Although the harmful effects of sun exposure are usually seen two or more decades later, eighty percent of the lifetime damage to the skin by ultraviolet radiation is believed to occur before the age of eighteen. This includes the development of roughened, coarse, leathery, wrinkled skin, a patchwork of pigmentary loss and unsightly brown spots, and an overall diminution in tone and elasticity owing to depletion and disruption of both the elastic and collagen fibers in the dermis that give the skin its resilience and structural support. It also frequently leads to a superimposed proliferation of an intricate, mat-like network of tiny, dilated, reddish, purplish, or bluish blood vessels (telangiectasia), often referred to (incorrectly) as "broken" blood vessels.
In no place are these changes more evident than in the broad, flat expanse of the decollete, the triangularly-shaped area of the chest extending down from the base of the neck to the cleavage between the breasts. Here, the accumulated damage described above bears the tongue-twister medical name of Poikiloderma of Civatte, which is usually evident by the time a woman has reached her late forties or fifties.
To compound this picture, the unrelenting downward pull of gravity during periods of pregnancy, nursing and overweight causes the breasts to sag with the passage of time.
If you have despaired of ever again wearing an elegant evening gown with a plunging neckline, or if you have given up on V-necks and resigned yourself to a life of high necklines, or if you have considered a surgical breast lift (mastoplexy) or implants to raise the breasts, but fear surgery, you can take heart. Non-Surgical chest enhancement and breast lifting may be just the answer for you.
As it does elsewhere, Botox has proven effective for diminishing wrinkles, crinkles and creepiness on the chest. A few tiny microdroplets spaced along a straight line just above the tops of the breasts can help to reduce the appearance of vertical wrinkles. Similarly, a number of minute amounts placed along an outwardly directed diagonal line beginning immediately above the inner side of each breast can help to diminish wrinkles that run horizontally. The accompanying photographs illustrate the use of Botox to reduce vertical wrinkle lines directly above and between the breasts.
A series of mild chemical peels may be used to combat widespread tone and texture problems. These include Jessner's solution (a mixture of low-potency acids), mild-strength trichloroacetic acid (10%-25%) and full-strength glycolic acid (70%). All have proven useful for smoothing the skin, lightening dark discolorations, and refreshing the general tone. Four to six in-office treatments spaced at two to four-week intervals are usually needed for best effect. I have found salicylic acid (30%) to be the most effective agent for managing decollete, but of course you and your doctor must decide what is best for you.
While some people experience slight redness and mild scaling that may last for a few days, as a rule, there is little or no downtime involved following any of these treatments. Fees for each treatment session may range from $250-$350. When more severe skin damage is present, a Golden Peel Plus, a medium depth peel, (see below) may be required.
Botox can be helpful for sagging breasts. Several different techniques have been developed. The one I favor consists of injecting small amounts of it into three sites along the chest muscles (pectoralis minor) located directly under the collarbone on both sides of the rib cage near the armpits. The slight weakening of these muscle areas that results allows the shoulders to be pulled backward by certain muscles in the back, the posture to be improved, and the breasts to be elevated.
Breast lifts of up to two-thirds of an inch have been achieved in this way. Two treatments are sometimes needed to maximize the effect, and the benefits may last up to four months. Ideal candidates are trim and fit women between the ages of 30 to 50 who are slightly stooped and round-shouldered. Fees range from $450-$900.
A Golden Peel Plus can also be employed for non-surgical breast lifting, either alone or in combination with Botox. It consists of two steps. The first involves the use of Jessner's solution, (a mixture of several, relatively weak acids), which acts as a kind of "primer" coat. The second is the application of a Golden Peel (Resorcinol 53%) to the entire exterior of the breasts, including the nipple and areola (the red area surrounding the nipple). Both chemicals are left in place for several minutes before neutralizing. Although some women do experience slight burning and discomfort, no local or even topical local anesthesia is typically necessary.
While a Golden Peel Plus can be performed over a lunch break, and may be considered a "lunchtime beauty fix," the results are not immediate, and there is a short healing period. Immediately afterward, the skin may be a bit red and slightly swollen. Three days later, the treated areas discolor to a reddish or light brown, and about two days thereafter, they form thick, dry, dark brown scales that take several additional days to fall off.
A series of four Golden Peel Plus treatments at two-week intervals may raise the breasts by as much as two-thirds of an inch, which is a particularly gratifying improvement in cases of mild breast flaccidity. Fees per treatment range between $300 and $400.
Although lasers and intense pulsed light (IPL) have each been employed successfully for treating "broken blood vessels, I prefer the use of radiowaves and have enjoyed great success with this modality over the years. With this method, a small amount of radio wave energy, akin to the type that is used by a regular AM/FM radio, is delivered through a hand-held probe and focused on the tiny capillaries. The disruption of the tiny capillaries that results leads to their ultimate disappearance. Hundreds of blood vessels can be treated in this fashion in one sitting in a matter of minutes. Most people require only topical anesthesia to reduce the "sting" that may be felt as the radio wave penetrates the skin.
Approximately 75 percent of people can expect to see an average of about 75 percent overall cosmetic improvement following two to four treatment sessions scheduled at intervals of two to four weeks. Fees may vary between $300-$400 per session.
Finally, there is nipple enhancement if you are looking to go bra-less again. Flat or inverted nipples or nipples stretched by breast-feeding can be quickly restored using either of the two available hyaluronic acid filling agents, Juvederm or Restylane. Following local anesthesia, a small amount of the material can be instilled directly under the nipples to give them what has been referred to as a "perk up." Results may last anywhere from six to twelve months, and a treatment generally runs between $750 and $1000.
With today's non-surgical chest enhancement and non-surgical breast lift techniques, you may once again be able to sport that risks neckline without risking surgery.