The décolletage is an area of the body which tends to show the greatest signs of accelerated aging and sun damage – this is primarily due to its direct and unobstructed exposure to the sun.  Interestingly enough, this region is generally overlooked by patients, with a preference to focus treatments on the face and other areas of the body. It is always eye catching to me, when I see a patient who has obviously gone great lengths to take great care of their facial skin, and the neck and chest have been clearly overlooked over the years.

In younger patients, accelerated aging of the décolletage is easy enough to prevent (or at least lessen), with foundational de-aging skincare products including intelligent* sunblocks, Vitamin C serums and a medical grade tretinoin products.  For patients who have neglected the décolletage, there are treatment protocols that show promise and success in reversing sun damage and maintaining a more youthful looking neck and chest.  Before we discuss these options, lets first review how the skin ages and touch on what “skin aging“ actually means on a cellular level …

Understanding the Science of Skin Aging

Plastic surgery patients that present to our office wanting to improve the décolletage have the general complaints of age spots, sunspots, hyperpigmentation, fixed vertical lines, and the general appearance of leathery skin with unappealing texture. These findings, are of course, common in all aging skin, and as we know, the culprit is largely due to UV radiation in the form of sun exposure.

To quickly review the well understood processes of skin aging, lets consider the following:  It is well known that 90% of skin aging is due to the sun, and up to 90% of skin aging occurs before the age of 18!  These are staggering statistics, which warrant consideration. 

The biochemical process of skin aging can be simplified to a chronic inflammatory condition which can largely be localized to 3 biochemical pathways: 

1) The development of free radicals which lead to an upregulation of pro-inflammatory cytokines

2) The upregulation of MMPs (matrix metalloproteinases) 

3) The accumulation of Advanced Glycation Endproducts (AGE). 

To simplify, in skin aging we begin to notice diminishing production of elastin and collagen as early as the mid-20s, which coincides with a lack of collagen and elastin organization resulting in a progressive loss of skin elasticity and eventual thinning of the skin.  Over time, we begin to see a lack of circulation in dermis as well, which compromises the delivery of key nutrients to the skin. Additionally skin cell 

turnover slows with aging, and with that we begin to see textural changes in our skin which presents as unevenness. The effects of UV radiation on the skin causes melanocytes to increase the production of melanin, which results in increased sunspots.  Lastly, with a slowed cell turnover, we see associated changes in skin hydration, as lipids created from the cell turnover, which would normally provide moisture-plentiful environment, become scarce, leading to dry, dehydrated skin with diminished tone and elasticity.

Now that we understand what skin aging is, how it develops, and what its components are, the success treatment of the aging decolletagé will follow a protocol of inflammation management, whereby we address skin aging by influencing the inflammation regulatory process, and in doing so, we can effectively reduce the number of pro-inflammatory mediators which are the culprits behind accelerated skin aging.

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