By Vanessa Fontaine
It’s just one of those things—skin loses tone over time. What can be done? Dr. Daniel Barolet, a dermatologist who specializes in laser treatments and is an assistant professor of dermatology at McGill University in Montreal, answers this and other key questions.
What causes skin to sag?
Skin is 80 per cent collagen. Over time, collagen fibres break down. There are fewer and fewer of them, and the dermis, the middle layer of the skin, gets thinner. The skin is therefore less supported. Collagen breaks down for all sorts of reasons. Heredity is one of them. You can’t ignore it; it’s the genetic lottery. Some external factors related to lifestyle, such as sleep, alcohol consumption, diet, exercise, and sun exposure, also contribute to skin’s aging.
Which areas are most affected?
For the body, wrinkled skin is especially noticeable on the knees, thighs, and arms. When people consult a dermatologist, it’s mainly for the face because it’s the most visible. The lower part of the face, in particular, becomes square as the skin slackens and jowls form. The aim behind treatments is to regain the face’s oval shape. People also consult us for the upper part of the face—hooded eyelids and sagging eyebrows, for example—and for the neck. This is an area that often gives away the age of patients who have undergone surgical procedures, a bit like hands do, but treatments are limited. The thinner the skin, the harder it is to treat.
What are the most effective treatments?
Radiofrequency, a kind of electromagnetic energy, is one of the first aesthetic technologies that’s been proven to combat sagging skin effectively. It came on the market about 15 years ago, but since radiofrequency on its own can’t penetrate the skin deeply, the results varied widely. A lot of people were disappointed. The technology still exists, but it’s often combined with microneedling (radiofrequency applied using microneedles), which helps the radiofrequency better penetrate the skin. What’s interesting is that microneedling also affects the texture of the skin, such as on small surface wrinkles. This technology has its limits, though: it only works well if the sagging is mild. For moderate or severe sagging, a different technology is needed: ultrasound.
With a device called Ulthera, the only one on the market, ultrasound waves contract collagen fibres deep down and with more precision. By heating the collagen fibre, you can contract it without breaking it—a little like what happens when a steak is placed in a hot pan. Ultrasound does not improve the skin’s appearance, but it can make it firmer. Don’t expect miracles, but there tends to be a marked improvement. With Ulthera, which is non-invasive, you get about 65 per cent of the results of a surgery such as a facelift.
Have any active ingredients been proven successful?
The best anti-aging ingredient is tretinoin, a derivative of vitamin A that is available by prescription. If you use it for six months or more, you’ll see a difference in the skin’s texture, on enlarged pores and fine lines, but it doesn’t make it firmer. There’s no ingredient that can fix sagging skin. None. And there are very few studies on the subject.
Facial Yoga
The face and the neck contain about 50 muscles, two-thirds of which are never engaged in facial expressions. Facial yoga promises to tone these neglected muscles and, in this way, lift sagging features. This favourite practice of influencers on platforms like TikTok seems to be somewhat effective.
A study published in the Journal of the American Academy of Dermatology in 2018 found that after 20 weeks, participants aged 40 to 65 who did facial exercises regularly looked three years younger, on average. But you’ll need to be diligent about making faces in the mirror— the study subjects spent an average of 30 minutes a day on their facial exercises.
If you’d like to try it, there are lots of facial-gymnastics apps for smartphones, such as FaceGym and Koko Face Yoga.
Two Exercises to Try
• To reduce a sagging jaw: do 10 big loud kisses towards the ceiling, stretching your neck.
• To firm the oval of the face: say the vowels “o, a, u, i” in an exaggerated way.
