Is gravity getting the better of your skin? Sudden excessive weight loss and pregnancy may be some reasons for skin laxity. But whether skinny, heavyset, pregnant or not, loosening skin seems like an inevitable reality for anyone with enough age under their belt. But does this truly happen to even the best of us? Is there no escaping? What hope is there for us older folk to achieve the skin tautness we had in our 20s- and then maintain it for as long as possible?
Let’s begin by understanding what causes loose sagging skin. And in case you were wondering, no, skin cells do not multiply with age to increase its square footage, giving us extra folds of skin to work with. There are a number of factors that create the perfect storm for loose sagging skin.
Firstly, collagen loss. Collagen makes up a large portion of tissue volume that is under the topmost layer of skin (epidermis). Think of collagen as stuffing in a teddy bear. It provides the skin its structure and integrity. By the time we are in our 30s, collagen production slows down. Our skin would also have suffered oxidative damage from the Sun’s UV rays, environmental pollutants, poor nutrition and excessive alcohol consumption. All these contribute to collagen damage and loss. When the rate of damage outweighs production, there is a net loss of volume in the skin.
A second contributor to saggy skin would be the loss of elastin. Elastin is responsible for the skin “bouncing back” after being stretched. This is yet another component of the skin that slows down in production by the time we’re in our 30s, resulting in a net loss. Skin that does not bounce back as much, is like a stretched-out spring that is unable to return to its original shape. Without elastin, skin becomes less taut and begins to sag.
Thirdly, reduction in bone mass or bone mineral density. Osteoporosis is a huge culprit especially in menopausal women due to the dip in estrogen levels. Other hormonal imbalances, mineral deficiencies and medications may also lead to osteoporosis. Besides resulting in bones that break more easily, its effects are also evident externally. Facial bones shrink, sockets around the eyes and nose widen and contours flatten out. As a result, muscles and skin that overly these bones lose support and begin to droop. Sagging above the eyelids, below the eyes, at the cheeks and under the chin are commonly noticed. Measures like using UV protection, keeping a healthy lifestyle and hormone therapy may slow down the progression of osteoporosis, but will never be able to stop it.
The collective reduction of volume due to collagen, fat, muscle and bone loss, coupled with the skin’s reduced ability to recoil over underlying structures creates the appearance of excess saggy overlying skin, much like a deflated balloon. And just to make sure we have the full picture in view here, Saggy Skin never travels alone, wrinkles always tag along- both the fine lines and not so fine folds variety. Effects are often noticed the most in the form of crow’s feet wrinkles around the eyes, under eye wrinkles, fine lines around the mouth, deepened creases along the nasolabial folds which may be accompanied by sagging of the cheeks, more defined neck lines, and sagging of the face in general.
Just when you feel like there’s no winning in this sag struggle wrinkle war, fret not, living in the 21st century affords you access to scientific advances to beat the clock. If age has not caught up with you yet, it’s never too late to take prevention measures for osteoporosis and skin collagen damage. Daily habits of applying sun block, exercise and eating a healthy diet will pay off in the long term. However, if the sag is already starting to show and you are after targeted modes of treatment that yield visible improvements in a short period of time, read on.
Many of these treatment approaches share the common goal of increasing collagen and/or elastin in the skin to restore lost volume. Collagen is produced by a type of cell called fibroblasts. The number of fibroblasts in our skin declines with age and exposure to damage. Depending on the condition of each person’s skin, as well as the targeted effect, certain methods or combinations of treatments and procedures will vary in efficacy, and may even carry the risk of undesirable results if not suitably chosen by a trained medical professional.
Treatment strategy #1:Ultrasound or Radiofrequency
These methods are two of the most commonly used treatment options for skin laxity. Both these devices heat up the skin, causing a controlled stress to be applied to the fibroblast cells, thereby stimulating a healing reaction that involves collagen production. Ultherapy and HIFU PLUS uses ultrasound energy and targets the layers deeper than the epidermis (top layer). Indiba, on the other hand, employ radiofrequency energy that is targeted onto the epidermis of the skin.
Treatment Strategy #2: Bio-stimulator Fillers
Biostimulators are substances that, when introduced to the skin cells, will generate a tissue response to yield the desired effects. Fillers that are also biostimulators work in a twofold way. When injected, effects are achieved not solely as a result from the volume injected. In addition, the filler continues to stimulate collagen production in the months following the injection. This allows your body to restore the lost volume over time via its own natural restorative processes.
Sculptra is a popular example of a biostimulator, consisting of poly-L-lactic acid. Poly-L-lactic acid is a substance that has long been used in dissolvable stitches and is safe to be introduced to the body and even dissolved into the bloodstream. Although results appear only after 2-3 Sculptra injections, as compared to immediately from other fillers, Sculptura’s effects last for approximately 2 years- about twice the duration of other fillers.
Profhilo and Sunekos are injections of hyaluronic acid that not only stimulates the production of collagen, but also elastin. Not to mention, hyaluronic acid comes with the bonus benefit of adding hydration to your skin. Kill 3 birds with 1 stone- perfect! 2-3 injections are usually administered over 3 months and effects last 6-9 months.
Dermalift involves yet another kind of bio-stimulator. In this procedure, Dysport (diluted botulinum toxin) is injected into the skin instead of the deeper facial muscles as in the more commonly known botox procedures.This technique produces a tightening of the collagen fibres and relaxes downward pull of creating a gentle lifting effect without restricting the function of facial muscles.
Treatment Strategy #3: Radiofrequency Microneedling
Working off a similar principle, microneedling uses multiple needles to create very controlled damage to kick start the skin’s natural healing response, forming new collagen and elastin as a result. Although microneedling has become an increasingly popular procedure to do at home, it carries risks of skin infections and worsening breakouts.
One of the more popular treatments that uses Radio Frequency Microneedling is SylfirmX.
Treatment Strategy #4: Thread lifts
A thread lift is a procedure done by a trained doctor whereby a dissolvable medical suture is inserted under the skin. This suture acts as a string to pull the skin more tautly, so as to reduce the appearance of sagging and wrinkles. Although this is a slightly more invasive option, and therefore carries more risks as compared to some of the other options mentioned above, its effects are more long-lasting, for approximately 1-3 years.
What about other non-prescription methods?
Tightening creams containing active ingredients like Retinol, Hyaluronic acid or Vitamin E slowly increase collagen levels in the skin. However, these options are more suitable for addressing fine lines, and only help minimally with sagging skin. Use these with caution and consider consulting a doctor before starting such creams, especially if you have sensitive skin or eczema.
Some studies have shown that collagen supplements may help to slowly restore the skin’s collagen. But evidence on this is still limited. If you do not have any allergies to the supplements, this is a very low risk option.
Doing facial muscle exercises may help to slow down muscle loss but there is little research to support this as an effective treatment method for sagging skin. Perhaps if these exercises were to be done consistently over a long period of time, some benefit may arise.
Massage & Guasha
While there isn’t overwhelming evidence to suggest that massages with various massage devices or gua sha tools can improve sagging skin. However, studies have shown that massage increases the skin’s blood flow which can in turn improve absorption and efficacy of skin care products.
This has only been a brief overview of the more talked-about treatment options out there. There is no one size fits all magic bullet treatment regime for loose skin as each person’s bone structure, skin condition and goals may be different. Look for an experienced doctor who will not simply alter your appearance to look like the person in the magazine, but one with a good eye to advise you on how to make changes that will improve your overall look in a natural way. An experienced doctor will also be able to recommend the best combination of treatments to suit your needs.