“Peach pit chest” is how Dr. Joel Cohen has come to describe the sun-damaged décolletage, after one of his patients likened her own crepey, dappled chest to the pebbly seed. “I think décolleté rejuvenation is becoming much more common,” says the board-certified Denver dermatologist. “People have gotten better about sun protection on their face, but [with the chest,] they tend to lose sight of protection as well as rejuvenation strategies, until the décolleté becomes very apparent.”
How sun damage presents on the chest
Sun damage can start to show on the chest as early as the 20s, in the form of brown spots and broken capillaries or ruddy patches. Over time, discoloration can become widespread and increasingly stubborn. “Some patients think they have a permanent sunburn from the persistent redness,” says board-certified Santa Monica, California, dermatologist Dr. Karyn Grossman.
As collagen and elastin production wane, the skin of the chest thins out and vertical creases eventually develop. “A lot of women assume it’s just from the way they sleep, but it’s really [due to] the nature of the musculature and the way the collagen fibers are aligned in this area,” explains board-certified New York City dermatologist Dr. Paul Jarrod Frank.
While lighter complexions naturally accrue more sun damage than skin of color, UV-induced symptoms “can be seen in darker skin as well—particularly the loss of collagen and changes in texture,” says Dr. Corey Hartman, a board-certified dermatologist in Homewood, Alabama. “Darker skin may not display hyperpigmentation and telangiectasia [broken blood vessels], but hypopigmentation [or skin lightening] is common as a result of chronic ultraviolet light exposure.”
How the chest’s anatomy influences cosmetic treatments
Regardless of tone or ethnicity, the skin of the décolletage tends to be thinner than that of the face and takes longer to recover from procedures. “The chest has fewer skin appendages, like hair follicles, sweat glands, and oil glands, which aid in healing and promote the production of collagen and elastin fibers,” Dr. Hartman tells us. “It has a lower capacity to heal and to stimulate natural growth factors that aid in prevention of skin aging.”
When lasering this area, he adds, “it’s important to remember that it may not recover as well post-procedure.” Accounting for these anatomical differences, doctors routinely modify treatments—dialing back energy levels on devices, for instance—and take a slow-and-steady approach overall, to avoid burning or scarring the vulnerable chest, notes Dr. Omar A. Ibrahimi, a board-certified dermatologist in Stamford, Connecticut.
Patience is certainly a virtue with the décolletage. “The chest takes twice the number of treatments to accomplish the same types of results as on the face—and the recovery is twice as long,” says Dr. Frank. “Most people need two to three treatments of whatever we’re doing on the chest, but the nice thing is that these results tend to last.”
When we polled dermatologists and plastic surgeons from around the country for their chest-rejuvenation protocols, we saw nuanced variations on the themes of thickening and evening the skin with a combination of injectables and devices geared at erasing spots, quieting redness, and smoothing textural blips. These are the most popular procedures for restoring a weathered décolletage.
Lasers and lights for uneven tone and texture
“No matter what cosmetic issue someone is complaining about, I’m always going to get rid of the superficial sun damage first and then work my way down,” says Dr. Frank. “The chest is a very common area to develop nonmelanoma skin cancers. Whatever we do to get rid of the sun damage is going to dramatically reduce the risk of first-time or recurring skin cancers.”
The doctors we spoke to rely most frequently on fractional lasers (like the Halo, Fraxel Dual, Moxi) as well as gentler picosecond lasers, which require a series of treatments for best results. These resurfacers spark a repair process that speeds cellular turnover to cast off sprawling hyperpigmentation while subtly enhancing the skin’s texture.
To tackle diffuse redness and broken capillaries, doctors reach for vascular lasers or intense pulse light (IPL) devices. While only the former is generally safe for skin of color, IPL boasts the advantage of “treating both red and brown discoloration at the same time—although we usually see improvement in brown more quickly,” Dr. Grossman shares.
As a finishing touch, notes Dr. Paul M. Friedman, a board-certified dermatologist in Houston, doctors can zap remaining isolated sunspots with pigment-specific lasers—like the Q-switched ruby, Nd:YAG, or alexandrite—most of which call for several sessions.
Fillers and biostimulators for thinning skin
When our faces thin out with age, volume is generally the answer. But on the chest, bulk is undesirable—which is why doctors routinely dilute (or hyperdilute) collagen-building fillers before injecting them, explains Dr. Hartman.
Both Sculptra and Radiesse work gradually, over multiple visits, to thicken the skin and minimize the look of creases. Dr. Grossman typically starts with two syringes of Radiesse or one to two vials of Sculptra, with follow-up injections six to eight weeks apart.
While the derms we interviewed unanimously champion biostimulators, each has their favorite. “When it comes to Sculptra versus Radiesse, it’s dealer’s choice, really,” says Dr. Mitalee Christman, a board-certified dermatologist in Boston. “I find Radiesse can swell more, so I’m just more comfortable with Sculptra.”
And then there’s Renuva, which aims to build fat rather than collagen. “For someone who is more skeletal, I’ve found it to be a great choice,” says Dr. Grossman. “It allows fat cells to migrate in and repopulate the area. This cushion of fat helps with texture and wrinkles and will hopefully provide a bevy of stem cells to keep the skin looking better for years to come.”
For lingering wrinkles, “we sometimes use hyaluronic acid fillers, which are very effective and long-lasting for vertical lines in the chest,” adds Dr. Frank.
Radiofrequency and ultrasound for laxity and creping
Ultrasound and radiofrequency (RF) build collagen over time for a subtle firming effect. Noninvasive devices like Ultherapy and Sofwave deliver ultrasound energy through the surface of the skin. Radiofrequency can also be applied this way—think: Thermage—but doctors can also drive it deeper into the dermis with RF microneedling tools like the Morpheus8 or Genius.
“For crepey skin, especially, I like RF microneedling, which will help with the texture while also tightening,” says Dr. Nazanin Saedi, a board-certified dermatologist in Philadelphia. Patients typically need three treatments, four to six weeks apart, and it’s safe for all skin types, she adds.
Dr. Cohen will sometimes layer various forms of energy for maximum tightening potential. “If there’s laxity, using Morpheus8 RF microneedling as well as Ultherapy microfocused ultrasound allows two different types of energy delivery to really help with collagen induction for the more significant décolleté sun damage, creping, and ‘peach-pit’ appearance,” he says.
One final PSA
Our doctors urge vigilant sun protection when treating the chest and encourage the use of high-SPF sunscreens plus a moisturizing retinol or a growth factor serum to bolster the effects of in-office treatments. Beyond those few key topicals, however, there’s no need for fancy chest-specific products. “My phone feeds me ads for pillows to help you sleep on your back and stickers to smooth vertical lines while you sleep, but I don’t ever recommend these,” says Dr. Christman. “I’m ambivalent enough about the youth industrial complex dominating our wakefulness, and I quite resent its extension into sleep. Let the woman rest!”
