What Causes Skin Laxity, and What Actually Improves It

Skin laxity is the loss of firmness you notice along the jawline, at the lower cheeks, on the neck, or on the upper arms. It has several causes at once, and what can change it depends on which of those causes is largest in your case.

The skin loosens because the connective tissue that supports it loses strength and elasticity. Age accounts for part of that; among the factors that act on the skin, sun exposure is the single largest one. What can improve it depends on how much loose skin there is. Daily sun protection limits further damage, a retinoid may make a small difference, and the American Academy of Dermatology (AAD) describes in-office non-invasive tightening as a modest change that appears over months. For a lot of sagging skin, the AAD says tightening may not help.

What is skin laxity, and what is changing underneath?

It is a loss of firmness in the connective tissue of the skin, and it appears alongside a loss of padding beneath it. MedlinePlus describes the skin in three main parts, the epidermis, the dermis, and the subcutaneous layer, and notes that each layer also contains connective tissue with collagen fibers to give support and elastin fibers to provide flexibility and strength (Aging changes in skin). It lists changes in the connective tissue that reduce the skin's strength and elasticity, which is called elastosis. Separately, it lists the subcutaneous fat layer thinning, so the skin has less insulation and padding. MedlinePlus records both as aging changes; the firmness loss belongs to the connective tissue, and the thinner fat layer is a change in what sits beneath it.

The National Institute on Aging describes the same loss from the other direction: age-related changes such as a loss of elastic fibers, or elastin, and of collagen make the skin look older, develop wrinkles, and become more fragile (Skin Care and Aging). Looseness that comes from the tissue under the surface is a different problem from a line in the surface, and a product that improves the surface does not address the support.

Why does skin lose firmness faster in some people?

Because the amount of ultraviolet exposure the skin has taken differs from person to person, and MedlinePlus names sun exposure as the greatest single factor in how skin ages. MedlinePlus lists environmental factors, genetic makeup, and nutrition among the causes of skin aging and then states that the greatest single factor is sun exposure. It also gives a way to see this for yourself: compare an area of your body that gets regular sun with an area that stays covered.

The cumulative nature of that damage is what makes it uneven between people. The NIA explains that ultraviolet light damages skin cells, that a short exposure can cause a sunburn, and that over time UV damage adds up and leads to changes in skin texture, premature skin aging, and wrinkles. MedlinePlus adds that elastosis is more noticeable in sun-exposed areas, where it is called solar elastosis, and that it produces the leathery, weather-beaten appearance seen in people who spend a large amount of time outdoors.

• Pigment. MedlinePlus notes that natural pigments appear to give some protection against sun-induced damage, and that fair-skinned, blue-eyed people show more aging skin changes than people with darker, more heavily pigmented skin.
• Hormonal change. The NIA says hormonal changes such as those that occur with menopause can make the skin thinner and drier. MedlinePlus adds that women gradually produce less oil beginning after menopause, while in men the decrease is minimal and usually comes after the age of 80.
• Everyday exposures. The NIA lists drinking too little water, spending too much time in the sun, living in a dry environment, and smoking among the causes of dry, rough skin in older adults.

Is loose skin the same as dry skin or a wrinkle?

No. Each of the three is a different change, and a product or procedure that helps one of them does not help the others. Dryness comes largely from reduced oil production: MedlinePlus says sebaceous glands produce less oil with age, which makes it harder to keep the skin moist and leads to dryness and itchiness. Laxity is a loss of firmness in the tissue underneath. A wrinkle is a crease in the surface. All three can be present in the same area of the face without being the same change.

The AAD says that when you see an immediate result from a skin-firming product, the product tends to be an effective moisturizer, and that a good moisturizer can plump up your skin and make fine lines and wrinkles less noticeable, though the result is temporary and depends on applying the product every day (Many ways to firm sagging skin). On lifting sagging skin, the same page is direct: dermatologists say that is not possible, because a cream or lotion cannot penetrate the skin deeply enough to do it.

Can anything you do at home firm loose skin?

Sun protection limits further damage, and a retinoid may add a small change; nothing applied at home lifts skin that has already loosened. MedlinePlus puts prevention first: because most skin changes are related to sun exposure, prevention is a lifelong process. Its advice is to use a good quality sunscreen outdoors even in winter and to wear protective clothing and a hat when needed. The NIA gives the specifics:

• sunscreen of SPF 15 or higher, labeled broad spectrum;
• applied 15 to 30 minutes before going outside, and reapplied at least every two hours, more often when swimming or sweating;
• staying out of the strongest sun, which in summer it gives as 10 a.m. to 4 p.m.;
• no sunlamps or tanning beds.

For firmness itself, the ceiling is low. The AAD says the results you see from a skin-firming cream will be subtle at best and that it is possible you will see none, but it also notes one exception: you may see a small change if a product contains a retinoid, such as retinol, which can help your body make more collagen. A moisturizer manages dryness and can make fine lines less noticeable for as long as it is applied; it does not act on the tissue that has loosened.

What can an in-office procedure change, and by how much?

The AAD describes the non-invasive procedures as producing a modest change, the minimally invasive ones as producing more at the cost of a wound and downtime, and a surgical lift as producing the most dramatic result. The table follows the AAD's descriptions.

Among the routes that are not surgery, the AAD describes laser resurfacing as the most effective procedure for tightening loose skin, usually better than any other skin-tightening procedure, and in the same section says that none of the minimally invasive procedures gives the results of a facelift, eyelid surgery, or neck lift.

Where the energy is delivered is what separates an in-office procedure from a product applied at home. For ultrasound, StatPearls describes the transducer as converting an electrical signal into sound waves through piezoelectric crystals, and describes the beam as narrowing to a focal zone before widening again (Ultrasound Physics and Instrumentation). In high-intensity focused ultrasound, StatPearls states, the probe has a curved surface, which creates a focal point of the waves at a controllable depth (Ultrasound Therapy). That is the structural difference from a cream: a cream stays at the surface where it was applied, and a focused ultrasound treatment is arranged so that the energy converges below it. None of that describes how much tightening follows, and none of it means tissue outside the focal point is unaffected; the size of the change is still the modest one the AAD reports, judged months later. Radiofrequency and laser deliver heat by different routes, which the table describes.

The time to the result is not the same as the time to the appointment. Collagen takes time to form, which is why a treatment done in an afternoon is judged months later.

When is skin tightening not the answer?

When there is a lot of sagging skin. The AAD lists conditions associated with a more favorable result: being at a healthy weight and maintaining it, eating a healthy diet, quitting smoking, drinking little alcohol, protecting your skin from the sun and never tanning indoors, and having a small amount of sagging skin. It then states the limit directly: if you have lots of sagging skin, skin tightening may not be helpful, and a surgical lift is what it describes as giving the most dramatic results.

Whether a procedure is appropriate at all, including during pregnancy, with a skin infection, or while taking certain medications, is assessed by a qualified clinician; the AAD names those three situations without naming the medications.

This article is general information, not medical advice. Whether a treatment is suitable, and what result it produces, is assessed by a qualified clinician. Treatment suitability, results, and recovery vary between individuals.