Knee wrinkles may sound like a trivial concern—the cosmetic equivalent of a first world problem. But given a moment’s consideration, this particular insecurity seems, to us, every bit as valid as, say, banana rolls or a mottled décolletage or sinewy hands—all of which have been drenched, zapped, and injected over the years in order to evade scrutiny. So why not the knees—these blatant bull’s-eyes intersecting our legs? As with other changes we develop with age, we can choose to embrace time-worn knees—finding beauty in the crags and creases, deeming them a privilege of sorts—or aim to reverse that which is tanking our confidence.
Personally, as knee before-and-afters have become more regular fixtures in my social feeds, I’ve acquired a new appreciation for (slash mild obsession with) this body part. When I recently asked my husband (after a beer or two) if my knees made me look old, his expression said what his mouth perhaps knew not to: “So now we’re worried about our knees?” But even he came to admit, days later, that once you start noticing knees, it’s kind of hard to stop.
This may be why doctors are seeing an increased interest in anti-aging treatments that address sagging skin in the knee area. Dr. Deanne Mraz Robinson, a board-certified dermatologist in Westport, Connecticut, considers such procedures to be a “natural extension of our body sculpting and aesthetic services,” she says. In her office, those seeking knee-specific fixes are sometimes still in their 20s but, most commonly, are in their late 30s through 50s—typically, women who’ve already invested in facial cosmetic treatments like injectables, lasers, and light therapies.
Board-certified New York City plastic surgeon Dr. Umbareen Mahmood agrees that saggy knees and related wrinkles on the legs are perfectly reasonable cosmetic concerns, acknowledging that patients today are “more concerned with global aging than they were several years ago.” Confirming my earlier suspicion, she adds, “You’re not imagining it—very similar to the hands and neck, knees can be a telltale sign of aging, despite a rejuvenated face.”
Why are your knees sagging?
Indeed, the anatomy of the knee—being built to flex—makes it susceptible to early signs of aging. “Everyone has ‘extra’ skin above their knees—without it, we wouldn’t be able to bend them,” says Dr. Mraz Robinson. “When you pair that ‘extra’ with the frequent movement of this area and the natural declines of collagen and elastin in the skin as we age, you will start to notice skin laxity.” Sun damage, weight loss and weight gain, genetics, and gravity all contribute to knee wrinkles and sagging in patients across ethnicities and body types, adds Dr. Mahmood. Beyond loose skin, it’s not unusual to store some fat above the knees, which can manifest as folds.
How can you fix saggy knees?
For those hoping to rehab this region, there exist both nonsurgical and surgical solutions. Generally speaking, doctors find that combining energy-based devices with collagen-growing injectables works best for improving mild to moderate laxity on patients of all skin tones who are within range of their ideal body weight. If sagging is more severe, surgery—removing excess fat and/or skin—could be considered in lieu of or along with noninvasive measures, Dr. Mahmood tells us. Here, a rundown of the best options.
Biostimulator injections
Radiesse (calcium hydroxylapatite) and Sculptra (poly-L-lactic acid, or PLLA) are considered biostimulators because they trigger our bodies to produce collagen proteins. In its unadulterated form, Radiesse is a brawny paste—thicker than a hyaluronic acid gel—delivering instant oomph in addition to long-term plumping, courtesy of fresh collagen. Sculptra, on the other hand, is a syrupy liquid, which gets absorbed by the body within about 48 hours, leaving behind PLLA particles onto which new collagen grows. When the initial swelling from this shot dissipates, you’re back to baseline, waiting (at least six weeks) for that promised collagen production boost.
When treating the knees and other thin-skinned body parts, doctors like to dilute or hyperdilute these fillers by adding more saline and/or lidocaine than they normally would for the face. This not only enhances the products’ spreadability, but “when the products are made hyperdilute, they’re able to stimulate more fibroblasts—and thus more types III and I collagen—in comparison to their nondilute form,” explains Dr. Mraz Robinson.
As for which is right for you? Well, “there are no head-to-head trials comparing dilute Sculptra to Radiesse,” notes Dr. Mraz Robinson. That said, when she wants a greater volume of product to work with, such as when treating the knee skin or buttocks, she tends to choose Sculptra over Radiesse—the solution simply covers a wider expanse. Of course, your doctor may feel differently—and our experts say that both are solid options for rejuvenating the knees.
Interestingly, while many patients prefer straight Radiesse to Sculptra for facial filling—appreciating the out-of-the-gate inflation it gives—diluting the paste for body-refining purposes changes its properties a bit—and sort of levels the playing field between the two biostimulators. In fact, recent Radiesse data shows that “the higher the dilution used, the smaller the immediate volumizing effect”—so, as with Sculptra, significant improvements may not be obvious for several weeks.
Both injectables can require multiple syringes or vials (at roughly $1,000 each) and repeat treatments, for results that last upwards of two years.
Ultrasound therapy
Both ultrasound OG Ultherapy and newcomer Sofwave use heat to drive collagen and elastin production—a process that “generally takes at least a month and continues for six months,” says Dr. Arisa Ortiz, a board-certified dermatologist in San Diego. “The new collagen that is made is shorter and tighter than old long-and-stretchy collagen”—and serves to modestly tighten loose skin and improve elasticity on the legs over time. While some people need only one session (at $1,500–$3,000), your provider may recommend two or three, for maximum payoff.
According to Dr. Ortiz, Sofwave is more comfortable than Ultherapy, thanks to its built-in cooling mechanism, and also tends to be a faster treatment. Another point of distinction: Sofwave delivers energy at a fixed depth of 1.5 millimeters—roughly the thickness of facial skin—whereas Ultherapy can operate at variable depths (1.5 mm, 3 mm, and 4.5 mm), potentially targeting deeper types of tissue. In Dr. Mahmood’s experience, Ultherapy “can cause fat loss if it penetrates to the subcutaneous layer [below the dermis] based on depth settings.” Acknowledging that this concept of fat atrophy via ultrasound is somewhat controversial—the evidence is largely anecdotal—Dr. Mahmood adds that while this side effect is undoubtedly deleterious to an aging face, it can actually be beneficial around the kneecaps, if excess fat is contributing to folds and laxity.
Radiofrequency microneedling
RF microneedling devices, like Vivace and Morpheus8, charge clusters of ultrafine needles with radiofrequency energy, allowing them to heat the dermis and galvanize collagen and elastin synthesis. Some machines, like the Morpheus8, can deliver energy deep enough to reduce fat on the body. Around the knees, a series of treatments (at approximately $1,500-plus each) can smooth crepey skin and subtly firm things up after several weeks. Certain RF microneedling treatments “can be pretty painful,” warns Dr. Mraz Robinson. “Most patients will need injectable lidocaine for comfort, and healing [of scabbing and bruising] can take 7 to 10 days.”
On the skin-care front, Dr. Mraz Robinson has found that following radiofrequency- and ultrasound-based treatments with regular use of Alastin TransFORM Body Treatment, a peptide-enriched lotion, can measurably bolster the firming effects of these procedures.
Fat- and/or skin-removal surgery
If damaged collagen isn’t solely to blame for saggy skin around the knees, then treatments aimed at repairing the protein aren’t going to cut it. “It’s crucial to determine if the appearance of the knees is due to fat, skin laxity, or a combination of both,” points out Dr. Mahmood. When there’s excess fat around knees, “liposuction is the recommended treatment versus injectables or devices,” she adds. (For the record, internet-hyped exercises for saggy knees will likely not reduce knee fat or cinch up the skin on your knees in a noticeable way. “Knee exercises, like leg extension, squats, hamstring curls, and calf raises, are generally focused on the surrounding muscles—particularly the quadriceps, hamstrings, calves, and glutes,” Dr. Mahmood says. By helping to build those muscles, they can, in fact, strengthen the knee and encourage fat-burning in the area, she explains, but “they’re not specifically targeted to shed knee fat.”)
When we eliminate knee fat, sometimes skin laxity can worsen, it’s worth noting, so doctors will commonly follow lipo with some form of nonsurgical skin tightening—unless the amount of excess skin demands a more powerful procedure. Knee lift surgery “is an option for those with moderate to severe laxity,” she says, assuming they’re relatively healthy nonsmokers within 30% of their ideal body weight. The surgery involves removing a crescent-shaped section of tissue above the knees—carefully and judiciously, she stresses, as taking too much can hinder the normal bending action of the knee and leave a thick, conspicuous scar.
