There is really quite a bit that you can do to slow down and prevent sagging of the skin, and the earlier you start the better results you will get. However—and what a bummer—there is a genetic factor to sagging and early wrinkling of skin, especially in women. If the older women in your family, especially your mother, had early sagging and wrinkling, then it is even more important that you start early.

The best way to slow down this progression is prevention: don’t tan, consistent daily sun protection with sun block every day; avoidance of weight fluctuations, toxins and smoking; eating a healthy non-glycemic diet; daily use of topical retinoids, antioxidants, peptides, growth factors, fruit acids. Dealing with estrogen loss helps too.

Of these the most important are to avoid weight fluctuations, don’t tan, and don’t smoke. When you gain weight the skin stretches to accommodate the increased volume. If it didn’t you would get stretch marks. Then you lose it and there is less volume inside the “sack” and it sags. The younger you are when this happens, the better the skin can bounce back because the natural elasticity is still good. The older you are—not so much. Chronic sun exposure and tanning destroy the collagen and elastic fibers and turn them into this gunk called elastosis—the yellowish bumpy stuff you see under the skin when you stretch it early on, and is visible to the naked eye later. Smoking puts carbon monoxide and other toxins in the skin through the blood vessels reducing the amount and health of the nutrient bringing blood flow to the skin and killing collagen and elastic fibers.

If you smoke, you get damage, if you tan—you get damage. If you smoke and tan (or just get a lot of unprotected sun)—you get more than double the damage of either one alone—more like four times the damage. Somehow they make each other much worse. And then, especially with weight gain, you stretch this skin that is damaged with grungy elastic and collagen fibers and the skin can’t recover. Just like that bra you washed and dried too many times, the elastic crumbles and there is no bounce back at all. The non-invasive and invasive procedures we will discuss later work a lot better on skin that has some natural elasticity and tone.

A glycemic diet can also damage the collagen and elastic fibers, making the skin more stiff and reducing elasticity. And it often leads to weight gain. But I have to admit that I have a very hard time following my own advice on this—unfortunately I love sugar and carbs.

When estrogen naturally decreases around menopause, many women see thinning and wrinkling of the skin—often within a year. As everyone knows, estrogen supplementation is a controversial and individual medical decision that depends on symptoms, the general risk/benefit ratio, and the risk/benefit ratio to an individual based on their own health history. You and your doctor will decide what is right for you. I will say this—estrogen helps reduce wrinkling, sagging and thinning of skin.

We covered home treatment with daily use of topical retinoids, antioxidants, peptides, growth factors, fruit acids in the post Skin Resurfacing the Easy Way. Read it. Do it.

All these lifestyle and home treatments help prevent and reduce the development of wrinkles, keeping the skin smooth and lessening the need for skin resurfacing. They also help prevent and reduce sagging, lessening the need for more invasive skin tightening. Are they going to significantly tighten skin—no. Are they doing to slow things down—yes. Are they going to help prevent things from getting worse—yes. Are they relatively easy to do—yes. Will they help your overall health—yes. Are they really expensive—no. Is there a reason you should not do these things—no.

Do any of the devices sold on late night cable to tighten skin work? You know the muscle exercisers, the electric stimulators, the light treatments? I have never seen any evidence that they do with the exception of the LED (light emitting diode) treatments. There is some evidence that the home LED devices may provide some minimal amount of collagen stimulation. The problem is that they are so much less powerful than the ones we use in the office, they have to be used for a long time each day (30-60 minutes) and you really don’t have any way of knowing whether the one you use works or doesn’t as there are multiple ones out there, knock offs and counterfeits. Do I use them—no.

Next: How to fix sagging skin without surgery