Billions of dollars go into an all-pervasive message telling us how important it is that we take care of the skin of our face. We're bombarded with images, products and services designed to keep our facial skin youthful, glowing and wrinkle-free. Unfortunately, that message isn't carried over to other areas of skin which are equally on display and often far more telling about how our skin, and bodies, are aging. There's a reason why women in the public eye have bemoaned their new wardrobe of scarves and turtlenecks as they age. In my own practice I have scores of women who have treated their face to decades of creams, chemical peels and laser treatments, all of which ended right at the jawline. This leaves the disconcerting and unnatural look of a youthful face on a much older neck and decollete. Hands can be equally telling and far more frustrating now that gloves are no longer de rigeur.
Unfortunately, the skin of these areas is significantly thinner than that of the face and rest of the body, so even with optimal care it often demonstrates accelerated aging. Chemical peels and laser treatments in this area need to be undertaken with great care and the correct tools to adapt to this difference as well.
That being said, dramatic and lovely improvements can be made in this area, often with some of the highest patient satisfactions of any area of treatment.
First off, any skincare that you do on your face should carry over to your neck, chest and the backs of your hands. Treat this skin with the same love and respect and you will be rewarded. I use my clarisonic brush with a sensitive brush head and all the same active ingredients - a light glycolic cleanser, an antioxidant vitamin C serum to build collagen, a low concentration of tretinoin (retin-A), hydroquinone for brown spots and a good quality moisturizer with peptides and other anti-aging ingredients. Each person's regimen will be a bit different, but those ingredients that are working well on your facial skin are almost certain to benefit these areas, too. You just need to gradually build up more potent ingredients such as acids and tretinoin here and really emphasize zinc or titanium mineral UVA sun protection. Under our bright mountain sun, this is the most important skin care treatment you have.
For any except those with the very palest skin types, I feel that deeper chemical peels off the face carry an unacceptable risk of hypopigmentation (scarring), hyperpigmentation (dark areas) and uneven results. Light peels can gently refresh these areas, but IPL and laser treatment offer the far greater control required by these delicate areas.
IPL (also known as Intense Pulsed Light or BBL, Broad Band Light) can do a lovely job at lifting brown spots and reducing reds and fine lines. It is especially effective on the hands which often respond in one to two sessions as compared to the usual 4-6 treatments that the face, neck and chest require. This therapy is safe on any part of the body and has no real downtime - patients might note slight flaking as their brown spots disappear, but this is unobtrusive and exactly the goal of treatment. It is important that patients minimize sun exposure and use a good sunblock for two weeks before and after each treatment, though.
Unlike IPL, which takes a series of treatments to achieve an optimal result, if patients can invest 5-7 days of downtime (redness and peeling), the chest area can be more dramatically refreshed by modalities such as a microlaserpeel, a very controlled laser resurfacing procedure which gently removes a precise depth of superficial skin (measured in microns - usually 4-15). This instantly lessens superficial brown spots, bumps and textural changes including fine lines. Laxity or loose skin resulting in much-hated necklace lines and wrinkling in the cleavage can be tightened up by deeper fractional resurfacing treatments which build collagen while tightening the skin. The most dramatic results can be obtained by layering all three treatments - IPL, then a microlaserpeel and finally a fractional treatment (click here to read more about fractional treatments). On each, settings can be customized according to the patient's concerns and time available for recovery.
Another advantage to treating the neck and chest is that it is an area which is easy to cover up with high necked clothes and scarves during the recovery, making treatments easier to fit into many's busy schedules.