Sagging skin — a problem you can fight at any age

You have lost ten kilos. The effort was enormous, the scale shows the result — but in the mirror, instead of satisfaction, a new problem appears. The skin on your abdomen and thighs has not kept up with the rest of your body.

Or another scene: in the morning, while putting on your makeup, you notice that the skin under your eye sits differently than it did a year ago. More delicately. More loosely.

It is the same issue, only in two different places. It is called skin laxity and it is not reserved for any one age group.

Why skin stops holding its shape

Two proteins are responsible for firmness and elasticity: collagen and elastin.

Teenagers naturally have plenty of them, which is why their skin looks the way it does. The problem is that the production of these proteins slows down as early as around your twentieth birthday. Not after forty. After twenty.

It shows first around the eyes. The epidermis there is exceptionally thin and the mimic muscles exceptionally strong — the effect of their daily work is quickly recorded in the form of under-eye wrinkles and crow's feet.

This is a completely natural process. The good news is that it can be slowed down.

An abdomen after weight loss and an abdomen after pregnancy are two different stories

Sagging skin on the thighs or abdomen most often affects patients who have changed their lifestyle and lost a lot of weight in a short time.

The body has shed the excess fat tissue — but the skin was not given time to adapt to the new body shape. Hence the disappointment after months of well-done work.

The second group is women after pregnancy. Even the fit and active ones. If the skin was not properly oiled and moisturized during pregnancy, the part that can be especially stubborn is the lower abdominal fold.

What you can avoid now so there is nothing to repair later

If you do not yet see a loss of skin density in yourself — this is the best moment to take care of prevention. It is remarkably simple:

• moisturizing eye creams,
• consistent sun protection,
• physical activity that keeps your muscles and skin in good condition.

That is it. No magic. But some changes cannot be avoided anyway — and that is when the conversation about treatments begins.

What aesthetic medicine can do today

Technologies change, devices are refined, and research into new methods of stimulating collagen production continues without a break. In practice this means one thing: there is no single treatment for sagging skin, there are more than a dozen, and the choice depends on where the problem occurs and how advanced it is.

Below is a short overview — the face first, then the body.

Microneedle radiofrequency — spectacular and with no recovery time

Very thin needles inserted under the skin emit radio waves. This produces a controlled overheating of the tissue, and in overheated tissue the body immediately launches a repair process.

The first effects are visible after a few weeks, but the remodelling of collagen is spread over months — the full result is usually assessed after three to six months. A series of 3–4 treatments is the standard; a single treatment is rarely enough, and the effect needs maintaining.

The laser that leaves no sign you have been to a doctor

The non-ablative Nd:YAG laser in Q-Switch mode is a non-invasive lift that deals with wrinkles and laxity at the same time. It tightens the skin and stimulates it to produce collagen.

It does not damage the epidermis, so it requires no recovery time. The results are natural, and that is why the treatment is liked not only by women but also by men who want to look younger without visible signs of intervention.

A bonus worth knowing about: along the way it reduces discoloration and shrinks pores. On oilier skin this gives really good results.

Infrared thermolifting — contraction and rebuilding

Infrared radiation at a specially selected wavelength (1100–1800 nm) causes the collagen fibers to contract and a visible reduction of wrinkles.

It works on two tracks, and that is the most interesting thing about it:

• thermal contraction of the existing collagen fibers happens almost immediately, on the day of the treatment itself,
• neocollagenesis, the formation of new fibers, takes place over 1 to 6 months — and it is what accounts for the lasting results.

The skin is densified and tightened, its firmness and elasticity increase. The method is suitable both for the face and for the décolletage, buttocks, abdomen or thighs.

It is worth knowing what scale of effect to expect. In studies using a device working in the infrared, after two treatments a month apart, objectively measured skin tightness improved by about 10–12% over the cheekbone, in the upper part of the neck and along the jawline. The patients themselves rated the improvement higher — about 32% for the cheeks. That is a real, visible change, but it is not a substitute for surgery and it has to be planned with that in mind.

Injections: when the skin needs material delivered to it

Needle treatments work differently from devices. They do not heat and do not tighten — they deliver a specific building material to the skin, or a signal to get to work.

Needle mesotherapy

With a microneedle I administer hyaluronic acid, which moisturizes the skin and restores its density, and calcium hydroxyapatite, which stimulates collagen formation.

This is an option for patients who want three things at once: deep hydration, radiance and firmness, and along the way the replenishment of any volume loss in the facial contour.

Mesotherapy with type I collagen

The second variety of needle mesotherapy uses type I atelocollagen — a collagen that stimulates the body to produce its own.

After the treatment the skin regains firmness, is better tightened and denser, and any deficits are filled in.

Platelet-rich plasma, or the so-called vampire lift

The material here is the patient's own blood. We centrifuge it and obtain plasma with a very high concentration of platelets.

Platelets contain a high concentration of active substances — natural growth factors involved in the repair and remodeling of tissue. Because the plasma is biocompatible, the body does not treat it as a foreign body.

What happens after the treatment:

• after the very first session the skin is smoothed and regains an even, healthy tone,
• its firmness and elasticity improve,
• the stimulated fibroblasts start producing collagen, so after a few weeks the skin becomes noticeably denser.

One note about the evidence. Platelet-rich plasma has an advantage over control treatments confirmed in randomised trials — in the assessment of patients as well as of doctors — but the effect is moderate, not spectacular. The studies are also small and differ in the way the plasma is prepared, so results from one clinic do not translate directly to another. Safety is good: the frequency of adverse effects did not differ significantly from the control groups.

Plasma also works excellently as a complement to mesotherapy.

PDO and PLLA threads

A treatment particularly recommended for women over the age of 40, who show signs of reduced collagen production.

The threads immediately firm the skin of the face and at the same time stimulate the production of collagen and elastin. They are fully dissolvable, they require no incisions, and the treatment can be repeated if needed.

Threads are an invasive treatment and it has to be said honestly what can be expected of them apart from the result. The most common thing is swelling — it affects roughly one third of patients. Less often there are dimples in the skin, temporary numbness of the area or a thread you can feel under the skin; then we come back to the treatment room. Satisfaction with the result is highest right after the treatment and after six months it is usually already somewhat lower, which is why threads are planned as part of a longer strategy and not as a one-off solution.

And what about thighs, abdomen and buttocks

Here is the good news: every one of the treatments described above works just as well on the body. The skin of the thighs or abdomen responds to the same stimuli as the skin of the face.

There are, however, two methods designed specifically for the body.

Endermologie

A special head simultaneously massages and suctions the tissue. It uses electronically controlled rollers and a vacuum effect, which together act on all layers of the skin.

The effect comes primarily from improved circulation and drainage: the skin becomes firmer and smoother to the touch, and in studies body circumferences went down by an average of nearly three centimetres per area. On cellulite itself the method acts gently — it improves its appearance but does not remove it.

Shockwave therapy

The treatment uses an acoustic wave, that is, a mechanical wave of high pressure and very short duration. This is not an electric current and it does not replace the work of the muscles. The energy penetrates deep into the tissue, and the impulses produce vibrations that cause alternating mechanical stretching and relaxation of the connective tissue.

The list of effects is long:

On the body the arithmetic is different from the face. Shockwave treatments and endermology are always a series — in clinical trials usually six to eight sessions performed once or twice a week, not single visits. Nor is there reliable data on what happens to the effect after a year has passed, so you have to assume it will need maintaining. If after a large weight loss the excess skin is considerable, none of these treatments will remove it — the conversation then concerns surgery, not aesthetic medicine.

• rebuilding and densification of collagen and the formation of new capillaries,
• firming of sagging skin,
• increased firmness and elasticity,
• smoothing of irregularities after liposuction and lipolysis,
• improved microcirculation and metabolism in the treated area,
• improvement of the microcirculation in the skin,

Which treatment for what — a summary

• Microneedle radiofrequency — Thin needles emit radio waves, controlled overheating triggers repair · Face, body · First effects after a few weeks, the full result after a few months; a series of 3–4 treatments.
• Nd:YAG laser (Q-Switch) — Non-ablative lift without damaging the epidermis · Face — especially oilier skin and skin with discoloration · Gradually, with no recovery time.
• Infrared thermolifting — A 1100–1800 nm wave contracts collagen and stimulates new collagen · Face, décolletage, buttocks, abdomen, thighs · Contraction on the day of the treatment, new collagen within 1–6 months.
• Needle mesotherapy — Hyaluronic acid moisturizes, calcium hydroxyapatite builds collagen · Face, neck, décolletage · Gradually.
• Mesotherapy with type I collagen — Atelocollagen stimulates the production of the body's own collagen · Face, areas needing densification · Gradually.
• Platelet-rich plasma (PRP) — Growth factors from your own blood activate fibroblasts · Face, body · Tone after the 1st treatment, density after a few weeks.
• PDO / PLLA threads — They tighten mechanically and stimulate collagen and elastin · Face — patients over the age of 40 · Firming immediately.
• Endermologie — Massage with tissue suction, rollers and vacuum · Thighs, abdomen, buttocks · Gradually, in a series.
• Shockwave therapy — An acoustic wave stretches and relaxes the connective tissue · Body, also after liposuction and lipolysis · Gradually, in a series.

Finally: the clinic is not everything

Even the best treatment cannot stand on its own. The treatment is always complemented by what you do between visits:

• more movement,
• getting enough sleep,
• reducing stress as far as possible,
• a diet rich in fruit, vegetables, whole grains and plenty of water.

These are not empty tips. They are literally the recipe for extending the durability of the results you have paid for.

And one more thing, because it is the most common question in the office: sagging skin does not mean it is too late. It only means the skin has stopped keeping up — and that can be made up for at any age. All it takes is matching the method to the problem, not to the age on your ID.

To rebuild firmness from within we use tissue stimulators — a group of products that stimulate the skin to produce its own collagen. The type of stimulator is selected by the doctor.

This article was prepared by Joanna Kuschill-Dziurda, MD, PhD.