Dear Paula,

I want to let you know how much your products have changed my life, starting with your books (which my beautician introduced me to) and now your product line and web site. What a huge load off my mind to know where to get accurate information, not to mention straight talk!

My concern is one that is not often addressed, perhaps because there is no obvious solution: sagging skin. I am 37 and very much see (and feel) my skin starting to drop, loosen and slowly “melt”, especially the lower portion of my cheeks. Wrinkles are often addressed but what about sagging skin? Does retinol address this issue? Or can it only be helped by cosmetic procedures? If cosmetic procedures are the way to go, are there any light, not-too-invasive ones I should consider?
Karen, via email

Dear Karen,

Although I love hearing your wonderful feedback about my products and the work me team does, I have to tell you I hate the question about skin beginning to sag.

The truth, the absolute truth, is that sagging skin isn’t something a skin-care product can address. Believe me, I wish it were different but it isn’t. I know you’re bombarded with countless skin-care products claiming otherwise but those claims are completely false.

Basically, the issue of sagging is all about genetics, gravity, and sun damage. We all know that sun damage destroys the underlying structure of skin making it less elastic. But your bone structure and the shape of your face determined by your genes also plays a major role in how your skin sags. If you have a thinner, narrower face, you will have more sagging because there’s less fat pads and bone structure to hold skin up and in place. Women with wider, fuller faces and a bit more fat content have less sagging as a result of their stronger facial architecture.

• The shifting and depletion of fat pads beneath the skin (these are so important for creating the shape of your face)
• Bone loss coupled with skin continuing to grow despite less framework to support it
• Gravity’s toll: everything is being pulled downward
• Genes affecting your face shape and structure

These are the other factors that you can control:

• Sun damage (almost every sign of aging comes back to this basic truth)
• Weight changes (most evident in the cheek area—you lose too much weight, your cheeks are no longer full and plump)
• Use of irritating skin-care products (irritation causes collagen to break down, and healthy, firm collagen is critical to skin’s youthful appearance)
• Over-manipulation of skin, which includes facial exercises. This pulls and stretches elastin, the other supportive element that is critical to your skin’s ability to maintain resilience (think about heavy earrings the stretched-out earlobes they cause!).

The combination of a brilliant skin-care routine emphasizing sun protection and the procedures a cosmetic dermatologist (or cosmetic surgeon) can perform are keys to stopping sagging from getting worse and correcting the sagging that you see now. For all the money you may waste buying skin-care products that claim to lift up or re-contour your skin, you could save that money and consider some very effective cosmetic medical procedures instead

When it comes to cosmetic corrective procedures to improve sagging skin, the top choices with the most research supporting their use are Thermage, Fraxel, laser resurfacing, and dermal fillers such as Sculptra, Juvederm, Perlane, or Artefill. Advanced sagging (think loose jowls or loose skin from the cheek area past the jaw line) can only be successfully addressed by cosmetic surgery.

You need to know that none of these are permanent solutions; you’ll need more than one treatment for best results, and each procedure has its pros and cons to discuss with your dermatologist. To find a board certified cosmetic dermatologist skilled in these procedures go to www.cosmeticdermatology.net. And remember—this isn’t an area to bargain shop, and never have any procedure performed at a facility that isn’t licensed or doesn’t have a doctor on staff at all times.

And of course continue using Paula’s Choice products and sunscreen! Put all this together and you’ll find the answers you’re looking for.