How to improve skin laxity (?) in inner thighs and above knees? (Photo)

Question

I am young (33) And very slim (45kg for 164) But for some reason, I suddenly and progressively (getting this very strange texture on the inside of my legs and above my knees, I Work out a lot (lagree pilates 2/3x a week), Walk a lot, Do Not have a sedentary lifestyle at all. I have done lymphatic massages, Tried some creams, but nothing seems to work. I’ve never had children and I have no hormonal issue (stopped pill 6 years ago). does anyone know what it is? What it can be caused by? Fix it?

Anna Chacon, MD, FAAD · Answer

Thank you for your question and for providing context. Based on your age, body type, and healthy lifestyle, it’s understandably frustrating to notice changes in skin texture and laxity, especially in areas like the inner thighs and above the knees — regions that are naturally prone to thinner skin and early signs of collagen breakdown.

What It May Be:
What you’re experiencing appears to be mild skin laxity, potentially combined with crepey texture — often due to loss of collagen and elastin in the dermis. This can occur despite being slim and active. Common contributing factors include:

Intrinsic aging (natural collagen loss begins in the late 20s–early 30s)

Sun exposure (even indirect or accumulated UV damage)

Genetics (some individuals are predisposed to earlier skin laxity)

Loss of subcutaneous fat (which can reduce skin support and make texture more visible)

Overtraining or rapid body composition changes (intense workouts without enough skin recovery)

Recommended Treatments:
Topical Options:
Prescription-strength retinoids (e.g., tretinoin): Stimulate collagen production and improve skin firmness over time.

Firming creams with peptides, growth factors, or caffeine: These can give a mild temporary tightening effect, though results are modest.

Urea or AHA-based moisturizers: Help with superficial texture and hydration.

In-Office Treatments:
These are significantly more effective for deeper skin laxity and crepiness:

Microneedling with Radiofrequency (e.g., Morpheus8): Stimulates collagen deeply and tightens skin over several sessions.

Ultrasound-based skin tightening (e.g., Ultherapy): Non-invasive and effective for sagging around knees.

Laser resurfacing (e.g., fractional CO₂ or Fraxel): Improves texture, tightens skin, and promotes collagen remodeling.

Injectables (e.g., diluted Radiesse or Sculptra): Biostimulatory fillers can improve firmness and volume subtly over time.

Body threads (PDO threads): For subtle lift and collagen stimulation in crepey areas.

Supportive Measures:
Daily SPF on exposed legs, especially if you're outdoors often

High-protein diet to support collagen synthesis

Hydration and essential fatty acids (e.g., omega-3s) for skin elasticity

Compression leggings occasionally post-workout can help with circulation

Final Thought:
Despite being healthy and active, skin changes like this are surprisingly common. Combination treatment — using both in-office procedures and supportive topical/home care — tends to produce the best results. Keep in mind that consistency is key, and subtle improvements build over time.

Let me know if you'd like help narrowing down a regimen or specific product options tailored to your skin type.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Camille Cash, MD · Answer

From the photos it appears you would be a good candidate for Morpheus8.  This minimally invasive treatment combines RF technology with microneedling to improve overall skin tone and texture.  Three sessions are recommended for optimal results.  I've included a video about this treatment that I hope you find helpful.

Daniel P. Markmann, MD · Answer

It is tough to tell texture from your pictures, but it looks like you have some laxity.   For mild laxity in this area, the best treatment is a combination of BodyTite and Morpheus Body.  They are minimally invasive and I have seen very nice results in this area.

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