o youngerTHE NECK The skin around the eyes is superthin. In fact, it’s the thinnest skin on the...

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As you enter your 40s, the thinning of your skin accelerates. This isn’t a change you’ll see overnight—it’s likely to take weeks, or even months, for the texture of your skin to transform. Melbourne, FL, dermatologist Anita Saluja, MD, says there are a few elements that cause skin to become crepey. “The sun, a loss of collagen and elastin, and a decline in moisture due to aging, can all cause changes in texture.” Crepey skin becomes more pronounced when there’s a significant amount of fat loss in the area (from aging or weight loss). “Chronic use of medications like steroids can also be a causative factor,” adds Dr. Saluja. A decrease in female hormones, which leads to dry skin, contributes to crepiness on the arms and thighs more so than the face. Hormonal replacement therapies may help improve the look of the skin.

WHY YOUR

SKIN CHANGES 01

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CALL IT WHAT YOU WILL: ELEPHANT SKIN, PAPER-THIN SKIN OR GRANDMA SKIN—IT’S ALL THE SAME, AND IT’S ALL

CREPEY. “CREPEY SKIN IS ONE OF THE MOST DIFFICULT SIGNS OF SKIN AGING TO PREVENT BECAUSE IT HAS SO

MANY DIFFERENT CAUSES AND CAN OCCUR ON SO MANY DIFFERENT PARTS OF THE BODY,” SAYS NEW YORK

DERMATOLOGIST MACRENE ALEXIADES, MD. BUT, JUST BECAUSE YOUR SKIN IS STARTING TO HAVE A MIND OF ITS

OWN AND LACKS THE FIRMNESS IT USED TO HAVE, DOESN’T MEAN YOU HAVE TO LIVE WITH IT LIKE THAT.

FAT LOSS +COLLAGEN & ELASTIN DAMAGE

+ A LACK OF MOISTURE

= THIN, CREPEY SKIN

Everyone is susceptible to crepey skin, but some skin tones and types are more likely to experience it than others. Anyone who’s prone to sun damage and has little melanin in their skin—think fair- and lighter-toned types—and those who bake in the sun or use tanning beds, may see signs of it faster or more intensely. Certain ethnicities, such as Latinas, African Americans and Asians, inherently have thicker skin than others, which may hinder the effects of crepiness to some degree.

WHO ITAFFECTS 03

Skin that has turned crepey is thin, loose and flaccid with a certain degree of sagging. Sacramento, CA, dermatologist Suzanne Kilmer, MD, says that crepey skin doesn’t look nearly as thick or plump as younger skin does. Often compared to the thinness of a piece of paper or a crêpe, it’s the thinning of the dermis and epidermis that make skin look like this. “Crepey skin differs from other types of skin aging,” says Dr. Alexiades. “It first appears as an increase in skin markings, which look like little dots around the hair follicle that start to merge into linear or diamond-shaped marks and connect the dots together.” Over time, the subtle creases and pores in the skin slowly become exaggerated as the breakdown of collagen and elastin becomes more evident. From there, skin folds accumulate and skin starts to thin out. Whereas a stretch mark is the cause of a dermal tear in the skin and a loss of elastin, and a wrinkle forms from repeat motions in one area, crepey skin is more so the result of a lack of skin thickness.

WHAT IT LOOKS LIKE

02

DID YOU KNOW?According to La Jolla, CA, plastic surgeon Robert Singer, MD, while these treatments may have benefits, they are not a replacement for surgery in patients with anything other than minimal concerns.

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THE NUMBER OF NONSURGICAL SKIN-TIGHTENING PROCEDURES PERFORMED IN 2014. SOURCE: ASAPS

298,223THE SKIN ON YOUR FACE GETS

MORE SUN EXPOSURE THAN

OTHER PARTS OF YOUR BODY,

MAKING IT MORE SUSCEPTIBLE

TO CREPINESS. “IF YOU DON’T

USE A GOOD SPF DAILY, THEN

YOU’RE PUTTING YOUR SKIN AT

RISK FOR DAMAGE,” SAYS DR.

KILMER. “SUN DAMAGE AFFECTS

ELASTIN AND COLLAGEN AND

CAN ACCELERATE FAT LOSS.

WHEN YOU LOSE FACIAL FAT,

YOU EXPERIENCE DEFLATION

LIKE HOW A BALLOON DEFLATES

WHEN IT LOSES AIR. UVA DAMAGE

ALSO TRIGGERS THE PRODUCTION

OF AN INTERLEUKIN (A GROUP

OF PROTEINS THAT REGULATE

WHITE BLOOD CELLS) THAT

CAUSES FAT TO BE LOST, TOO.”

The quality of the skin on the face is affected by sun damage, repeat muscle movement and a breakdown of the integrity of the skin. The eyes and neck are most likely to show crepiness first; over time, skin on the cheeks can start to thin, too. Plenty of women have crepey skin on their faces that also comes with sunspots—a dead giveaway that sun exposure has basically eaten away at the collagen, leaving the skin with little fullness or elasticity.

HOW TO FIX IT There’s more than one way to alleviate crepey skin on your face. “Peeling away fine lines with hydroxy-acid creams, lotions or chemical peels may help. Stimulating collagen with nightly retinoid creams or retinol may improve the look of your skin, too,” says Dr. Saluja. An ablative fractional laser can also amend your skin’s texture. “It’s the best thing you can do to minimize the crepiness, but it has the most downtime of the options,” says Dr. Kilmer.

THE FACE

B E F O R E

Edina, MN, facial plastic surgeon Edward Szachowicz, MD, used the Fraxel re:pair CO2 laser and Sculptra, a dermal filler, to address this patient’s age-related skin changes.

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WHAT ELSE TO DO: Swiss line by Dermalab Cell Shock Youth-Inducing Cream is full of plant-derived stem cells and collagen-promoting peptides and claims to help restructure skin’s underlying architecture so that it’s tighter. $270, shopswissline.com

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THE AFFECTED AREAS

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Crepiness on the neck is different from crepey skin elsewhere. The skin here is naturally thin and thins out even more once collagen and elastin begin to break down. Skin doesn’t just become loose; it also becomes laden with horizontal bands. Sun damage and smoking speed up the extent of the damage.

HOW TO FIX IT Most experts agree that the best way to tackle crepiness on the neck is with a laser that stimulates collagen production to thicken the skin. “My go-to is the Fraxel Dual laser, which contains both erbium and thulium wavelengths,” says Dr. Waldorf. “It makes a difference on thin areas of skin with just one treatment.” Because neckbands are a contributor, too, those can’t be glossed over, which is why a neuromodulator like Botox, Dysport or Xeomin is necessary. “It helps where muscle movement aggravates the appearance of the neck, making the crepey skin bunch up,” Dr. Waldorf adds.

THE NECK

The skin around the eyes is superthin. In fact, it’s the thinnest skin on the face. Years of environmental damage and squinting can wear away the thickness of the skin, making the eyes look worn out. “The skin here looks like crêpe paper—very thin with fine puckers. Patients with eczema often have crepey skin around their eyes, even if they are younger, due to the chronic inflammation and dryness,” says New York dermatologist Heidi Waldorf, MD. While genetics do play a role, once the skin around your eyes begins to look crepey, it affects your overall appearance.

HOW TO FIX IT The extent of how thinned out your skin is will determine what is best. Some dermatologists and plastic surgeons prefer a one-two punch method that consists of first smoothing the skin with a series of chemical peels around the eyes or fractionated CO2 laser treatments on the eyelids (you will be put under anesthesia so you won’t feel anything, but plan for a few days off to fully recover at home), which stimulates collagen to help thicken the skin. Then, once the skin has begun to soften and increase in thickness, Botox and/or a hyaluronic acid filler can be injected into the little lines around your eyes to help minimize them.

THE EYES

WHAT ELSE TO DO: Because the skin around the eyes is thin, it’s best to use an eye cream with ingredients that are as pure as possible (to reduce the risk of irritation and reaction). Blending science with nature, Schaf Skincare Nutritive Daily Eye Cream is free of toxins, fragrance and parabens and helps to smooth and firm the eye area with peptides, CoQ10 and hyaluronic acid. $40, schafskincare.com

F I N D A B E A U T Y D O C T O R N O W!The essential guide to help you make the right choices. Turn to page 193.

WHAT ELSE TO DO: Loading skin with firming ingredients like peptides and niacin will help tighten it and downplay its loose texture. NIA 24 Neck Sculpting Cream is the perfect adjunct to use with in-office treatments because it adds moisture and gives a tightening effect over time. $118, skinstore.com

Crepiness on the neck

skin elsewhere. The skin here

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CREPEY SKIN ON THE BODY IS FORMED THE SAME WAY AS ON THE

FACE, BUT THE BIGGEST POINT OF DISTINCTION IS THE ROLE THAT

WEIGHT LOSS PLAYS. YOU’VE ALREADY GOT THE SUN DAMAGE AND

COLLAGEN BREAKDOWN, AND WHEN YOU ADD WEIGHT LOSS INTO

THE MIX, YOU CAN BE LEFT WITH SKIN THAT’S THIN, STRETCHED

OUT AND ALMOST MUSHY. ANOTHER DIFFERENCE: “IT’S HARDER

TO TREAT SKIN ON THE BODY WITH ANTI-AGING ACTIVES ON A

DAILY BASIS BECAUSE OF THE AMOUNT OF SKIN THAT NEEDS

TO BE COVERED WITH PRODUCT,” SAYS DR. ALEXIADES.

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THE KNEES

THE HANDS

Aged hands are a telltale sign of how old you are. They’re notorious for becoming wrinkly over time and displaying signs of crepiness, which results from both sun damage and fat loss. Overwashing your hands can also zap your skin of moisture, which needs to be replaced often.

HOW TO FIX IT Long-lasting collagen fillers are the go-to for most doctors. “Fillers like Radiesse and Sculptra can improve the appearance of your skin by revolumizing the area,” says Dr. Saluja. “Another option is Ultherapy (a noninvasive ultrasound treatment that tightens and lifts skin), which is now being used to treat crepey skin on the hands, too.” Applying Retin-A to the backs of your hands nightly, and sealing it in with a layer of moisturizer that contains ingredients like urea, shea butter, petrolatum, mineral oil or hyaluronic acid, will also help improve skin texture so that it begins to look thicker and firmer over time.

urea, shea butter, petrolatum,

acid, will also help improve

begins to look thicker and firmer over time.

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WHAT ELSE TO DO: Firm and hydrate loose skin with DermaQuest Stem Cell 3D Body Crème, a botanical-based anti-aging body cream. $70, dermaquestinc.com

Years of basking in the sun, plus weight fluctuation, can cause skin around the knees to become loose and crepey.

HOW TO FIX IT For this part of the body, Dr. Alexiades says she’s had success with the Profound laser, a minimally invasive injectable laser treatment, which delivers energy deep within the skin via fine needles at a threshold temperature. “Bypassing the skin’s surface allows for more energy to be delivered than with a skin surface tightener.”

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THE AFFECTED AREAS

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Skin on the inner thighs loses firmness over time, becoming loose and more stretched out. Just like how skin on the rest of the body becomes crepey, the same thing happens to the skin on the thighs, which is naturally thinner than other parts of the body.

HOW TO FIX IT The most effective way to improve the appearance of crepiness on the thighs is with topicals. “One of the best things to use is retinol or Retin-A, or even a DNA repairing cream that’s designed for the face,” says Dr. Alexiades. “When dealing with the thighs and other large areas of the body, it can get expensive because you have to use more product to cover all of the skin. But, it’s one of the best ways to limit the effects of crepiness.”

THE THIGHS

Crepey skin on the chest becomes accentuated by sun damage. A lack of moisture in the area—the chest is often exposed to the sun and other environmental damagers—only makes the crepiness (and any wrinkles) more pronounced.

HOW TO FIX IT Treatments like microdermabrasion can help smooth out skin, but for more of a transformation to the skin’s surface, your doctor may recommend anywhere from one to five sessions of Fraxel. “We’re also using Ultherapy to treat crepiness on the décolleté because it stimulates collagen production in a deeper layer of skin,” says Dr. Saluja. Microfat grafts may also be a beneficial solution for some patients.

THE CHEST

The undersides of the arms, the elbows and the area where the arms connect to the chest near the armpits, are some of the crepiest areas on the body. “Women get it so bad here,” says Dr. Kilmer. “Part of the reason why it’s so apparent on the undersides of the arms is because of hormonal changes due to menopause. As estrogen levels drop in the body, collagen is diminished, so there’s less supportive collagen in the arms and thinning skin becomes more noticeable.” When you lose weight in your arms, which can be an area that fluctuates, the skin becomes stretched out.

HOW TO FIX IT A skin-tightening treatment, which helps firm skin by inciting new collagen to be made, may be needed. And, because the arms are a hard area to treat, a more accurate microinvasive skin tightener, such as ThermiTight, may be your best option. It works differently than more traditional radio-frequency treatments in that it “injects” energy deep into the skin with tiny probes (the areas are first injected with anesthetic, so you won’t feel much during the treatment). The results take up to six months to see and some doctors say they are not yet certain if they are long-term. You may be swollen for a few days afterward, but the brand claims you typically only need one 60-minute treatment for it to work.

THE ARMS& ELBOWS

WHAT ELSE TO DO: Rich in skin-softening

and retexturizing glycolic acid, Glytone Ultra Heel and Elbow

Cream helps transform skin. $50, dermstore.com

WHAT ELSE TO DO: Restorsea Repairing Neck and Decollatage Treatment improves skin texture with a patented natural enzyme and vitamin C. $150, restorsea.com

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In addition to keeping skin moisturized, preserving the integrity of your skin’s collagen and elastin is key. “The best way to do this is through the regular and consistent use of anti-aging ingredients. Intermittently, you should undergo laser or energy-based treatments, which can make bigger contributions to the collagen, elastin and hyaluronic acid content in the deeper levels of your skin,” says Dr. Alexiades. Topical products that contain growth factors, peptides, alphahydroxy acids and retinoids will help, too.

STIMULATECOLLAGEN

02

Hydration is important for maintaining healthy skin. Properly moisturized skin looks fuller, plumper and more resilient and snaps back into place. On the flipside, a lack of moisture will make crepey skin look worse—drier, thinner and unable to recoil. Dr. Waldorf says that when crepiness is a matter of lost hydration (which is common in patients with atopic dermatitis skinconditions), applying a bland barrier cream or occlusive, like Vaseline, will help.

MOISTURIZE REGULARLY

01You want to try to keep your weight fairly consistent and not fluctuate too much. The reason: “Fat loss will increase the appearance of lines and wrinkles and crepey skin,” says Dr. Waldorf. With less of a cushion of sorts to support the skin, changes in skin quality and texture become much more evident. “In some areas, patients with crepey skin can improve its appearance with very small superficial injections of a thinner hyaluronic acid filler like Belotero, or one that gives a skin-boosting effect like Restylane Silk.”

MAINTAIN A STABLE WEIGHT

03

If crepey skin is a problem, these skin-care ingredients, which are commonly found in creams, lotions and serums, can help improve the look and feel of your skin.

ESSENTIALINGREDIENTS TO USE

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ALPHAHYDROXY ACIDS

Besides brightening skin, AHAs like glycolic acid help repair collagen and bring new skin cells to the surface.

CERAMIDES

Naturally found in skin, ceramides lock in water so moisture doesn’t escape.

GLYCERIN

With its slick feel, glycerin draws on water in the air to lock it into your skin, which is why these work best on damp skin.

HYALURONIC ACID

This ingredient helps to lock in moisture by attracting water to the area and plumping up the skin.

PEPTIDES

Peptides promote collagen production, which leads to stronger, firmer and smoother skin.

WHAT ELSE TO DO: OKU offers personal skin-care coaching through your phone. The handheld device uses light and sensor technology to assess changes below your skin’s surface, up to 2 millimeters, and then gives suggestions on how to prevent and correct them. $299, getoku.com

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INSIDE

tipWhen it comes to correcting crepiness, Dr. Saluja says it’s important to know that treating crepey skin is one of the most difficult tasks to accomplish in aesthetic medicine. There’s only so much improvement that can be done due to the biological components of crepey skin. “It’s best to keep your expectations realistic,” she says. The crepier the skin, the less healthy the collagen and elastin is.

Because the sun is directly responsible for degrading healthy collagen and elastin, which makes skin look weathered, crepey and loose, it is crucial to use sunscreen daily on both your face and areas of your body that are exposed. NB

PROTECT YOUR SKIN FROM THE SUN

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PETROLATUM

Superthick—it’s in a lot of moisturizers—petrolatum keeps moisture in the skin by creating a seal of sorts.

RETINOL

Whether you use an over-the-counter or prescription-strength version, this vitamin A derivative thickens skin.

SHEA BUTTER

An intense moisturizer, shea butter is loaded with essential fatty acids that keep skin hydrated and pliable.

UREA

It works to thicken skin, address changes in skin texture and exfoliate, too.

WHAT ELSE TO DO: Vaseline Intensive Care Healing Serum moisturizes skin on the body and delivers a dose of concentrated ingredients to lock moisture in and keep skin perfectly hydrated. $8, target.com

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o youngerTHE NECK The skin around the eyes is superthin. In fact, it’s the thinnest skin on the...

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Transcript of o youngerTHE NECK The skin around the eyes is superthin. In fact, it’s the thinnest skin on the...