One of the wonderful things about the beauty business is that there is almost no problem too niche for the men and women in white coats not to have put their minds and their pipettes to dealing with it. Not that the décolletage is all that niche; strictly speaking, it takes in the whole of our bodies from neck to waist, including the back and the front. But, of course, what most of us are worried about is the area that might more properly be called the embonpoint, the part that shows, that we like to look smooth and plump and creamy when we’re wearing a low-cut dress or a swimsuit. In Britain’s rather dreary climate we can get away for most of the year without worrying about it too much – remember the wonderfully witty writer Nora Ephron’s saying, “you can’t own too many black turtle-necked sweaters” in her rant against the travails of ageing, I Feel Bad About My Neck? But given that long-sleeved, high-necked swimsuits are not yet featuring on the fashion pages, there is no escaping the issue come the summer.
Dr Philip Levy, a Swiss-Canadian esthetic dermatologist working in Switzerland, sums up the problem like this: “The chest is one of the most-exposed and least-cared-for areas of the body. Sun damage conspires with the passage of time to thin the skin and create wrinkles, sunspots and crêpe-paper-like texture. Even side-sleeping, which chronically compresses the skin, contributes to the vertical wrinkling pattern on the chest known colloquially as a ‘waterfall’ or ‘alluvial fan’.”
All the dermatologists I have spoken to reiterated that it is the area most women take the least trouble with, which they come to regret as they grow older. Dermatologist Dr Nick Lowe, for instance, urges women to wear sun-protection cream whenever they wear anything less than high-necked clothing. But there is hope for damaged skin: therapies are available, and they are improving all the time. Just one note of caution though: have a treatment at least two weeks before a big event, as almost all of them leave the skin looking rather pink and sometimes bruised.
Let’s start with the simplest remedy that I know works – because I tried it out for myself about six years ago, on skin that had spent far too many days in my youth exposed on South Africa’s beaches – is Decoll-therapy. Devised by therapist Joanne Evans and Dr Jules Nabet at the Medical Rooms in Kensington’s Royal Garden Hotel, it has a double-pronged approach. Firstly, laser therapy is used to stimulate the cells that produce collagen, and thus improve the texture of the skin, while also taking care of broken capillaries, freckles and sunspots. Then Botox is used to deal with wrinkles and lines. It takes 30 minutes and costs £400. One session is usually enough, but the downside is that it only lasts as long as the Botox (about six to nine months) and brown spots tend to recur, so it needs doing once a year at least. Decoll-therapy is a firm favourite among some of Nabet’s long-standing clients. Doreen Chipchase, who is in her mid-50s, found it revolutionary. “The lines and wrinkles on my décolleté are non-existent and the skin looks plump, firm and smooth,” she says. “I now have the chest of a 30-year-old. My friends have noticed the difference and have commented on it.”
Newer on the market are micro-firming treatments, which are based round using radio-frequency and micro‑needling together. At EF Medispa, owner Esther Fieldgrass offers MicroFirm, where the skin is treated with an anaesthetic ointment before micro-needles penetrate the surface, using bipolar radio-frequency energy, which is claimed to stimulate collagen regeneration and new elastin. The tiny, invisible holes caused by the micro-needles allow cosmeceutical products from companies such as SkinCeuticals and Dermaquest – which are applied afterwards and help with recovery – to sink deep into the skin. A more expensive option is to have the AQ Stem Cell treatment as after-care instead. This uses stem-cell technology, which the brand says will speed up the recovery and improve healing. Currently, EF Medispa only offers these treatments at its Chelsea branch, but they will be available in all of its spas in the New Year. MicroFirm costs £800 per session and a course of four (costing £3,000) is recommended at one‑month intervals. The AQ Stem Cell is another £200 per session. After a complete course, one treatment a year should be enough.
Dr Nick Lowe also offers a micro-needle radio-frequency treatment, Intracel, which Lowe says heals quickly, tightens collagen and elastin and deals with pigmentation. It costs £800 a time; he recommends four sessions at monthly intervals, and then occasional top‑ups, provided a night-time cream is used regularly. For décolletés with lighter, surface sun damage, such as a few brown spots and wrinkles, Lowe recommends the gentle Fraxel Dual laser, which works on pigmentation with one wavelength and wrinkles and scars with the other. This is also designed to allow creams and lotions to penetrate the skin more easily, and so he recommends a skin-lightening cream to follow, such as his Super Light Skin Tone Perfector Cream (£18.99 for 50ml, from Boots). A session costs £875 and he suggests having between three and four.
Meanwhile, medical technology company Ulthera is about to bring a new décolleté treatment to the UK called Ultherapy, which if it does all it promises will be a miracle treatment. It is said to “tighten, tone and lift loose skin to counteract the effects of time and gravity”. It does this by using micro-focused ultrasound energy, which precisely heats tissue at multiple depths, with the aim of regenerating the skin’s collagen/elastin cushion that gives the skin its youthful look. For the first time, ultrasound energy is directed not only into the skin, but also deep underneath, to address the fibromuscular tissues – the skin’s foundational layer, which is typically addressed in cosmetic surgery. It is approved by the US Food and Drug Administration and takes 60 minutes, with most patients needing only one session. Ulthera says that while there’s some immediate improvement, it takes two to three months for the full effect to be revealed. The treatment, which starts at £2,000, will be available from December through Dr Alexis Karidis, one of the UK’s best-known cosmetic surgeons.
In Switzerland, Dr Levy, a pioneer in treating the décolleté with hyaluronic acid, offers a bespoke therapy that involves superficial dermal micro-injection techniques (mesotherapy), which deliver an anti-ageing cocktail to both layers of the skin: the superficial epidermis and the deeper dermis. Apart from hyaluronic acid for plumping, the cocktail can be blended with multivitamins, and he finds it particularly effective in firming a crêpey décolleté. This costs about £265, or about £398 with a deep laser pre-treatment.
Meanwhile, there are always specialist creams. It seems every dermatologist or cosmetic surgeon worth the plates on his door has developed a range of his own. They all come with impressive-sounding research and ingredients. Certainly, skin that is regularly exfoliated and moisturised looks a great deal better than skin that doesn’t. Elevate’s Bust Firming Cream (£69.95 for 125ml), which contains key plumping and hydrating ingredients, comes with the soubriquet of “the boob-in-a-tube”. Around 10,000 were sold within 24 hours of the cream being launched. Louisa Glen, a young mother who was worried about wrinkling in the décolleté area after giving birth, decided to try it. “It’s been amazing,” she says. “I’ve been using it every day for three months now, and I think my skin is much smoother and the tone of it is better. I can really see the difference.”
Dr Phillip Levy’s lotions – an Intense Stem Cell Booster Cream (£290 for 50ml), and an Intense Stem Cell Booster Serum (£280 for 30ml) – use ArganCellActiv anti-ageing and firming agents. These were developed in Levy’s own laboratories and he claims they are the first plant-derived stem-cell extracts proven to help regeneration. It’s a potent mix that also includes hyaluronic acid, tripeptides and vitamins A, C and E.
Then there’s considerable excitement round the launching of RéVive’s Peau Magnifique Youth Recruit Intensive Neck and Décolletage Serum. It is most famous for its Peau Magnifique for the face, which promises to slow the visible signs of ageing and became a bestseller in spite of its £930 price tag. Dr Gregory Bays Brown is behind the technology, which is based round “renewal epidermal science”, and is supposed to speed up cell renewal. The neck and décolletage version is said to firm, tighten and smooth the skin, as well as reducing the appearance of lines and wrinkles. It’s a 28-day course costing £575 for four 7.5ml vials, available from Liberty exclusively.
Deciding which route to go down isn’t easy, so it’s worth choosing your aesthetician with care, to make sure that they offer the right treatment for you. One thing, however, is certain: those who are after a creamy décolletage are spoiled for choice.