“With age, the skin itself changes with a loss of collagen and support as well as a loss of elastin,” Dr Jameson tells us. “Elastin provides the skin with the ability to stretch and snap back into position and when elastin is lost the skin becomes loose and slack and is unable to maintain its structure and position.”
“In addition to these changes the skin itself thins and becomes more transparent through changes to the epidermis as well as changes to the epidermal-dermal junction which flattens out and results in more fragile skin.”
Plus, our skin naturally gets weaker as we age, and while the changes might be visible on a surface level, Dr Jameson says skin sagging can be attributed to a loss of supportive structures beneath the skin as they result in less support.
“Atrophy of the fat pads, bone loss and resorption as well as cartilage loss all contribute to loss of the facial structure. The skin therefore loses its platform of support resulting in a sagging appearance.”
However, environmental influences and the way we look after ourselves is said to play a big role in how to prevent skin sagging too. The major culprits are of course chronic exposure to UV radiation (also known as photo ageing) and smoking. Other culprits include air pollution, poor nutrition, and rapid, extensive weight loss (and also weight fluctuations over time).
“Skin damaged by the environment appears roughened and is deeply wrinkled with a loss of elasticity and recoil, making the skin appear ‘saggy’,” Dr Jameson tells us.
Like sun damage, the effects of environmental and lifestyle influences that contribute to future skin laxity might not become apparent until we hit our 40s or 50s – especially for women.
Dr Jameson says this is because the component of the skin called the extracellular matrix is the one that will exhibit the sins from our youth and they often take a little while to appear. Despite this, there are a few preventative measures we can start putting in place to prevent our skin sagging in the future.
“The primary prevention method is to avoid exposure to UV radiation,” Dr Jameson tells us. “Smoking is another contributor and smoking cessation and avoidance of passive smoking is essential to maintain healthy skin and prevent further free radical damage. In addition, avoidance of air pollution is important and this can vary significantly depending on where in the world you live.”
“Other preventative strategies to prevent skin sagging in healthy skin include maintaining a healthy diet filled with healthy fats and protein, regular exercise and maintaining a healthy weight. Hormonal treatments may also come into play especially for women as early menopause can contribute to a loss of collagen,” Dr Jameson adds.
Aside from preventative strategies, there are an array of non-surgical cosmetic procedures that can work to prevent skin sagging as well as treat already sagging skin.
“Radio Frequency is a popular method which works to deliver heat energy into the skin to denature collagen and stimulate a wound response in the skin, which over time then produces a skin-tightening effect that peaks over a three to six-month period. There are multiple options available such as older monopolar radiofrequency treatments such as Thermage and Pelleve and newer bipolar Radio Frequency treatments which often combine microneedling to further enhance the effects such as the Intensif and Infini.”
Laser is another popular non-surgical option for skin tightening.
“Laser uses directed laser energy to result in coagulation and ablation of the tissues which again stimulates a controlled wound response and the production of new, healthy collagen. The more heat that is delivered precisely into the skin, the more a tightening effect will be evident. Ablative lasers such as CO2 and Erbium are generally more effective for skin tightening as they ablate the epidermis causing a contraction of the tissues but they are associated with higher risk and downtime than non-ablative lasers,” Dr Jameson says.
“Ultrasound is gaining popularity as a skin tightening treatment, with ones on the market such as Ultherapy and Ulthera. Microneedling and Platelet Rich Plasma (PRP) also work as an autologous treatment utilising the body’s own plasma to regenerate the skin and repair damaged collagen and elastin fibres.”
Although there are a myriad of treatments to undo damage once it’s done, Dr Jameson stresses that prevention is key – because nothing beats “a strict adherence to a broad spectrum SPF 50+, topically applied antioxidants, such as vitamin C, L-ascorbic acid or niacinamide, and starting on a retinol (or one of its derivatives) from your 20s onwards.”
Story by Yadira Galarza Cauchi