ProductsYou notice it in a mirror or in a photo taken with your arm raised: the skin on your upper arm looks thin and finely wrinkled. That's crepey skin. Before you choose a crepey skin treatment, it helps to know that it's a different problem from wrinkles, with different causes and different fixes.
Crepey skin and wrinkles aren't the same problem
Crepey skin is thin, loose skin with fine wrinkles that looks like crepe paper. Unlike a wrinkle, which forms a line, crepey skin affects an area of skin. It is most noticeable where skin is naturally thinner and has had years of sun exposure: the upper arms, chest, neck, and the skin above the knees.
Expression wrinkles come from repeated muscle movement. Repeatedly, frowning or squinting can cause lines in the skin to become permanent. Crepey skin comes from thinning of the dermis, the deeper layer of skin. Botox works by relaxing muscles, so it doesn't help crepey skin. There is no muscle movement causing crepey skin. The skin underneath has lost thickness and elasticity.
What causes crepey skin
Crepey skin develops when the dermis, the deeper layer of the skin, loses collagen and elastin, the two proteins that keep skin firm, resilient and elastic. Both decline naturally with age. Treatments can stimulate new collagen production, but lost elastic tissue is more difficult. This is one reason that improving skin texture is easier than correcting significant skin laxity.
Age is one factor, but these factors can speed it up:
- Years of UVA exposure. UVA rays pass through window glass and penetrate deep into the skin where they can damage the collagen and elastic tissue. So time spent near a sunny window or while driving matters. Over time, chronic sun exposure can cause solar elastosis, a buildup of abnormal elastic tissue that adds to changes in skin texture and elasticity.
- The decline in estrogen around menopause. Women's skin loses up to 30 percent of its collagen in the first five years after menopause.
- Rapid or repeated weight loss can leave loose wrinkled skin, especially on upper arms, thighs, and abdomen.
- Smoking, which speeds up the breakdown of collagen and elastin.
- Dry, under-moisturized skin, which makes crepiness look more noticeable, though it doesn't cause the crepey skin.
- Certain long-term medications, most commonly oral or topical corticosteroids, which can thin the skin.
Sun history usually matters more than age. That's why I ask about your sun exposure, medications and weight changes. Years of steroid cream on the arms or a recent weight loss can change which treatment I recommend. The sun-damaged areas where crepiness appears are also where precancerous spots and skin cancers tend to develop, so I examine the skin before discussing anything cosmetic.
Crepey skin on arms, chest, neck, and legs: why each area behaves differently
Each area has different skin thickness, sun exposure and fat underneath, so the same treatment can give different results on the arms, chest, neck and legs.
Upper arms
The inner upper arm has thin skin, little underlying support, and often both sun damage and weight change. Results here are usually more modest. Texture, tone, and fine crinkling commonly improve, while some loose skin remains. If the skin hangs significantly, I'll recommend the right approach for you at the consultation.
Chest
The chest combines decades of sun with sleep creasing, the vertical lines from lying on your side. Because so much of the problem is surface texture and sun damage, the chest usually responds well to resurfacing such as Fraxel.
Neck
Neck skin is thin and moves all day. As on the chest, sun damage is usually the main cause, and both radiofrequency and Fraxel can treat the neck. Neck bands come from muscle, and a sagging jawline comes mostly from lost support in deeper tissue, so I assess them separately.
Legs above the knee
Crepiness above the knee is often tied to weight change and sun. As on the arms, texture usually improves more than looseness.
What helps at home, and what it can't do
Prescription retinoids are among the best studied home treatments for fine wrinkles. A retinoid is a vitamin A cream. With regular use, it speeds skin cell turnover and helps the skin make new collagen. The FDA-approved label for Renova (tretinoin cream) covers fine facial wrinkles. It notes that results can take up to six months to show and that it doesn't restore younger skin. Using it on the arms, chest, or legs is off-label, meaning the label doesn't cover those areas. Retinoids aren't used during pregnancy, so I'll ask whether you're pregnant or planning to be before prescribing one.
Along with a retinoid, these can help:
- A moisturizer with ceramides and hyaluronic acid, applied to damp skin after showering. Better hydrated skin looks smoother.
- An alpha hydroxy acid lotion, such as lactic or glycolic acid, a few nights a week for surface roughness
- Peptide products, which may help, though the research behind them is weaker than retinoids.
- Daily broad-spectrum sunscreen on all uncovered skin, which the American Academy of Dermatology recommends every day to reduce skin aging
If you only put sunscreen on your arms and chest in summer, here's why it matters year-round. Home care commonly improves texture, hydration, and tone, and slows further damage. It can't replace lost elastin, though, so looseness usually remains.
Crepey skin treatment in the office
For the upper arms, thighs and knees, I usually recommend radiofrequency skin tightening, sometimes paired with Fraxel for texture. For the chest, I usually recommend Fraxel first. Both radiofrequency and Fraxel prompt your skin to make new collagen. We offer several radiofrequency devices as well as Fraxel. That lets me choose the treatment that fits your body area and skin.
- Radiofrequency skin tightening. Radiofrequency is energy that heats the dermis without breaking the skin. It tightens existing collagen and helps the skin make new collagen. Our devices include one designed for larger areas such as the thighs and abdomen. Treated areas include the neck, arms, thighs and knees, and there's no downtime.
- Fractional laser resurfacing. Fraxel treats many tiny spots in the skin and leaves the skin around them untouched, which improves texture and sun damage. It's used most often on the face, neck, chest and hands, and it can also treat larger areas such as the arms or legs. Expect redness, mild swelling and rough texture for 3 to 5 days. Fraxel can also help tighten mildly loose skin.
I examine the area, and I design and oversee every plan. My medical assistant, who has 13 years of experience, performs the laser and radiofrequency sessions.
How long before anyone notices
New collagen takes months to form, so the first weeks usually show little. With radiofrequency, visible results usually show within 3 to 6 months. Depending on the device, radiofrequency is a single session or a series of treatments spaced a few weeks apart. With Fraxel, many patients notice improvement within about 4 months, usually over a series of treatments spaced about a month apart. A retinoid works on a similar timeline. Results usually fade over time as aging and sun exposure continue, so I tailor maintenance to how your skin responds. Daily sunscreen and a retinoid help results last longer.
FAQ
Can crepey skin be reversed?
Partly, in most cases. Texture, tone, and fine wrinkling commonly improve with a retinoid and in-office treatment that prompts new collagen, while some looseness usually remains.
What treatment works for crepey skin on the arms?
It depends on how much of the change is texture and how much is looseness. For most upper arms, I recommend radiofrequency, sometimes paired with Fraxel for texture. Results on the arms are usually more modest than on the chest, and if the skin hangs significantly, we'll decide on the right approach together at your consultation.
Does retinol help crepey skin?
It can help somewhat, though less than a prescription retinoid. Over-the-counter retinol is a weaker relative of tretinoin, which has the stronger evidence. Give any retinoid several months before judging it.
At what age does crepey skin usually start?
There's no fixed age. Visible crepiness commonly appears in midlife, often earlier with a long sun history or after significant weight loss. Menopause frequently speeds it up.
Where to start with crepey skin
The right skin treatment for crepey skin depends on the area of the body and your sun history. I first determine what's causing yours, then create a treatment plan for that area. At your first visit, I examine the area and check the surrounding sun-damaged skin for spots that need attention. I also ask about medications, weight changes and menopause.
Most patients need in-office treatment as well as home care. I tell you what's realistic for that area, and we decide together which to start with.
If the skin on your arms, chest or legs has started to look like crepe paper, request an appointment or call to have it assessed in person at 931 5th Ave on the Upper East Side.
