You slather on creams and do anything you can to prevent wrinkles from forming on your face, but have you been paying just as much attention to your chest? Probably not. Only when you catch a glimpse of your exposed skin while wearing a scoop neck shirt or plunging neckline, do you realize that your chest doesn’t match your face. If you see a smattering of brown spots speckled all over, vertical lines that look like arrows along your clavicle and wrinkles between your breasts (let’s be honest, how many times did you forget to apply sunscreen there?), then we’re talking about décolletage damage.

“Because the delicate décolletage [the area from the base of your neck to your cleavage] is usually neglected, it’s one of the first places to show signs of aging,” says Marlene Mash, MD, a board-certified dermatologist and cosmetic surgeon in Plymouth Meeting, Pa. While using over-the-counter anti-aging creams and serums might help slightly, if you’re more interested in undoing the damage, most doctors will suggest more aggressive treatments.

Décolletage Distress

“Since skin is thinner in the décolletage area and tends to produce less collagen, it’s particularly vulnerable to damaging UV rays,” says Karen Linder, MD, a board-certified dermatologist in Scottsdale, Ariz. “The skin is usually more sensitive there and doesn’t heal as quickly as other parts of the body.”

Years of sun worshipping in your teens can bring on brown spots, a crepey texture, and fine, vertical-lined wrinkles by the time you reach the tender age of 30. This was certainly true for Katherine, 33, who spent her summers at the beach and on a boat, all the while slathering her skin in baby oil.

“I was always putting sunscreen on my face, but never thought about my chest area, until I saw a picture of myself in a strapless dress two years ago. It was wrinkly with brown spots, and I knew I was way too young to look like this. I set up an appointment to talk about my options almost immediately after,” she says.

Skin Savers

Once you’ve decided to move forward, book a consultation with your doctor. He or she will look over your chest, assess the damage and make a recommendation for a series of procedures based on what your décolletage looks like.

“I want the patient to have realistic expectations going into this. I tell her that we can reverse a lot, but there’s only so much we can do for serious damage,” explains Dr. Mash.

Turns out, there’s no one-size-fits-all procedure for everyone. Your doctor may recommend a series of intense pulsed-light treatments, non-ablative laser treatments, chemical peels or microdermabrasion for resolving the pigmented spots and rough texture. She may even want to use Botox for smoothing out the vertical lines and deep wrinkles.

“It’s rarely one or the other. It’s like a recipe that needs to be put together,” Dr. Mash adds. Final results take a while, so expect to be back in at your doctor’s office over the next few months for multiple sessions—at least three to six for a series of peels or microdermabrasion, and at least two for light therapy. Botox usually only requires one session, as the results last for months.

Procedure ABC’s

For your first treatment, expect to be in the office for no more than an hour. If your package includes a peel or microdermabrasion, you’ll do only that, and then come back to have the laser treatments.

Pre-appointment, your doctor might prescribe a lightening regimen with hydroquinone to help bring the brown spots to the surface, making them easier to zap with the laser.

“There’s no downtime, and the dead skin flakes off taking the discolorations with them. You’ll see newer, younger looking skin in a few days,” says Dr. Linder. At your laser session, expect your doctor to switch between an intense pulsed light (IPL) and a non-ablative laser.

“I had the IPL first, which was hot, but didn’t hurt. Then a skin tightening laser. That was warm and felt good, almost like a massage,” says Katherine, who had a combination of light therapy treatments over the course of three months. If you’re receiving Botox, your doctor may be able to do it during the same session. Two weeks or a month later (depending on what you need), you’ll be back in the office for your next treatment.

Back To Normal

At home, you’ll initially notice your brown spots getting darker. Don’t panic—it’s normal. The spots are coming up to the surface, and will flake off a few days later, says Dr. Mash. Depending on your treatment, you’ll see new, baby-smooth skin, with significantly less pigmentation and fine lines. Maintenance in between appointments is usually simple. You’ll follow a skincare routine suggested by your doctor and avoid any sun exposure, which will counteract the results.

“I was thrilled after just two sessions. The crepey look was gone, most of the brown spots disappeared, and I finally felt like the skin on my chest was age appropriate,” says Katherine.

The results can last, as long as you are vigilant about sunscreen. “You’ll probably want a touch up or two over the next year, especially if you do Botox, which wears off,” says Dr. Mash. “But I can’t say it enough—sunscreen is SO important. One slip up and the spots will resurface, putting you right back where you started.”