About Treatment Options for Loose Crepey Skin

The aging process brings about a myriad of changes in the skin, including those that cause the skin to appear lax, thin, and wrinkled—like crepe paper. Several factors can cause the skin to lose its firmness and elasticity over time. These include:

• Decreased collagen and elastin production: Collagen and elastin are important structural proteins in the skin. As we age, the production of these proteins decreases, while our existing collagen and elastin breaks down. Decreased production of these proteins means that our skin is not able to replace what is lost during the natural breakdown process – this leads to an overall reduction in the skin’s collagen and elastin content over time. As a consequence, skin quality decreases—the skin appears more thin, wrinkled, and lax.

• Chronic sun exposure: Ultraviolet (UV) radiation from the sun accelerates the breakdown of collagen and elastin fibers. Interestingly, fibroblasts—which are the cells in our skin that synthesize collagen and elastin—make less of these structural proteins when they are surrounded by less of them in their environment. You can therefore think of this as a self-perpetuating problem—as collagen and elastin content decreases in the skin, fibroblasts are less able to synthesize replacement collagen and elastin, which further decreases their content in the skin, and so on.

• Genetics: Genetics play a role in determining how skin ages. Some individuals of certain racial backgrounds may be genetically predisposed to maintain better skin quality as they age. For example, histologic studies have demonstrated that individuals of African descent possess fibroblasts that tend to be large, multinucleated, and more metabolically active. Larger, more active fibroblasts are better able to synthesize collagen and elastin, which is why those of African descent are often able to maintain their skin’s quality until much later in life. However, while this may be beneficial from an aesthetic standpoint, these fibroblast characteristics are also responsible for why those of African descent are more likely to develop keloids and hypertrophic scars as a result of skin injury.

• Lifestyle habits: Smoking, poor nutrition, rapid weight gain/loss, extreme physical or emotional stress, illness, excessive alcohol and/or drug use, and other factors, can all have adverse effects on one’s skin quality.

Although it may not be fully possible to restore one’s skin quality to what it was when you were 18 years old, there are several strategies that can be employed to improve the appearance of thin, loose, crepey skin. Broadly speaking, poor skin quality can be treated with some combination of the following:

• Laser and other energy-based devices (such as radiofrequency) which employ controlled energy to tighten skin and stimulate your skin to synthesize and remodel collagen and elastin.

• Biostimulatory fillers which also promote the synthesis of collagen and elastin, in addition to improving the health of your skin’s extracellular matrix.

• Hyaluronic acid fillers which help to lift, reflate, and reposition lax, hanging skin. When these products are placed intradermally, they also stimulate fibroblasts (although to a lesser extent than biostimulatory fillers do), bolster the extracellular matrix, and consequently improve skin quality.

• Polydioxanone (PDO) threads can also help temporarily lift and reposition lax, hanging skin. These threads are eventually broken down by your body in the same way that absorbable surgical sutures are. When this happens, new collagen is stimulated to form, which helps to improve skin quality. For this reason, PDO threads can also be placed within the skin itself—not to achieve a lifting effect, but to achieve a biostimulatory effect to improve the health and structure of your skin.

• Fat transfer is performed by obtaining fat from one area of the body (usually the abdomen, thighs, or flanks) during a liposuction procedure, and transferring it to another area of the body where volume is needed/desired. In addition to the volumizing effect that fat transfer can achieve, improvements in skin quality are observed to result from this treatment, by virtue of fat being rich in growth factors and other bioactive compounds.

Exosomes are tiny extracellular vesicles that are released by various cells, including stem cells, that contain a number of useful proteins, lipids, and genetic material such as microRNAs. These molecules all play crucial roles in intercellular communication, and consequently, cellular behavior and function. Some of the possible benefits of exosomes include collagen stimulation, anti-inflammatory effects, skin hydration, moisture retention, wound healing, and regenerative effects.

On what areas of my body can I improve the appearance of loose, crepey skin?

Areas where loose, crepey skin frequently becomes a visible issue include:

• • • Face
    • Neck
    • Upper chest
    • Arms
    • Back of the hands
    • Abdomen
    • Buttocks
    • Thighs
    • Around the knees

Our physicians at the Gateway Aesthetic Institute and Laser Center can offer you customized treatment approaches to properly address your invidual skin quality concerns, and anatomic areas that are your focus.

What are some options for treating loose, crepey skin on the face?

If you are confronting severe skin quality issues on the face, the most appropriate treatment for you will likely be fully ablative laser resurfacing. This is the most effective laser treatment for tightening skin, improving deeply etched wrinkles, and erasing decades of sun damage. If your skin quality issues aren’t severe enough to warrant fully ablative laser resurfacing, then there are several fractional laser resurfacing treatments that might be good options for you, such as Fraxel DUAL fractional nonablative laser, Halo fractional resurfacing, and/or Fraxel re:Pair. 

The results of various forms of laser resurfacing are often optimized by procedures that add volume to your face, such as fat transfer and injectable soft tissue fillers which can not only revolumize but also improve skin quality through stimulating the production of collagen and elastin. A well thought out maintenance skin care regimen that is designed to maintain the results of your treatment is also of the utmost importance. This will usually consist of less aggressive laser and energy-based device procedures, in conjunction with periodic treatments with soft tissue fillers, neuromodulators, and possibly PRP and PDO threads.  

 It must be stated that, if your facial skin laxity is severe, a face-lift may be your best course of action. If you are not interested in a face lift, you may be a candidate for a Nasolabial Fold Lift, which is a minor, easy to recover from, aesthetic surgical procedure that is performed within the comfort and familiarity of Gateway Aesthetic Institute and Laser Center by our board-certified dermatologists. This procedure removes heavy, sagging, jowling skin along the folds of the lower face, is performed with local anesthesia only, takes about an hour, and requires sutures to be in place for one week. Click here, to learn more about the Nasolabial Fold Lift, or contact us to schedule a consultation with one of our board-certified dermatologists.

What are some options for treating loose, crepey skin on other parts of the body?

While treatments will vary according to an individual’s needs, as well as the anatomic areas that need to be addressed, they may generally include:

• Improving skin quality with lasers such as:
  • 1064-nm Nd:YAG
  • 2940-nm Er:YAG
  • Fraxel DUAL fractional nonablative laser
  • Halo fractional resurfacing

• Improving skin quality with other energy sources such as radiofrequency

• The use of biostimulatory soft tissue fillers such as Radiesse® and Scultpra® which help the skin synthesize its own, natural, innate collagen and elastin.

Additional biostimulatory strategies such as PRP, PDO threads, exosomes, and possible adipose tissue derived growth factors and other bioactive compounds harvested during liposuction to further stimulate and nourish the skin.

As in the case of severely lax skin on the face, if your issues are severe enough, then a surgical intervention such as a brachioplasty (for the arms), thighplasty or thigh lift (for the upper legs), or tummy tuck (for the abdomen) may be your best course of action. Our board-certified dermatologists can meet with you in consultation to determine whether surgery is the best approach for you to obtain the results that you are seeking, or whether a less invasive approach can be offered to you at Gateway Aesthetic Institute and Laser Center.

Why trust Gateway Aesthetic Institute and Laser Center to help me address my loose, crepey skin?

At the Gateway Aesthetic Institute and Laser Center, we believe that the health of your skin is intimately connected with all facets of your well-being. Skin that appears lax, thin, and unhealthy can be incongruous with how you feel, or wish to feel, about yourself. Our board-certified dermatologists are laser and skin-care experts, who by virtue of their education and years of specialty experience understand how cutaneous biology, regenerative medicine, and laser physics should intersect to reinvigorate the health of your skin. Their knowledge, combined with our wide array of lasers and energy-based devices, allows us to customize your treatments to address your individual concerns and preferences, thereby maximizing the amount of improvement and value that you receive from a single treatment session.

Artistic skill combined with sound medical and aesthetic judgment are the keys to natural, attractive, and well-balanced results. Our physicians take a holistic approach to skin assessment, and take great joy in creating comprehensive, individualized treatment plans that combine a variety of treatment modalities to help patients feel confident and refreshed. When you place your care in the hands of highly experienced, specialty-trained physicians, you can feel confident that your safety, well-being, and beautiful aesthetic outcomes will be meticulously handled.