Many of us are diligent about caring for the skin on our face and neck, dutifully applying eye creams, serums and moisturizers. But what about the chest area, also known as the décolletage?
Often overlooked in skin care regimens, the décolletage can sneakily betray your age and deserves as much TLC as your face because it is just as susceptible to environmental aggressors, perhaps even more so. Fortunately, there are a number of effective measures in preventing damage, repairing harm and maintaining a youthful complexion below your neck.
“The chest area does not age well, and the first thing that people can do is pay attention to it,” says Miami dermatologist, Jill Waibel. That’s because the skin on the chest is very thin. While the skin on your cheeks is about 3 mm thick, the skin on your neck and chest is only about 0.75mm, “so it doesn’t take a lot of ultraviolet damage to cause a lot of sun injury to your skin,” explains Dr. Waibel. Moreover, the neck and chest area contain fewer sebaceous glands and melanocytes which help hydrate and protect the skin from UV rays.
That is why the use of sunscreen is imperative. “Frankly, 90% of aging on our skin is caused by the sun,” reveals New York City dermatologist, Robert Anolik.
“And today’s fashions typically leave the face, neck and décolletage uncovered. That means there’s constant sun exposure – ultraviolet rays are hitting the skin and causing breakdown of collagen and elastin fibers, DNA damage, hyperpigmentation and broken capillaries and that’s what bothers people.”
But the at-home care doesn’t end with sunscreen. The home skin care regimen should mimic what we do for the face, continues Dr. Anolik who encourages patients to use retinols on the chest too. “Retinols are really helpful for rejuvenation as opposed to prevention which is fundamental with the sunscreen.”
But, “using the same skincare that you use on your face neck and chest is a tiny step,” counsels Dr. Waibel. “I always say ‘skincare is going to help you about 10% of the way, procedures are going to do the rest.’” Enter the lasers.
There is a wide range of lasers that address a variety of issues from hyperpigmentation to redness to wrinkles. These span from aggressive CO2 ablative re-surfacing lasers to gentler fractional lasers to ones that target specific concerns like broken blood vessels. “You can do light lasers on the neck and chest and we know that doing light lasers prevents aging, prevents skin cancer and stimulates collagen. Nothing stimulates collagen more than a laser,” says Dr. Waibel.
“We’re losing 1% of collagen, a year starting at age 20, so by the time you’re 40 or 50, you’ve lost 20% or 30% of your collagen. That’s significant. Collagen is a lot like working out. When you lift weights, you break down the muscles and by breaking them down, you build them up more. Same thing here. We are heat-injuring your collagen.”
This is accomplished by means of fractional resurfacing lasers like the milder Clear & Brilliant laser and the more intense Fraxel and ProFractional lasers. There are different brand names and each laser works slightly differently, but in essence they all target the superficial skin layers, stimulating the top layer of collagen, reducing wrinkles while clearing pigment lesions and photo damaged skin. “Because they strengthen that surface layer of collagen, they are so helpful for fine lines, pores and those vertical crease lines that a lot of women get mid-chest between the breasts extending up toward the clavicle,” explains Dr. Anolik. “They also reduce hyperpigmentation, especially the diffuse bronzing on the chest (not to be confused with sun spots) because when collagen production is triggered, exfoliation is also stimulated whereby the skin releases sun damaged and abnormal skin cells.”
When it comes to treating sun spots – a higher concentration of pigment collected in one area – Dr. Anolik relies on several Q Switched lasers and to address vascular irregularities like broken capillaries and cherry angiomas, Dr. Anolik turns to lasers that target the hemoglobin in the blood vessels such as a pulsed dye laser and a KTP laser. General redness is tackled by Dr. Waibel with a Broad Band Light (BBL)and Intense Pulsed Light (IPL) treatments.
For a common, but chronic condition called Poikiloderma of Civatte, aka “super sun damaged skin”Dr. Waibel turns to Photodynamic Therapy (PDT). This combination chemical and laser treatment causes the destruction of precancerous lesions and photodamage. “PDT is unique in that it is both a medical and cosmetic treatment rolled into one,” explains Dr. Waibel. “PDT can be used to prevent future pre-skin cancer and skin cancer. The results are brighter, smoother, younger, healthier rejuvenated skin. This procedure has been proven to be effective for acne as well.”
To address wrinkles, further collagen boosting can be achieved with injections of a biostimulator like Sculptra in conjunction with any laser treatment. “We call that laser-assisted delivery,” explains Dr. Waibel. And, according to Dr. Anolik, it’s not uncommon to place droplets of Botox into the skin in this area because “there are some muscle fibers under the surface of the skin that do contract and relaxing those fibers can improve the appearance of those creases from the dynamic movement of muscle.”
These are many different lasers and procedures. Can they all be done at the same time? Yes, says Dr. Anolik. Not only will combining procedures shorten the overall downtime, but it has the added advantage of more efficiently addressing the issue of sunspots. “A ruby laser might vaporize pigment particles,” explains Dr. Anolik, “but the fractional resurfacing lasers help exfoliate the skin so if there’s residual, unwanted or abnormal pigment that’s not vaporized, much of it can be released at the same time with the exfoliation process.”
It’s important to note, however, that using these lasers and light treatments in tandem requires considerable skill. “Your face has a lot of adnexal structures like eccrine sweat glands and hair follicles, your neck and chest don’t. What adnexal structures do is they improve wound healing. I correct a lot of problems and complications from other people doing laser and one of the number one mistakes is using too high a power on the neck and chest. You have to turn down the setting when you come off the face,” reveals Dr. Waibel.
Another consideration when it comes to the décolletage is the larger blue veins that can appear on the chest wall and the breasts. Called reticular veins, they can sometimes serve as “feeder” veins to spider veins. Thinning aging skin, breast feeding, a breast reduction or breast augmentation – in other words, “every time we have inflammation on the breast” – can cause these blue veins to show through, according to New York City vascular specialist, Luis Navarro.
Fortunately, these veins respond very well to sclerotherapy, says Dr. Navarro. A sclerosant solution is injected into the prominent veins which causes irritation and their eventual collapse. The treated veins are ultimately absorbed into the body and the blood is redirected naturally to flow through other healthier veins. One to three sessions are needed for the veins to disappear completely. There will be some bruising but “in the upper part of the body, bruising goes away pretty quickly and you can cover it up with makeup or we can give you a prescription cream to make it go away much faster,” explains Dr. Navarro. “Once people know it can be done, they are very happy. The results are excellent and once the veins are eliminated, they usually don’t come back.”
As with most endeavors, consistency is key to success. Both Dr. Waibel and Dr. Anolik recommend that a prescribed combination of treatments be performed twice a year. One reason is because exposure to ultraviolet rays continues on a daily basis and the resurfacing is important to collagen quality. Another is that sun spots from years of sun exposure in childhood tend to resurface and these treatments can eliminate them as they pop up.
“I do find that once you get rid of a sun spot, if it’s 100% gone, it’s gone,” says Dr. Anolik. “If you treat the sun spot and you see that half of it is improved, where it’s 50% faded, if you get more sun exposure, some of it can start to come back. So, when we’re maintaining and re-treating 6 months later, sometimes we’re treating brand new spots and sometimes we’re going after the ones that didn’t fade entirely.”
And of course, with all the options of modalities, a bespoke approach is key. “I have 70 lasers and we have a lot of biostimulatos and fillers,” says Dr. Waibel. “You have to customize the treatment to what is going on with that patient.”
Dr. Waibel: Side sleepers, especially those with larger breasts, should try to sleep on their backs with a silk pillow case so as to avoid the formation of décolletage wrinkles.
Dr. Anolik: An at-home remedy for bronzing or hyperpigmentation diffused across the chest, is the use of exfoliating peels or masks containing glycolic or alpha hydroxy acids which can be very helpful in evening out the skin tone.