Décolletage and chest rejuvenation in Singapore:
sun damage, crepe lines and poikiloderma

Why does the décolletage age faster than the face?

The skin of the upper chest is structurally different from the face. It is thinner, it has far fewer sebaceous glands and hair follicles, and that matters because the follicles are where the skin regenerates from after any injury or treatment. It also sits on a flat, slightly convex surface that is exposed in most clothing and that folds into vertical creases whenever you sleep on your side. In Singapore the ultraviolet index is high all year, and the V of the chest is lit through open collars, in the car and at the pool in a way the face, which gets sunscreen and a cap, often is not.

The result is that the chest shows three kinds of change, and they are not the same problem. The first is dryness and crepiness: fine horizontal and vertical lines that appear when the skin is pressed together and smooth out when it is stretched, because the dermis has lost water and collagen. The second is laxity with deeper vertical lines between the breasts that are present at rest, more marked in women with a fuller bust and in side-sleepers. The third is sun damage: scattered brown spots, and the mottled red-brown change with fine vessels and a thinned, shiny surface called poikiloderma of Civatte. Each needs a different approach, and the first task is to work out which you have, and in what proportion.

What is poikiloderma of Civatte, and why does it matter for treatment?

Poikiloderma of Civatte is the name for a reticulated, red-brown discolouration with fine dilated vessels and mild thinning of the skin on the sides of the neck and the V of the chest. Its signature is the sharp sparing of the skin shaded by the chin, which tells you the cause is chronic ultraviolet exposure. Fragranced products applied to the neck and chest are thought to contribute through photosensitisation, and women with fair skin and a tendency to flush are over-represented; Greek work from 2005 asked whether it belongs on the same spectrum as rosacea. It is harmless, it is common after 40, and it is frequently mistaken by patients for pigmentation alone.

It matters because the three components, red vessels, brown pigment and thinned skin, respond to different energies, and a device chosen for one can make another worse. A pigment laser aimed at the brown will not touch the red and can leave pale patches in thinned skin; a vascular setting that quietens the red leaves the brown. Dr Sin Yong examines the chest with a dermatoscope to confirm the diagnosis, to weigh the red against the brown, and to exclude a solar lentigo, a seborrhoeic keratosis or anything that needs a biopsy before treatment. Melasma is a facial condition and is not expected on the chest, so a symmetrical brown patch there is examined with that in mind.

“I do not treat 'pigmentation on the chest'. I treat red, brown or thin, and poikiloderma is all three at once, which is why the device that cleared your sun spots is the wrong one for it.”

Dr Sin YongOn décolletage sun damage

Décolletage treatment options: skin boosters, RF microneedling, laser and Time Freeze Laser LCLR®

The options below are the ones Dr Sin Yong draws on for the chest. Which are used depends on the pattern found, on skin phototype, and on whether the neck and hands are being treated in the same plan, which they often are; the combined approach to all three areas is on neck and hand revitalisation.

Hyaluronic acid skin boosters

Micro-injections of non-crosslinked hyaluronic acid across the décolletage restore water to the dermis and improve the crepe quality of the skin. They are the usual first injectable for dryness and fine lines, and they add no volume, which is what you want on a flat surface. Profhilo, which Dr Sin Yong uses on the face, neck and hands with a modified BAP technique, is described on its own page; which booster, if any, suits your chest is decided at examination.

RF microneedling

RF microneedling places radiofrequency heat at a chosen depth in the dermis through insulated needles, prompting collagen remodelling for texture, crepiness and early laxity. On the chest the depth is set shallower than on the face because the skin is thinner, and the energy is chosen for phototype, since post-inflammatory darkening is the risk to avoid on Asian skin. It is the option considered for vertical lines that are present at rest.

Laser toning and vascular settings

For the brown and the red of sun damage, low-fluence laser toning with the 1064 nm Nd:YAG addresses diffuse pigment conservatively, and a long-pulsed setting on the same wavelength is used for the vessels of poikiloderma. The two components are staged rather than treated in one pass, and the chest is tested before a full treatment because it heals more slowly than the face.

Time Freeze Laser LCLR®

Time Freeze Laser LCLR® is Dr Sin Yong's laser protocol for taking away excess and tightening from the surface, used on the face and body with no redness and no downtime. On the chest it is considered where laxity rather than sun damage is the main finding, and only after examination.

What is not used on the chest

• Dermal filler to 'fill' chest lines: the surface is flat and thin, and filler shows and migrates.
• Aggressive resurfacing: the chest has few follicles to heal from, so deep ablative treatment carries a scarring risk that is not worth taking.
• Any laser on a spot that has not been diagnosed.

Sun strategy for the chest: the part of the plan that does the most

Every treatment on this page is undone by continued unprotected sun, and poikiloderma in particular returns if the exposure that caused it continues. The sun strategy is written into the plan before any procedure.

• A broad-spectrum sunscreen of at least SPF 30 on the neck and chest every morning, reapplied if you are outdoors; most people stop at the jaw.
• Collars and crew necks on days with long sun exposure, and awareness that the driver's side of the chest is lit through the window.
• Perfume and fragranced body products sprayed on the neck and chest are moved to clothing or the wrists while poikiloderma is being treated.
• Side-sleepers who want to reduce vertical creasing can try a pillow between the arms or sleeping on the back; the evidence is practical rather than scientific.
• A yearly look at the chest for any spot that is new, changing or different from the rest.

None of this requires the clinic. It is listed first because it is the one part of the plan that decides whether the rest holds.

What decides the plan, and what to expect afterwards

The examination decides the plan. The factors are which pattern dominates, crepe, laxity or sun damage; skin phototype, which sets laser and radiofrequency energy and may rule out some settings; whether the neck and hands are being treated together; any history of keloids, since the chest and shoulders are the commonest keloid sites and a chest keloid changes what can be done; recent sun or a tan, which postpones laser; and pregnancy or breastfeeding, which postpone injectables. The fee follows the treatments chosen and the areas, and is set out in writing after the consultation.

Aftercare in broad terms

• After skin boosters: small raised points and occasional bruises that settle; no massage; sunscreen from the next day.
• After RF microneedling: pinkness and a fine grid that fades; keep the skin clean, avoid make-up on the area until the surface has closed, no sun.
• After laser: mild redness; brown spots may darken before they flake; no picking, no sun, bland moisturiser.
• Written instructions for each treatment are in the aftercare hub, and any blistering, lasting redness or change you did not expect is reviewed by Dr Sin Yong rather than waited out.