Hot Under the Collar

This past winter, as I sat in the theater watching American Hustle, I got just as swept up in the fashion as in the plot. While I suspected that my husband, David, was debating the plausibility of wearing three-piece suits, I was more interested in what Amy Adams wasn’t wearing: a buttoned-up top or, apparently, a bra. Though, like everyone, I couldn’t keep my eyes off her chest, I wasn’t ogling her assets; I was scouring the screen for a sunspot, a wrinkle, anything to prove my thesis that, as you close in on 40—a birthday Adams will celebrate in August—your décolletage reveals more about your age than your face does. In a way, her flawlessly smooth, freckle-free skin felt like the film’s real con. Walking home, I said to David, “You have to admit, those tops were a little ridiculous.” He nodded: “Yeah, ridiculously awesome.” I rolled my eyes. I’d sooner fake a British accent and sell forged art than sport something that low-cut in public.

It wasn’t the possibility of flashing a nipple that put me off. It was something more intimate: After figuring out the perfect combination of fillers to smooth my brow and lift my cheeks, baring my cleavage would mean pulling back the curtain (or, in my case, the turtleneck) to reveal an embarrassing contrast. I’ve treated my décolletage like a stepchild, in the Brothers Grimm sense of the word. I’ve worn hats that protect only my face. I’ve forgotten to apply sunscreen. I’ve neglected to moisturize. The result: fine lines that radiate from my cleavage in a fireworks display of middle age. But Adams inspired me. I was ready to get something off my chest, and when I started to research options, I learned I wasn’t the only one. The breast-to-collarbone region is, it seems, the latest battleground in the war on aging, and there are some powerful new weapons in the arsenal.

My first stop was the office of Paul Jarrod Frank, a New York cosmetic dermatologist, who walked me through the challenges of treating wrinkles in this particular area. Chief among them is the fact that the skin is far thinner here than it is on the face, meaning traditional hyaluronic acid fillers like Juvéderm and Restylane can leave visible clumps. For fair-skinned women like me, the bluish hue of those products can also show through the epidermis—obviously, not a good look. But, happily, there’s now another option: Belotero, a newer hyaluronic that’s liquid-thin, moldable, and colorless. According to Dr. Frank, it’s “really opened up” doctors’ ability to treat the area.

There are, of course, some downsides. Belotero costs between $500 and $1,000 per syringe, about $100 more than other fillers, and because it’s injected into the top layer of the skin, where there are more capillaries, it tends to cause more bruising. This layer also has more nerve fibers, which means the injections hurt, and the pain can be compounded by the fact that the U.S. Food and Drug Administration approved Belotero without a numbing agent mixed into it. (Juvéderm and Restylane come pre-dosed with lidocaine.) Some—but not all—doctors add the lidocaine themselves. When I had Belotero injected into the fine lines around my upper lip a few months ago, the doctor used only a topical numbing agent. The injections burned so wildly that the ice pack I was handed afterward melted before I felt any relief. Dr. Frank, mercifully, not only applied a topical but also combined the filler with lidocaine and, to prevent bruising, epinephrine. He injected one syringe into the lines in my cleavage and massaged the fluid up and across my chest. The whole thing took about 10 minutes, and when I removed the ice pack, I noticed that the wrinkles that had bothered me for so long were barely visible.

But filler can go only so far. According to Julius Few, a plastic surgeon in Chicago, sunspots are a major issue for many women, as are crepey texture and outright sagging. For years, the standard protocol for erasing hyperpigmentation and deep wrinkles was aggressive laser treatment. But now, forward-thinking dermatologists are taking a more elegant approach by combining less-invasive treatments in a single office visit. Dr. Few prescribes his patients a two-week prep course of retinol to aid in healing and then treats them with Erbium, a fractional laser that smooths wrinkles and removes discoloration, and Ultherapy, a micro-focused ultrasound that stimulates collagen and tightens the skin. Results can last more than two years, and recovery takes less than three days. Is the change dramatic? That depends on your perspective. A recent study published in the Journal of the American Academy of Dermatology reported that one session of the ultrasound decreased subjects’ mid-clavicle–to–nipple distance by about one and a half centimeters. Some plastic surgeons are not convinced that tightening the skin less than two centimeters is enough to warrant Ultherapy’s $2,500-to-$3,500-a-pop price tag and prefer to use a less expensive combo of aggressive lasers and Belotero—despite the two-week recovery time. But for busy women—and for those with darker skin, which has a higher risk of scarring when lasered—Dr. Few’s approach may be worth its weight in gold.

Still, no matter how clever doctors are becoming about combining high-tech treatments, it seems nothing can compare with stem cells. The New York plastic surgeon Sydney Coleman is harvesting them from patients’ own fat to rejuvenate the décolletage on a cellular level. His nano-fat-grafting technique involves removing about two ounces of fat from the patient’s abdomen or inner thigh and then spinning it in a centrifuge to separate out the most stem cell–rich bits. That fat is then delivered to the skin intradermally via a tiny cannula. The result, he says, is fewer wrinkles, better overall texture, and more-resilient skin. “Damage from sun exposure on the neck and chest can interfere with blood supply,” Dr. Coleman explains. “Stem cells start a process called neo-angiogenesis, which replaces old, tired blood vessels with new ones.” There’s next to no downtime, and full results are visible within three to six months.

Elsewhere, the Beverly Hills plastic surgeon Lawrence Koplin is working with a microscopically fine mesh to separate out stem cells from the fat. He uses the same type of needles that deliver Belotero to fill deep lines on the décolletage and then injects the stem cell serum in a crisscross pattern on the chest. He has been doing the procedure, which he calls nano stem cell grafting, for about seven months and says it’s revolutionizing his practice. “For years we’ve been damaging the skin with lasers, peels, and abrasion—all of it injuring the skin to get to a new layer,” he says. “Now we are putting stuff that has curative, healing, regenerative power into the skin for transformational results.”

It sounds exactly like the treatment I’ve been looking for since I turned 40: the fountain of youth in a syringe. But there is, sadly, a wrinkle. Costs for the stem cell procedures can run up to $13,000. So for now, I’m sticking with a regimen of sunscreen and Belotero—and thus far, that seems to be enough. A week after my visit to Dr. Frank, my chest was as smooth as a ’70s Halston model’s. You won’t catch me in a plunging sequined number à la Amy Adams anytime soon, but I have been doing up fewer buttons on my blouse.