Sagging Skin: Derm-Approved Head-to-Toe Fixes

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As we age or experience weight loss, sagging skin becomes a common concern that is difficult to treat. While surgery might be the most effective and permanent option, there are ways to help skin snap back without having to visit the operating room. For all the nonsurgical fixes that can help tighten and tone sagging skin, we talked to top dermatologists to find out what is working best from head to toe. 

Fort Lauderdale, FL dermatologist Dr. Igor Chapik explains that sagging skin is caused by “volume loss of muscle, fat, and bone” while Austin, TX dermatologist Sarah Gee, MD adds that a lifetime of sun exposure and intrinsic elastic fiber loss contribute to texture issues. To get started, Dr. Gee suggests incorporating a retinoid. “A good retinoid coupled with sunscreen prevents the UV-induced breakdown of elastic tissue,” she recommends. “Add a good hyaluronic acid–containing moisturizer to draw in water and you’ve got yourself some plumping and lifting.”

Skin Fixes

“There used to be two options: surgery and chemical peels,” notes Northville, MI dermatologist Farhaad Riyez, MD. “Deep chemical peels, such as those involving phenol or high-concentration trichloroacetic acid (TCA), have historically been used to address more severe sagging of the skin. These peels penetrate deeper layers of the skin, causing significant exfoliation and stimulating collagen remodeling. Deep chemical peels can help improve the appearance of moderate to severe sagging by promoting skin tightening and reducing the appearance of wrinkles, fine lines, and age spots. However, they are associated with higher risks, such as prolonged healing time, potential complications, and increased sensitivity to the sun.”

Dr. Chapik suggests addressing sagging skin on the face with strategically placed long-lasting filler. He states, “I address sagging skin depending on the area. However, Sculptra is the cornerstone.” He uses diluted Sculptra placed superficially to address skin laxity and texture. For deeper causes of sagging, Sculptra is placed deeply. Additionally, Dr. Gee recommends the CoolPeel carbon dioxide laser for improving texture, tone, and thin appearing skin.

Ultrasound + Micro-coring

Laguna Hills, CA dermatologist Jennifer Channual, MD adds that Sofwave, which utilizes ultrasound energy, is a good option. “Sofwave is an energy-based device that delivers ultrasound energy to the dermis to stimulate new collagen. It is FDA-approved for lifting the eyebrows, jawline, and under the chin, and softens smile lines. It’s a great nonsurgical treatment option that helps with skin laxity and has great patient satisfaction.” Like Sofwave, Ultherapy also tightens using ultrasound and is a go-to tightener for Spokane, WA dermatologist Wm. Philip Werschler, MD.

Ellacor, a micro-coring treatment, is said to cause skin contraction and many dermatologists are excited about it. “New to the block is Ellacor to reduce tissue without surgical flaps of a facelift,” says Chicago dermatologist Jordan C. Carqueville, MD. Fort Lauderdale, FL dermatologist Dr. Matthew Elias agrees and says it is probably the only thing that really works nonsurgically for all patients.

Combination Approaches

New Orleans dermatologist Mary Lupo, MD says Ellacor seems promising, however, she believes to get skin to tighten without surgery it takes a combination approach. “Ellacor is in its infancy and more must be learned regarding depth, vectors and density, spacing, etc. I do think it has potential, as does new advances in ‘laser coring.’ I’ve avoided a facelift by combining vectored Sculptra injections, toxin for the jawline depressors and RF microneedling treatments. To avoid a facelift, it takes an entire toolbox. And of course, if you wait too long, you must do surgery.”

Bloomfield Hills, MI dermatologist Linda C. Honet, MD agrees. “To rejuvenate the face and neck to a beautifully youthful, natural contour, volume restoration needs to be addressed. Whether the skin is being treated with noninvasive procedures or a surgical lift, dermal filler like Sculptra is excellent adjunctive treatments for volume.”

RF + Microneedling

For more pronounced sagging, Dr. Gee says radio-frequency microneedling can help improve elasticity and collagen density and therefore tone. “One of my favorite and most elegant devices has a handpiece that has needles that go up to 6mm in depth. It can tighten sagging skin of the body such as on the abdomen or saggy skin on the knees, which no one likes,” she says.

Additionally, Dr. Betsy Backe from Carmel, IN, recommends Profound, a radio-frequency microneedling device known for its significant collagen and elastin production. “I love Profound, which is a radio frequency microneedling device in a class by itself,” she explains. “You can see a doubling of collagen and up to five fold increase in elastin, which is the spring-back protein, all in one treatment. It’s great for treating saggy jowls, tightening the jaw line and neck, treating crepey or loose skin on the knees or thighs, and is very effective for treating cellulite.”

An Upgraded Routine

“Lastly, protect your investment and continue with skin care, particularly those containing peptides,” adds Ontario dermatologist Dusan Sajic, MD. “Copper tri-peptide helps to stimulate healing, and can boost the effects of the procedures above. Hyaluronic fragments, on the other hand, will help boost the production of your own hyaluronic acid.”

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