Anatomical-Functional-Aesthetic Classification of Cervical Aging: Development of the S-F-M Score and Visual Mandala Model.

[BACKGROUND] Cervical aging is a multifactorial process affecting skin quality, fat distribution, and platysmal activity, yet existing assessment tools typically address these elements in isolation. A need remains for a comprehensive, intuitive, and clinically applicable classification model to guide diagnosis and treatment planning.

[OBJECTIVES] To propose a unified anatomical-functional classification system for cervical aging that integrates three independent axes-Skin (S), Fat (F), and Muscle (M)-into a visual mandala model, allowing for personalized treatment strategies.

[METHODS] A structured literature review was performed to evaluate existing cervical classification scales and their anatomical foundations. Based on the synthesis of validated criteria, the S-F-M Score was developed, with each axis graded from 0 (normal) to 3 (severe alteration). These scores are combined into a cervical phenotype (e.g., S2-F1-M3) and plotted on a radial diagram to visually guide diagnosis and therapeutic focus.

[RESULTS] The S-F-M Score enables a modular and reproducible assessment of cervical aging. The visual mandala representation enhances communication and decision-making by highlighting the dominant aging vector. Practical examples demonstrate its application in selecting tailored treatments, such as biostimulators for skin laxity, lipolytic approaches for submental fat, and botulinum toxin for platysmal hypertonia.

[CONCLUSIONS] The S-F-M classification and mandala model offer an integrative and scalable tool for cervical aesthetic evaluation. By aligning clinical diagnosis with anatomical targets, this system supports individualized, layer-specific treatment planning and provides a foundation for standardization in both clinical practice and future research.

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