What to Do About Sagging Skin

What Causes Sagging Skin? 

The structural foundation of your skin is provided by something called the dermal extracellular matrix. This matrix is composed of molecules such as collagen, elastin and glycosaminoglycans (e.g. hyaluronic acid—active ingredient in skin fillers). Aging and environmental factors such as sun exposure, stress, pollution and smoking lead to the breakdown of these substances, leading to wrinkles, crepiness, and sagging skin.

What sort of lifestyle changes can people make to prevent sagging skin?

Lifestyle changes can help to address the environmental causes of sagging skin. The first and most important step is to limit sun exposure and to always wear a broad-spectrum, mineral-based sunscreen when outdoors or when exposed to sunlight through glass (i.e. one with zinc oxide and/or titanium dioxide).

Avoiding exposure to first and secondhand tobacco smoke is also of critical importance. Tobacco smoke contains a high concentration of free radicals, which are highly oxidative and damaging to all human tissue. Additional lifestyle changes to promote youthful, vibrant skin include maintaining adequate hydration with lots of water, a well-balanced diet, and the avoidance of excessive alcohol use. Alcohol is a diuretic, which means it will deplete your body’s natural store of water, and in excess, can also be toxic to your health.

Is it possible for a topical product to firm or lift skin? 

Countless cosmetic products claim to firm or lift the skin. Although few results are documented with high-quality and objective evidence, based on decades of clinical experience, it is clear that limited benefits for sagging skin can be achieved with topical products. These topicals work primarily to stimulate the formation of collagen, elastin and other structural components of the skin matrix. In addition, good moisturizers, when used in a regimented manner, can provide modest improvements by hydrating the skin.

What are the top ingredients that promise to firm skin?

The highest level of medical evidence supports the use of retinoids. Retinoids, such as retinol, tretinoin, adapalene and tazarotene, are closely related to Vitamin A and are well recognized for their ability to stimulate collagen production, and to enhance the appearance of skin by effacing fine wrinkles, lightening age spots, firming skin and improving surface texture. They also imbue the skin with a flattering rosy glow.

Hydroxy acids, also called fruit acids, are some of the most widely used and studied anti-aging skincare compounds. When applied to the skin, they increase epidermal proliferation and thickness, and restore hydration. Clinical trials have shown the effectiveness of these ingredients in reversing the effects of photoaging and improving wrinkles, skin elasticity, tone and hydration. Alpha hydroxy acid, such as glycolic acid, and beta hydroxy acid, such as salicylic acid, are the two main classes of hydroxy acids.

More generally, antioxidants, such as Vitamins C and E, as well as various plant extracts and peptides have been used with some success to address the various pathways involved in sagging skin. Plant extracts and certain peptides target the extracellular matrix to address the loss of supportive structure and elasticity, and the antioxidants protect against contributing environmental factors.

What are the products that you love?

EltaMD UV Restore Broad Spectrum Sunscreen SPF 40

• All mineral sunscreen (15% Zinc Oxide, 2% Titanium Dioxide)
• Offers high-energy visible light protection
• Ginger root extract and saccharide isomerate help to improve skin smoothness and combined with other antioxidants, combat free radicals
• Squalane restores the skin’s natural moisture
• Oil-free and non-comedogenic; Gluten-free
• Great for all skin types
• Apply to face and neck 15 minutes before sun exposure, reapply every 2 hours

Alastin Restorative Skin Complex

• Ideal for fine lines and wrinkles
• Restores volume by supporting production of healthy elastin and collagen
• Improves skin texture and evens skin tone
• Potent antioxidants help protect the skin from free radical damage
• Great for reducing dryness caused by dry climates and retinoids
• Apply twice daily in the AM and PM to the face and neck

Alastin Restorative Neck Complex

• Ideal for aging skin, dark spots, thin tissue paper-like skin
• Helps to increase skin hydration
• Supports the production of new, healthy elastin and collagen
• Apply twice daily in the AM and PM to the neck

SkinCeutical C E Ferulic

• Ideal for aging skin, sun damage, dryness, free radical damage, dark spots
• Improves the appearance of fine lines and wrinkles
• Evens and brightens skin tone
• Clinically proven to reduce environmental oxidative damage by up to 41%
• Contains a synergistic antioxidant combination of 15% Vitamin C, 1% Vitamin E, and 0.5% Ferulic Acid, protecting the skin from free radicals that contribute to aging skin
• Apply once daily in the AM, after cleansing and toning

SkinCeuticals Triple Lipid Restore

• Ideal for aging and mature skin, dry skin
• Contains ceramides, natural cholesterol, and fatty acids that nourish and repair skin      
• Improves the look of skin fullness and texture
• Great for reducing dryness caused by dry climates and retinoids
• Apply twice daily in the AM and PM to the face and neck

La Roche Posay Toleriane Double Face Moisturizer

• For those whose skin requires more moisture than a lightweight serum
• Deeply hydrates and soothes skin
• Great for sensitive skin types
• Prebiotic Thermal Water contributes to healthy skin
• Ceramide-3 helps to create a protective barrier that keeps in moisture
• Glycerin is a natural moisturizing agent that attracts water to the skin
• Niacinamide (Vitamin B3) calms irritation and promotes cellular turnover
• Soft, oil-free texture is easily absorbed
• Use as a daily or twice daily facial moisturizer

What else do I need to know about treatments for sagging skin?

Topical treatments are best for the treatment of early signs of sagging skin and the prevention of future worsening. Advanced stages of sagging skin require medical procedures to correct.

• Non-invasive procedures that help tighten skin at a deeper level, include radiofrequency treatment, intense pulsed light/radiofrequency combination treatments and high intensity focused ultrasound.
• Minimally invasive procedures include microneedling, chemical peels, neuromodulators (Botox and Dysport), PDO threading, dermal fillers and fully ablative and fractionally ablative lasers.
• Cosmetic surgery is the most invasive of the procedures which does tighten and repair skin, but it typically requires anesthesia and involves increased downtime.

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Brandon Kirsch, MD

Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the Naples Community Hospital.