Formulate user Jenn wrote in with some sun-damage concerns:
So lately (and by lately I mean over the past several years LOL) my decolletage has been looking worse for wear. I'm now in my 50's, and I must admit I spent a lot of time laying in the sun with no protection on my chest in my younger years. I was young, not thinking about the future, and wanted that tan! It was the 70's, everyone wanted that healthy glow! I now want to do better, and both protect my chest from further damage and treat the damage that's there. What are my best moves for protection and treatment? Are there any particular types of damage I should be on the lookout for that are especially concerning, outside of not looking very good? Also, I know I'm not the only gal who's neglected her poor decolletage when it comes to the sun. Any insight into why we do this, and is it worse in women than in men because we lay out in the sun, or are they just as bad off?
Thanks for writing, Jenn! You bring up some super interesting questions, and we're excited to help you find the answers!
To learn more, we spoke with Dr. Samuel Hetz, Medical Director of Concept Medical, an award-winning advanced cosmetic clinic based out of Ottawa. Dr. Hetz is an old friend of the Formulate Journal - you can find his past insight here, here, and here. We're sure you'll find his knowledge of sun damage and the best ways to treat it helpful!
What are the primary types of sun damage that individuals can experience on their chest?
Dr. Hetz: You can experience all the typical signs of sun damage on the chest, including hyperpigmentation (sun spots), wrinkles, and sunburns. However, the chest area is also prone to a condition called poikiloderma which is when the blood vessels are enlarged and create a red or spotty red discoloration on the chest and some parts of the neck. This condition differs from a burn in that it does not fade into a tan or peel away; rather, it is permanent, but can be treated with topical creams or laser therapy.
What are the best ways to protect the chest from sun damage?
Dr. Hetz: Covering up with clothing and wearing proper broad-spectrum sunscreen will be the best way to shield the chest from sun damage. We recommend SPF protection of at least 50+ to adequately protect the skin when in full sun. You want to be sure that if you are spending a lot of time outside, you reapply your sunscreen every two hours and take shade breaks when you can.
Should you wear certain types of clothes to protect yourself from the sun?
Dr. Hetz: Different sun-blocking shirts are available made from quick-drying polyester material that can block around 98% of UV rays while keeping you cool.
Is there a type of sunscreen you would recommend?
Dr. Hetz: We recommend a mineral-based sunscreen with at least SPF 50+, such as this one from SkinCeuticals. The SkinCeuticals Physical Fusion UV Defense SPF 50 is a tinted mineral sunscreen specifically formulated for dry and sensitive skin but can be used on most skin types. Mineral sunscreen is best for sensitive skin as it does not contain the same potentially irritating chemicals that chemical sunscreen uses to block UV rays. Plus, mineral sunscreen is a physical sunblock, so you do not need to wait for it to absorb into the skin to be adequately protected.
Why do you think that so many people are diligent when it comes to applying sun protection to the face, but skimp on the chest/neck/breasts?
Dr. Hetz: Many people are already applying different skin care products to the face specifically, so adding sunscreen to their routine is second nature. Unfortunately, many simply forget the importance of protecting their neck/chest or do not think they will be exposed to the sun in the same way their face will, depending on what they are wearing and doing that day. For women specifically, it is much more common to see visible signs of aging on the chest and neck, which is a testament to the need for better sun protection.
When it comes to the chest area, does sun damage manifest differently in male and female patients? Or is it pretty similar?
Dr. Hetz: Everyone can be susceptible to sun damage; the most telling factor is the skin's level of melanin, regardless of sex. However, because sun protection and skin aging are also reliant on many lifestyle choices, we can see some variation in how it appears in men versus women.
Different hormones, including estrogen and testosterone, also affect biological processes around collagen production, which is responsible for skin elasticity. So often, we see collagen degradation sooner in women, which contributes to more intense visible signs of aging when combined with sun damage.
Additionally, many women wear clothing that exposes the neck and chest during peak sun seasons, leaving them susceptible to more sun exposure when not adequately protected with SPF. However, again regardless of gender, wrinkles and hyperpigmentation can appear when you do not take the steps to avoid sun damage.
What are the gold-standard treatments that are done in-office for sun damage to the chest/breast area?
Dr. Hetz: In our office, we use microneedling with radio frequency which can reduce the signs of aging caused by sun damage, helping to eliminate facial lines and restore the skin's volume. With this procedure, 24 fine, gold-plated microneedles are stamped into the skin, and RF energy is then deposited to the desired depth, which triggers a healing cascade and in turn, stimulates collagen production. This treatment can also be done to treat the neck/chest area.
If you are struggling with mainly wrinkles on the chest, injectables can help replenish the volume in the skin. Many people opt for this treatment as it is less invasive, and results develop naturally post-treatment. More invasive treatments that can treat both hyperpigmentation and collagen loss include laser therapy and intense pulsed light (IPL) therapy, both of which work to tighten the skin's appearance. However, both treatments require the patient to avoid the sun for two weeks before and two weeks after treatment which can be difficult but is necessary for the best results and to ensure a safe treatment.
What products/ingredients/routines would you recommend to care for sun-damaged chests, necks, and breasts outside of your office?
Dr. Hetz: Many topical skin care products can help expedite the results of your in-office treatment. To reduce the effects of sun damage, retinol will be a key active ingredient you will want in your skincare regimen. The strongest potency of retinol may be drying for sensitive skin, so it is best to start in lower quantities and build your way up. A moisturizer containing retinol that is applied each night before bed is a good starting point. This way, the ingredients can work while skin cells cycle at night to help stimulate new collagen production.
For additional sun protection in the morning, applying a vitamin C serum before your sunscreen is necessary for optimal protection against free radical damage caused by environmental factors, including UVA rays and pollution. We have four different vitamin Cs in our office, to suit all of the different skin types and skin concerns.
Realistically, how much can treatments reverse sun damage to this area? Obviously, nothing can turn back the clock and undo the damage, but how do you help your patients have realistic expectations?
Dr. Hetz: Our approach is always to educate patients first on their unique condition, how treatments may interact with their complexion, and what they can expect for downtime and results. Of course, results vary, however, we find each patient is better prepared for what to expect when they are aware of the ins and outs of how their chosen treatment works. We always work with patients through consultations to decide on the best treatment option available as well as to help ensure optimal results. Often, treatments such as microneedling and PRP therapy see the best results after multiple sessions, especially for more advanced cases of skin aging- so we always want to commit to working out a long-term treatment plan with patients so we can help them achieve those results.
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