Aging affects the entire body in very similar ways. The skin becomes wrinkled, loose and often dotted with pigmented discolorations. While much focus is understandably placed on these skin aging changes in the face, and even on the back of the hands, there are other potentially treatable areas that are overlooked. One of these is in an area that I frequently here women complain about…and it is the one that can have been heavily exposed to the sun in the past…the décolleté or breast cleavage area.

Unlike the rest of the breasts, the upper inner poles of the breast mounds and across the sternum can be exposed to heavy sun exposure particularly in those who have a history of tanning or a lot of swimsuit wear on the beach or by the pool. In theory, woman who sleep a lot of their sides or wear cleavage-enhancing bras, push the breasts closer together potentially creating cleavage wrinkles as well. Undoubtably, however, sun exposure and loss of skin elasticity and subcutaneous fat with aging are the main culprits.

An aging décolleté and cleavage area is well known and a point of disdain for some women. Many products have been used for its treatment including topical creams, chemical peels, specially-designed pillows, nighttime cleavage inserts and bras that spread the breasts apart. Medical skin care approaches have included hydration, collagen plumping creams, exfoliation through chemical peels and light laser resurfacing and pulsed light therapies for brown and red spots. While all of these have their merits, and combinations are better than either one alone, their results are usually modest.

Injectable fillers have been revolutionary in their anti-aging effects in the face and the hands, so it is logical that they be applied to the cleavage area as well. But the cleavage area is large and requires a lot of volume to have a visible effect. This is unlike the 1 or 2ccs of synthetic filler that work well in the nasolabial folds for example. For this reason, the best synthetic injectable filler for the cleavage area is Sculptra. This water-diluted mixture containing poly-lactic acid crystals adds substantial volume in a single treatment. It usually takes one or two additional injections sessions to get the maximal result that may last up to two years.

Fat injections are also a good injectable filler option because the amount of volume that can be added is virtually limitless. The cleavage area can be filled from the sternal depression upward. and out laterally over the inner breast mounds if necessary. Using 15 to 20ccs of fat can create a real ‘cleavage lift’. Fat contains stem cells which have theoretical but unproven benefits for volume-deficient wrinkled and inelastic skin. When combined with pulsed light therapies and light fractional laser treatments for the skin of the cleavage after fat grafting, a visible and sustained rejuvenative effect can be obtained.         

Dr. Barry Eppley

Indianapolis, Indiana