reference for when, and in what order, products should be applied for maximum benefit. During the consult, notes can be written on the handout for patients to refer back to at a later date.

The next step up the ladder includes procedures patients should consider every three to four months, or quarterly, such as facials, microdermabrasion, chemical peels, and even some devices. There are many options at this stage, but she says the treatments included on her pyramid offer a good, representative starting point so that patients do not get overwhelmed.

The next rung up the pyramid includes options for reversing the signs of aging: neurotoxins, fillers, lasers, other devices, and body contouring options such as CoolSculpting.

“I actually think that botulinum toxins offer a large element of prevention as well. When you’re not scowling, those lines will be less deep,” Dr. Gohara says. “So sometimes I make a double headed arrow from neurotoxins to the prevention category to emphasize that point.”

At the very top of the pyramid is surgery, which, if considered, will likely be not more than once in a lifetime for a particular area.

Dr. Gohara also includes a box in the top corner of her handout to emphasize exercise, sleep, and a well-rounded diet, so patients understand that skincare requires a holistic approach and that those three elements are an important piece of this puzzle.

This article is based on “The Skincare Pyramid,” an article that originally ran in the July/August issue of Modern Aesthetics® magazine. To read the original article, visit

Mona Gohara, MD is a fellow of the American Academy of Dermatology, an active member of both the Women’s Dermatologic Society, where she previously served on the Board of Directors, and American Society of Dermatologic Surgeons where she serves on the Media Relations Work Group. Dr. Gohara works closely with media online and in print to spread the word about skin health. She is in private practice at Advanced DermCare in Danbury, CT, and also maintains a clinical faculty position at Yale New Haven Hospital where she sees patients and teaches residents.

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