What exactly is "poor quality skin"?

Question

How do you treat it? Will medical grade skincare help/fix it? Can you look at someone and tell they have bad skin? PS blamed my skin for my loose skin after a fl/nl. What are my options now?

Michael Brucker, MD · Answer

This is a great question and I'm sure one that many patients have.  Skin quality can be compromised by many things including weight gain and loss, sun damage, pregnancy, and age.  Some patients genetically are predisposed to poor skin quality.  Poor skin quality refers to skin that has lost elasticity and appears to be loose, crepey, and/or have stretch marks.  This type of skin does not have the ability to "snap back" once stretched out.  While procedures can be done to remove the loose skin, it will always be more susceptible to stretching again and your results may tend to have less longevity than a patient with good quality, elastic skin.  Once the excess skin is removed surgically, you can have laser treatments to help improve the surface texture.

David W. Rodwell III, MD · Answer

When that comment was made to you it was probably used to mean a loss of elasticity of the skin.This of course happens to everyone as a normal part of the aging process, but the changes can be more significant in some patients due to a combination of genetics and environmental factors (excess sun exposure, smoking, etc).  The problem that this presents with facelift surgery is that there is an increased amount of relaxation of the skin and underlying tissues after surgery has been done.  You can lift, reposition, support, tighten, etc, etc, etc all you want, but that does not stop the fact that there will inevitably be tissue relaxation after surgery.Again, this happens with all patients, but in someone who has much more loss of elasticity than the average patient you must know how that impacts the healing after surgery and how it adds a few limitations to what can reasonably accomplished.  Patients in this category also have a higher likelihood of needing an early "tuck-up" or retightening procedure.

Jonathan Kulbersh, MD · Answer

Poor quality skin, in terms of a facelift, is skin that has lost elasticity due to age and/or other factors, such as smoking or extreme weight gain and loss. Unfortunately, once your skin has lost elasticity, improving its quality is quite difficult. In my opinion, your facial plastic surgeon should have alerted you to the quality of your skin before your procedure, so you could adjust your expectations.
While the skin can be tightened and the excess removed in a facelift, if the skin is thin and inelastic, it won’t hold its shape as well. I’d recommend fat grafting to give your face more volume and pick up some of the slack. You might also be able to improve the quality of your skin and restore elasticity with chemical peels or laser therapy. Medical grade skin care is important, too, but it will not restore elasticity. I hope this helps.

Jeffrey M. Darrow, MD · Answer

Skin has several components to it, collagen, elastin, etc, that give it it's strength and elasticity.  these are abundant in youth and so the skin is thicker, and stronger.  Numerous things can lead to decreasing skin strength and elasticity such as aging, sun damage, smoking, prior excess weight gain, poor nutrition, certain drugs, etc and there are some people who have a genetic defects in the strength of their collagen.  A facelift/necklift is done by tightening the deeper layers and smoothing the skin over this tightened deeper layer.  If the skin has lost it strength and elasticity, it may look good for a period of time but will loosen over time and some of the results will be lost over time.  There may be an option for a revision to improve your result but you should check with your plastic surgeon.  Best wishes.

Richard Baxter, MD · Answer

Age and environmental factors such as sun exposure cause the skin to thin, lose elasticity, and weaken. Once this occurs to significant degree, it will not stay smooth and tight no matter the skill of the surgeon. medical grades kin care products are a start, but energy-based treatments such as Ultherapy or radiofrequency should be considered.

Andrew Campbell, MD · Answer

Poor quality skin is skin that has lost it's elasticity. Youthful skin has elasticity like a rubber band. Poor quality skin is more like a string or a plastic bag. If you stretch it, it doesn't bounce back. In regards to a face and neck lift, poor quality skin can often show a little bit of laxity after the lift when youthful skin would not. The lift stretches the skin a little, and as this stretch is "relaxed" during the healing, the youthful skin will bounce back and you won't be able to see any laxity. Poor quality skin won't bounce back and you end up with a little bit of laxity. The technique of facelift can help minimize the laxity, but a facelift doesn't improve the skin quality. The skin quality can be improved with lasers, but only fractionated lasers, like the Halo laser, can safely be used on the neck skin.Andrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa Aesthetic Centers

Aaron Capuano, MD, FACS · Answer

This is a great question and one I spend a considerable amount of time explaining to patients as skin quality is a major component of fantastic and lasting surgical results.  It is so important that I make sure that all of my face/neck lift patients pre-treat their skin with a specific regimen, that is determined, based on their specific skin health. The health of your skin plays a vital role in its recovery following surgery and paying close attention to skin health before and after surgery is extremely important.  This is  because suturing into unhealthy skin could comprise your results.  
There is no specific definition of poor skin quality but consider it the antonym of good skin quality as defined by Dr. Zein Obagi, dermatologist.  Healthy skin is defined as "skin that is naturally smooth, strong, firm, even-toned, hydrated and free of disease".
To address your additional concerns regarding why poor skin quality was discussed as a reason for recurrence of skin laxity after a facelift.  While this may be the case, without an in-person consultation, it is difficult to determine the cause of your recurrent loose or excess skin.  First, it is important to determine whether your surgeon performed a facelift that included tightening your SMAS fascia, because skin-only facelifts are known to result in early recurrence of skin laxity.  This is because this surgery both fails to fix the anatomical problem associated with facial aging, and because the skin is not meant to hold tension and ultimately stretches back out.  Next it is important to rule out genetic elastin or collagen disorders.  You may alternatively need volume replacement of your subcutaneous fat compartment, which can be accomplished with fat grafting.  Lastly, chemical peels and lasers can adjunctively improve residual laxity, but both have their limitations.    I recommend consulting with a Board Certified Plastic Surgeon, one who pays close attention to and deals with skin quality, pre and post surgery, for optimal results.

Craig R. Dufresne, MD · Answer

Dear hobe,
Thank you for your question. Skin quality is based on thickness, laxiety and if there is significant environments damage. Skin care does help a lot. You can tell a lot by just examining the skin tissue. Some people have genetic mutations that affect the elasticity and poor healing and scaring

Amy S. Bekanich, MD · Answer

Hi -
This is one of the most frustrating things in aesthetic surgery of the face.  While surgery can remove excess skin and tighten the strength layers underneath to give shape the remaining skin will not ultimately be altered.  At first it may appear smoother and tight but as the swelling goes down and things relax a little - as they should with regular movement etc - the "quality" of a patient's skin shows through.  Yes, you can typically tell what general quality a person's skin is when looking at them.  The biggest offenders of the skin are sun, smoking, genetics, health and how the skin has been cared for through the years.  This is why I emphasize to each and every patient that once they start putting time and effort into their facial appearance they need to do it in all aspects - surgical, avoiding sun, using recommended products every morning and night, no smoking, good  sleep and nutrition. You need to do this in order to slow down the damage that is happening.  And my pet peeve is sun exposure.  Regular sunscreen applied every 2 hours when in exposed areas and a wide brimmed hat is an absolute must.  As for the elasticity and texture that is lost you can look to non-invasive treatments like fractional lasers, as well as medical grade facial peels, microneedling and regular use of Retin-A. I have had great results combining surgery with a variety of less invasive treatments.

Chester F. Griffiths, MD, FACS - Account Suspended · Answer

T
his is an excellent question- thank you for sharing. The
term “poor skin quality” usually refers to skin that has lost collagen and elasticity
over the years. This results in thin, damaged, “crepey” skin that has poor
barrier function and is more susceptible to ongoing damage in the future. The
causes of “poor skin quality” vary, but can include genetics and long-term sun
damage. The good news is, there are treatments emerging everyday in the
aesthetics field to improve skin quality. For example, microneedling with radio
frequency can stimulate your body’s collagen stimulation and ultimately leading
to more firm, healthy skin over time. Certain lasers such as IPL or BBL (photo facials)
can also improve skin quality by reversing sun damage and improving skin’s texture.
For more information, please schedule a consultation with a board-certified specialist
who is experienced with these treatments. Best, Dr. Griffiths.

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