Today, while most women spend countless resources on facial treatments designed to prevent or reverse signs of aging, there is very little focus on conditioning and treating the décolletage. One reason for this oversight is that in modern times the décolletage is viewed as an extension of the body, not the face, even though it is the first place (along with the backs of the hands and face) to show signs of aging. That is because the skin of the décolletage is thinner and more sensitive than the skin of the face. It has fewer sebaceous glands, less elasticity, and the neck muscles are not supported by any bone structure. Eventually, whether through environmental damage, neglect, or the natural aging process, the skin on the décolletage soon becomes dry and crépey and is prone to sagging. Finally, the gradual weakening of the platysma muscle contributes to platysma banding, a sagging neck, and loose jowls.

A Missed Opportunity
Most women give the décolletage no more than a quick wash in the shower, typically paying more attention to protecting, nourishing, and hydrating the arms and legs than the chest area. The lack of targeted care, combined with the use of harsh soaps and perfumes, accelerates the loss of moisture in the delicate skin of the décolletage. In fact, according to Diane Heinz, licensed paramedical aesthetician and salon owner for 35 years, “I see a huge disconnect between the face and the décolleté among my clients – they quite simply fail to include the décolletage in their daily anti-aging routine.”
This absence of daily care is exacerbated by years of sun exposure, which leaves the skin on the neck and chest looking leathery, discolored, and rough. Freckles and brown spots are common, and in time, the structure of the skin begins to break down and become thin. “Most of the crépey texture, lines, wrinkles, brown spots, and thin skin on décolleté can be attributed to sun damage. The importance of a good sun protection factor cannot be overstated. However, sunscreen is not the only preventative measure. Daily, targeted, comprehensive care of the neck and chest is essential.” says Heinz.
How a person sleeps also plays a role in wrinkling of the décolleté. Second only to sun damage, sleeping on the side is a leading cause of wrinkles for this area. Since we sleep an average of 2,600 hours a year, certain sleeping positions can create wrinkles on the face and chest area. Sleeping on the back helps and if that is not an option, creative products like silicone décolleté pads help prevent the delicate skin of the décolletage from forming wrinkles while sleeping.
Sleep wrinkles aside, there is still the issue of the chronically-overlooked and under-treated area of the décolleté. Surely there is nothing more futile than a beautifully-conditioned, age-defying face, paired with a sagging neck, discolored, and a wrinkled chest. The failure to see the décolleté as an extension of the face and treat it accordingly is a missed opportunity for skin care professionals everywhere.
That said, there is currently an emerging trend and new-found interest in treatments and products designed to improve and recondition the décolleté and consumers are embracing the concept. There could not be a better time to include this zone in your practice and offer stand-alone treatments and targeted add-ons that can be done during a facial to greatly enhance your bottom line while leaving clients looking ageless from head to décolleté.

Treating the Décolletage
The key to any anti-aging or rejuvenating treatment is to stimulate the metabolism and regeneration of skin cells. Devices and treatments designed to smooth, tighten, and rejuvenate the décolletage are plentiful; however, special care and consideration must be paid to the thin, delicate skin of the area. The layer of fat is thinnest in this zone; therefore, the skin is more permeable and more responsive to treatments and external stimuli than the face or body.
Treatments can range from gentle exfoliation and general conditioning to restore dull, lifeless skin and improve hydration, to more specialized treatments to address specific needs such as static lines, broken capillaries, hyperpigmentation, acne, and redness.

Exfoliating the Décolletage
Modalities designed to exfoliate the delicate and often sensitive skin of the décolletage should begin with lower concentrations of exfoliating agents to determine tolerance and sensitivity levels. Enzyme peels such as papain, bromelain, or curcubita pepo are ideal for first-time peels. These offer a safe way to naturally dissolve the keratinized protein layer of the skin and stimulate the regeneration process without disrupting the pH balance, leaving the décolletage softer, smoother, and more youthful. Over time, a gradual increase of peel strength will build tolerance and prevent irritation. At some point, the client will be able to graduate to more effective exfoliating agents, such as lactic acid, that offer more dramatic and pleasing results.
Lactic acid is quite possibly the best exfoliating agent for the décolletage. Not only does it have excellent exfoliating and cell regenerating abilities that rival other lactic acid solutions, but it has unique qualities that make it more suitable for treating the décolletage.
Compared to glycolic acid, lactic acid has a larger molecular structure, making it slightly less permeable, but ideally more suitable for exfoliating the décolletage. It acts as a skin softener and does not dehydrate the epidermis the way other alpha hydroxy and beta hydroxy acids do, but actually improves moisture levels in the skin. In a study conducted by Walter P. Smith, Ph.D., published in the Journal of the American Academy of Dermatology, the efficacy of lactic acid (4 percent) was compared to glycolic acid (4 percent). He concluded that lactic acid was less irritating and slightly more effective at stimulating cellular turnover than the glycolic acid. In further observations, he noted that while four to five percent lactic acid modulated surface and epidermal changes, 12 percent lactic acid affected both the epidermis and the dermis resulting in changes in skin smoothness and texture, a reduction in depth and number of lines and wrinkles, and improved epidermal and dermal firmness and thickness.
Blended peels or combination peels offer yet another exfoliating modality. These are comprised of a combination of exfoliating agents that can address a multitude of conditions at once. Manufactured blended solutions often contain lower percentages of acids that, together, produce similar results to a single, higher percent acid without the risk of irritation. Creating blended peels enables skin care professionals to provide customized, targeted, treatments to clients. For example, by blending lactic acid and kojic acid, they are not only able to exfoliate and recondition the skin, but they are able to effectively correct dark spots and uneven skin tone, a common condition of the décolletage.

Preparing the Décolleté for a Peel

• Cleanse the skin to remove surface debris and oils. This allows for optimum penetration of the enzyme or acid solution. Clients with oily skin need to be thoroughly degreased since failure to do so will inhibit the efficacy of the treatment.
• Select the appropriate enzyme, single solution, or blended solution based on an analysis of the client’s skin, the décolletage, the condition(s) you are trying to correct, along with the client’s expectations, bearing in mind that straight acids will penetrate deeper than blended acids or enzymes.
• If using an acid solution, use a sweeping motion to apply the solution to clean, dry skin with cotton pads or sponges for a gentle application. For a more intense application and a deeper peeling action, use medical gauze or a fan brush. 
• First-time applications should process for no more than six to eight minutes, then rinse with tepid water for one minute. 
• For clients who are accustomed to peels and tolerate the solution well, two to three coats of the appropriate acid solution can be applied for a deeper peel.

A note of caution: As with all treatments involving exfoliation modalities or ingredients, special attention must be paid to clients with skin type III or above on the Fitzpatrick scale to avoid pigment complications.

Conditioning the Décolletage
There is an abundance of active ingredients that deliver reparative benefits to the skin, but as discussed, the décolletage deserves special consideration. As a rule, a heavier cream base is ideal for this area and depending on the client’s needs and skin condition, these ingredients are perfect for rejuvenating the décolletage: alpha lipoic acid, antioxidants, ascorbyl palmitate, dimethylaminoethanol, and niacinamide.
Alpha lipoic acid is an effective anti-aging, antioxidant, and anti-inflammatory ingredient. It is both fat-soluble and water-soluble so it is readily absorbed through the lipid layers of the skin where it neutralizes free radicals in the cell plasma membrane and the extracellular fluid of the cell. Alpha lipoic acid will reduce redness and irritation, shrink pore size, minimize lines and wrinkles, and improve blood flow by regulating the production of nitric oxide, transforming dull, lifeless skin into vibrant, healthy skin. Alpha lipoic acid boosts the effectiveness of other antioxidants, making them more powerful. While alpha lipoic acid is a powerful ingredient (400 times stronger than vitamins E and C combined), it is non-toxic, making it an ideal choice for clients with sensitive skin or prone to allergic reactions.
There is undeniable evidence that antioxidants are playing an increasingly important role in the skin care industry for their ability to inhibit oxidation. Antioxidants are absorbed into the cells of the stratum corneum where they bind to unstable electrons to stop them from attacking collagen strands and other cells of the skin. Apart from their ability to neutralize free radicals, some antioxidants deliver corrective actions such as reduced hyperpigmentation and collagen synthesis. Little wonder that manufacturers are harnessing the power of antioxidants in a myriad of skin care products. While there is an ideal concentration level for each antioxidant, they are most effective when combined with other antioxidants. The best of these for the décolletage include idebenone and green tea extract:
Idebenone is considered one of the most advanced anti-aging antioxidants available today. It protects cells from deterioration, shields skin from environmental damage, improves the look of fine lines, reduces skin dryness, and improves skin texture, making this one of the best antioxidant treatments for the décolletage. Idebenone is most notable for its ability to protect the skin from ultraviolet damage, both before and after exposure.
Green tea extract contains a number of powerful polyphenols that deliver antioxidant, anti-inflammatory, and anti-carcinogenic properties to the skin. The most beneficial of these polyphenols is epigallocatechin-3-gallate (EGCG). Capable of delivering greater antioxidant protection than vitamins C and E, epigallocatechin-3-gallate prevents collagen breakdown and reduces ultraviolet damage, two of the most significant issues associated with the décolletage.
A note of caution: Antioxidants are unstable and break down rapidly when exposed to light. Products should be packaged in blue, opaque, or dark brown containers to address this problem. Or look for an antioxidant with a relatively new plant compound, ferulic acid, which acts as a stabilizer.
Ascorbyl palmitate (fat-soluble vitamin C ester) is an effective collagen builder and free radical scavenger designed to inhibit the oxidation of proteins and the peroxidation of lipids. That makes it ideal for treating hyperpigmentation, strengthening the skin’s barrier function, reducing inflammation, and protecting the skin from future ultraviolet damage. Compared with ascorbic acid, ascorbyl palmitate delivers eight times more vitamin C, making it a choice-ingredient for the overly-exposed décolletage.
Dimethylaminoethanol (DMAE) is a powerful anti-inflammatory and membrane stabilizer. It is a precursor to acetylcholine, a neurotransmitter that causes muscles to contract and tighten under the skin. As a firming agent, dimethylaminoethanol delivers instant tightening to improve sagging skin and fine lines. The décolletage looks smoother, firmer, more toned, and lines and wrinkles are diminished. The effects of its skin-toning abilities are cumulative, so with regular treatments, the condition of the skin will continue to improve.
Derived from niacin (vitamin B3), niacinamide is a potent cell-communicating ingredient that increases ceramide and free-fatty acid levels in the skin, preventing it from losing water and stimulating microcirculation in the dermis. Niacinamide is also capable of lightening skin discoloration and preventing melanin from forming. It stimulates collagen production and is ideal for reducing inflammation and correcting redness.

Treating the Platysma Muscle
The platysma muscle is located at the front of the neck, under the chin. This muscle holds the neck and jawline in place and gives the neck its firm, tight, youthful appearance. As we age, the platysma muscle weakens, causing prominent midline bands, a loose neck, and sagging jawline. When stimulated, this group of muscles will tighten, resulting in a more toned, smoother, youthful look.
Microcurrent stimulation delivers a low level of electricity equal to the body’s own natural electrical currents, triggering a cellular reaction that stimulates the production of collagen and elastin, improving circulation, and ultimately re-educating weakened muscles. This gives the muscles the energy necessary to keep their tension and maintain their new contour, the effects of which are both immediate and cumulative.
For long-term results, clients will require a series of treatments followed by regular maintenance. The added benefits of microcurrent stimulation include improved product penetration, visibly reduced puffiness due to improved blood circulation, lymphatic drainage, and increased moisture levels.

Add-on or a Stand-alone Treatment
Treatment of the décolletage should be an important part of every skin care professional’s practice. As an add-on, it completes a facial. The décolleté should be cleansed at the same time as the face, treated with an exfoliating enzyme or agent, and conditioned with an anti-aging solution or cream. When done in conjunction with a facial, this add-on should only increase the total treatment time by a few minutes, but the results leave the client’s overall appearance more revitalized and youthful.
A stand-alone treatment should include the following steps that will result in marked improvement in the tone, texture, and moisture content of the décolletage:

• Thorough cleansing and decreasing.
• Exfoliation.
• Targeted treatment designed to address and treat the client’s unique concerns such as acne, dark spots, sun damage, static lines, and dehydration. Depending on the treatment plan, this step could include topical treatment and/or 
• light therapy.
• Microcurrent stimulation of the platysmal muscle.
• Anti-aging or corrective treatment to finish.

Allow 45 to 50 minutes for the treatment and consider other add-ons such as an eyebrow wax or hand treatment during the exfoliation phase.

At-home Care
Finally, the success of any treatment plan for improving the décolletage depends on post-procedure care. Clients should be encouraged to:

• Cleanse the décolleté each morning and evening.
• Avoid harsh soaps and body washes.
• Apply anti-aging cream or serum recommended for the décolletage.
• Use a broad-spectrum sunscreen every morning.
• Gently exfoliate the skin twice a week.

References:
Smith, Walter P., Ph.D., (1996). Journal of the American Academy of Dermatology: Epidermal and Dermal Effects of Topical Lactic Acid. 35(3): 388-91.

Karen Poirier is co-founder and editor of Healthy Skin Solutions, an online resource that focuses on current and viable information related to skin care, skin conditions, and emerging trends in the skin care industry. She is the co-founder and marketing director of New Age Skincare, LLC, a cosmeceutical line of products formulated to provide the most intensive care for all skin types while delivering time-tested and proven results.