If there’s one part of the body that falls under the category of “forgotten areas,” it’s the knees. But what the knees lack in aesthetics, they make up for in function. Now, they are experiencing increased interest as more treatments focus on this often-disregarded body part.
What You Knee-d To Know
No body part is immune to aging, knees included. This high-stress region stretches (extra skin allows for this) to accommodate weight while walking and moving. Couple the stretching with a breakdown of collagen and elastin, aging and sun damage, and the knees can equate to wrinkled, saggy, crepey skin that “just hangs.” Aside from the knees, the thighs also frequently need to be included in the overall rejuvenation strategy. “It’s a continuous area, so if the skin on the thighs is saggy, it will contribute to sagginess and other textural changes in the knees,” says Santa Monica, CA dermatologist Ava Shamban, MD.
Sun Damage + Discoloration
The knees experience sun damage, which zaps elasticity from the skin. Of course, diligent use of daily sunscreen is the easiest way to prevent photoaging, “but often we overlook the knees and lower body when applying it,” says Houston plastic surgeon German Newall, MD. The sun can leave its mark on the knees in more ways than one. Stubborn hyperpigmentation is a common byproduct. But, not all discoloration results from the sun. Some people have naturally darker skin there, which is challenging to treat. Charlotte, NC dermatologist Gilly Munavalli, MD says, “We look for an underlying cause, like the chronic rubbing of the knees from clothing, or constant kneeling like in yoga positions, to determine how to correct it.”
For starters, wear sunscreen, especially if your clothes don’t cover your knees. Next, incorporate an exfoliator with alphahydroxy acids or lactic acid to remove dead skin so the knees don’t look scaly. Finally, apply retinol or a retinoid—Dr. Munavalli endorses the nightly use of prescription-strength 0.1-percent tretinoin—to boost cellular turnover and create new collagen. Body lotions and creams with retinol and other collagenstimulators are good alternatives if your skin can’t tolerate stronger formulations. Dr. Munavalli recommends using a hydroquinone-based cream twice daily with a retinoid at night to lighten discoloration. Or, your dermatologist may suggest a combination of radio-frequency (RF) microneedling and topical tranexamic acid.
Like the face, the knees experience volume loss over time, which ages them. Dr. Shamban explains that cumulative ultraviolet exposure causes skin to thin and “chew up” fat. “Fat loss plus collagen thinning equals saggy knees,” she adds.
Fat can be grafted to volume-deficient knees, but Chicago plastic surgeon Peter Geldner, MD calls the results “seldom perfect.” Some doctors like to employ hyperdiluted Sculptra Aesthetic (although the use is off-label, more-than-normal amounts of saline make it more spreadable), which Dr. Shamban says adds a little “padding.” “Combining Sculptra with micro-focused ultrasound or radio-frequency microneedling also volumizes them,” she adds. Renuva, a treatment that gradually reinstates lost fat, plumps tissue, too. It is important to note that off-label treatments are being evaluated, and stacking of technologies can have uncertain outcomes.
Spider + Varicose Veins
New York vein specialist Luis Navarro, MD calls spider veins “an evident and frequent offender of the knees.” Although these tangles of thin red, purple or blue lines are a cosmetic hindrance, their larger, ropey cousin, varicose veins, signify veins that aren’t working correctly due to the main superficial vein branching out across the knee.
Spider and varicose veins form from genetics, poor diet, a lack of exercise, and sitting with the legs crossed for extended periods. On top of that, Dr. Navarro says female hormone shifts from birth control and hormone replacement therapy can weaken the veins’ walls and exacerbate spider veins. “The same goes for biotininfused hair supplements. They increase the capillaries on the scalp, but they make spider veins worse.”
Sclerotherapy is the gold standard for treating spider veins. Injecting a chemical compound into the veins irritates their lining, forcing the veins to collapse and disappear over the coming weeks. But the pain factor is a reason women avoid sclerotherapy. To make the treatment more comfortable, Dr. Navarro uses cold air and mechanical vibration to overload the sensory fibers of the nerves. If varicose veins plague the knees and thighs, endovenous laser ablation is the fix. It takes 25 minutes to complete under local anesthesia without making any cuts. “We use a laser to close the vein. You can go back to work the next day,” Dr. Navarro shares. And if spider and varicose veins persist, patients may need both treatments.
No body part is immune to aging, knees included.
Saggy, Crepey Knees + Loose Skin
Fat loss, gravity, sun damage, and loss of collagen and elastin, the skin’s primary structure and support proteins, all contribute to lax skin. Loose skin above and at the knee is tough to treat, so Dr. Shamban says a multimodal approach is needed.
RF microneedling treatments are the choice du jour because they improve loose skin and spot-treat fat. Dr. Munavalli references a study treating knee wrinkles with Candela’s Profound RF, a long-pulsed, radio-frequency microneedling device: “We found it effective in reducing those wrinkles by at least 50 percent.” Other RF microneedling devices, such as the Genius and the Morpheus8, also improve mild sagging and poor skin texture.”
When a loss of muscle tone accompanies loose skin, doctors may recommend Emsculpt NEO. It’s performed on the quads and can be paired with ultrasound to induce new collagen for tighter skin.
The last resort is skin excision, which is only done when necessary because of its large scars and potential complications. Dr. Geldner has seen cases of extreme shin debulking and poorly planned skin excision, some of which are uncorrectable.
With age, fat can collect around the knees. Irvine, CA plastic surgeon Andrew Smith, MD shares that it’s still unknown exactly why this happens. “It probably was always there and becomes more evident as the skin loosens.”
Doctors can use a few methods to eliminate fatty pockets, including liposuction and CoolSculpting (off-label). Liposuction removes small pudges of fat while adding shape to the knees. “Some people have great thigh definition narrowing to an athletic knee and shapely calves, but not everyone is so lucky,” says Dr. Geldner. “Others complain of tube-shaped lower thighs that camouflage the knee. In those patients, liposuction clears the fat to show off the thighs.”
For those who aren’t keen on surgery, a few sessions of CoolSculpting work, as does EmSculpt and injections of Kybella (although use in this area is considered off-label and results can be unpredictable). Freezing and killing the fat cells eliminates them naturally to define the knees. Another solution is minimally invasive BodyTite. “It deposits radio-frequency energy into the tissues to melt localized fat and induce skin tightening,” Dr. Newall shares.
Oftentimes, a multimodal approach is needed…
Incessantly Dry Skin
Sun damage is part of the cause of super dry knees, but the knees also have few oil glands. As dead skin accumulates on the surface, dryness increases and accentuates wrinkly folds. To make matters worse, decreased collagen levels can make the skin feel flaky and thin.
To hydrate parched knees, layer on a urea- or hyaluronicacid– rich hydrating serum or cream. Dr. Shamban suggests combining topical hyaluronic acid with a retinoid for a boost. You can also “slug” the knees with petroleum jelly to lock moisture into the area.
The Ultimate Anti-Aging Knee Arsenal
Everything to stockpile for youthful-looking knees.
A Skin-Tightening Lotion
Even if you regularly hydrate your knees, the addition of a collagen- and elastin-stimulating treatment like SkinMedica Firm & Tone Lotion for Body leads to tighter-looking skin. ($165)
Power-Packed Body Retinol
Retinol is a game changer for the body, but the key is to find one with natural moisturizers like Paula’s Choice Retinol Skin-Smoothing Body Treatment so the skin doesn’t become irritated. ($29)
The thicker the cream, the better the hydration factor, and if it contains vitamins, like Skintensive Daily Moisturizer, that’s a bonus. ($29)
Protecting your skin with sunscreen is vital to maintain the skin’s integrity. Opt for a weightless, hydrating formula like Cotz Silky Foam SPF 30 that spreads evenly across the thicker skin of the knees. ($28)