America\'s Dermatologist

Drooping, sagging skin is one of the telltale signs of aging.

It happens to everybody eventually, although certain factors can push the process along more quickly.
 

What Causes Facial Skin to Sag?

The main causes of sagging facial skin can be summed up in a simple equation: aging + sun exposure + gravity. As we grow older, our skin loses two types of connective tissue, collagen and elastin, which are essential for making skin look tight, plump, and youthful. Facial muscles also weaken with age, and the malar fat pads under the cheeks descend as well. Repeated exposure to sunlight (and other
lifestyle factors, especially smoking) greatly speeds up this process. Then, as the skin becomes less elastic, it becomes more vulnerable to the persistent pull of gravity.

As facial skin sags, two major folds form: the nasolabial folds that run from the corners of the nose to the corners of the mouth and the “marionette” lines that run from the corners of the mouth to the jawline. Sagging skin also causes the forehead to permanently furrow, the eyelids to droop, neck skin to lengthen, and jowls to appear.
 

What Causes Body Skin to Sag?

Loosing a lot of weight—for example, after having gastric-bypass surgery—can result in large amounts of loose, sagging skin, particularly on the abdomen, buttocks, thighs, and upper arms. No amount of stomach crunches, pushups, or leg curls will tighten that skin.

Women who have gone through a pregnancy also develop loose skin, particularly around the abdomen. Often (but not always) they can re-contour their body to its pre-pregnancy shape through exercise and careful dieting.
 

What Treatments Are Available for Sagging Skin?

Several cosmetic treatments can help tighten mildly loose skin and help minimize the appearance of any deep facial folds that have formed as a result. Severely drooping skin can also be treated, but usually surgery is required. Talk with your physician about your options.

• Injectables and dermal fillers. Injections of products containing botulinum toxin, such as Botox and Dysport, can temporarily help soften furrows (especially those on the forehead) that develop as skin loses its elasticity. Dermal fillers—products like Restylane, Perlane, and Sculptra—can help temporarily plump up and smooth out nasalabial and marionette lines.
• Radiofrequency rejuvenation.This non-invasive procedure uses radiofrequency waves to stimulate collagen production deep within the dermis. As the new collagen forms, the skin becomes firmer and tighter.
• Laser liposuction. This minimally invasive liposuction uses a small cannula placed under the skin to remove pockets of unwanted body fat. It also stimulates collagen formation, causing the skin of the treated areas to contract and tighten.
• Laser resurfacing. This procedure, which removes the skin’s top layer, can improve moderately deep wrinkles. Laser resurfacing requires, however, at least a week of home recovery and presents some risks, including discoloration of the skin.
• Surgery. For deep and extensive wrinkles, a facelift (rhytidetomy), tummy tuck (abdominoplasty), arm lift (bracheoplasty), or other surgical procedure is often the only treatment option. Although such surgery is very common today, it should not be undertaken lightly. Seek care from an experienced plastic surgeon.