A lovely fifty-something-year-old woman was referred to me by a plastic surgeon colleague because of bladder control issues. She appeared much younger than her chronological age and extremely physically fit and when I asked her why she had consulted the plastic surgeon she responded “I am fat and am considering a tummy tuck.” She grasped a subtle roll of abdominal flesh to demonstrate to my nurse practitioner and me what she was referring to. I glanced at my nurse practitioner in disbelief and we both responded by pinching our little abdominal rolls between our thumbs and index fingers, tacitly acknowledging that there are some fat deposits on the body that are tenacious and impossible to lose despite the healthiest of diets and plenty of physical activity and exercise. I commented, “You look like you’re in great physical shape and that little roll is all about gravity; time and gravity are cruel conspirators.”
As the years pass, our chromosomes contract and fracture, genes turn on and off haphazardly, mitochondria break down, proteins unravel or clump together, reserves of regenerative stem cells dwindle, bodily cells stop dividing, bones thin, muscles shrivel, neurons wither, organs become sluggish and dysfunctional, the immune system weakens and self-repair mechanisms fail. There is no programmed death clock ticking away inside us — no precise expiration date hard-wired into our species — but, eventually, the human body just can’t keep going.
–Ferris Jabr, How Long Can We Live? (NY Times Magazine, April 28, 2021)
The bony skeleton is the scaffold of our body, much like the framework upon which an art canvas is tightly stretched. Attached to the skeleton are the many muscles that define the shape of the body. Superficial to the muscles is the subcutaneous fatty tissue that provides the support for the skin. The skin is the most superficial layer and in our younger years is characteristically smooth, tight, elastic and supple by virtue of two important dermal structural proteins, collagen and elastin. Collagen helps skin maintain its structure and firmness and elastin provides elasticity.
Aging decreases the integrity of bones, muscles, subcutaneous tissue and skin. It is little wonder that age-related tissue atrophy, further influenced by the force of gravity, results in a generalized sagging and drooping of many areas of the body with a loss of the smooth, tight, elastic and supple outermost layer of the body, correlating with the decline in collagen and elastin production with aging. Other factors that may adversely affect these structural proteins include genetics, overexposure to the sun, tobacco, exposure to environmental pollutants, weight loss, and pregnancy.
The Seven Dwarves of Old Age
The Golden Years Are Here at Last
I cannot see,
I cannot pee,
I cannot chew,
I cannot screw,
The golden years are here at last.
My hearing stinks,
My memory shrinks,
No sense of smell,
I look like hell,
The golden years are here at last.
Moving me requires a team,
Gluing my teeth requires cream,
My back requires special beds,
My body won’t work without my meds,
The golden years are here at last.
My walking is way too slow,
My urine does not want to flow,
My saliva sometimes tends to drool,
I wait forever to produce my stool,
The golden years are here at last.
The golden years are here at last
The golden years can kiss my ass.
Poem by Lou Harrison
Gravity is the powerful invisible force that pulls things towards each other. Earth’s gravity gives weight to physical objects including humans, keeps up from floating away, and is what makes objects fall. The gravitational force of the moon is of sufficient intensity to cause the ocean tides. This force also contributes to the downward descent of body parts.
TIME + GRAVITY–> TROUBLE
The ravages of time plus gravitational forces spells trouble for our youthful suppleness and smoothness. Although this affects all areas of the body, some body parts are particularly susceptible.
One’s youthful and supple skin that is tautly sculpted over his/her jawbones and other facial bones fashioning a tight and smooth neck and a sharp jawline—like an artist’s canvas properly stretched over a wood frame—gradually becomes lax and saggy, causing the development of a slackening jawline, jowls and sometimes creating the appearance of having multiple chins. Eyebrows may droop over the eyelids and the upper and lower lids may sag and become baggy in appearance. “Turkey neck” is the term used to refer to the unattractive wrinkled, sagging and crepe-papery skin of the neck that occurs with platysma muscle weakening and loss of collagen and elastin of the overlying skin. The saggy and wrinkled skin can eventually cause one’s face to have a prune-like appearance, as compared to the supple, plum-like appearance of youth.
Cooper’s ligaments provide support to the breasts and help them maintain their youthful and perky shape. Over time, there is loss of collagen and elastin in this supportive tissue and combined with the unrelenting force of gravity will give rise to Cooper’s droop, the pendulous breasts experienced by many older women.
Upper Arm Jiggles
The saggy skin under the triceps muscles of the arm is often referred to by the unkind descriptive term “bat wings.” This flaccidity is much more common in women than men and weight loss is a major risk factor along with loss of underlying muscle tone and diminished dermal collagen and elastin. With weight gain there is expansion of the skin to accommodate fat accumulation, but with weight loss skin does not contract as readily as it expands, causing this loose skin and pockets of retained fat.
The lower abdomen is a common site for an accumulation of fat and saggy skin. The descriptive term “muffin top” is used to describe this above-the-hip fat when it extends circumferentially around the body. This particular locale of fat accumulation is highly resistant to measures used to remedy it. Yours truly is not overweight, generally consumes a healthy diet, exercises daily, yet has an annoying pinch of fatty tissue that obscures any possibility of sporting the lower aspect of a “6-pack.” When time and gravity team up, they become a powerful force that is extremely difficult to conquer.
Gravity, time and weight gain lead to an enlarging “apron” of abdominal fat (“pannus” in medical speak) that hangs in accordance with the force of gravity, obscuring the penis. Weight gain also causes a bulging of the rounded mound of fatty tissue overlying the pubic bone, the male equivalent of the female mons pubis, further concealing the penis within the mass of fatty tissue and causing it to appear shorter. Penile length is usually reasonably intact, with the penis merely buried in a mass of pannus and mons. Easier said than done, but lose the fat and presto, the penis will reappear.
Scrotal Sac Slack
A young man’s scrotum is tight and provides excellent support to the “family jewels” within. The combined factors of testes weight, gravity and time cause a southward migration of the testes throughout life, particularly so as collagen and elastin connective tissues weaken and scrotal skin becomes less supple. With aging, there is also loss of muscle strength of the dartos and cremaster muscles, causing scrotal relaxation and looser hanging testes, respectively.
A not uncommon complaint voiced by my older patients with dangly testes is that the scrotum contacts the toilet water when one is seated on the toilet. Since the low-hanging testes is less protected, it is more vulnerable to trauma and irritation than the well-supported testes, susceptible to injury when one sits down and discomfort when one participates in cycling, motorcycling, horseback riding and other sports. The low-hanging testes can cause hygienic issues as well as embarrassment and the desire not to be seen naked by a sexual partner, in a locker room or even at the beach in a bathing suit.
Time and gravity morph the round and high-lifted butt into a shapeless and saggy version of itself. The underlying gluteal muscles tend to lose bulk and tone and the overlying skin yields, causing jowls of the butt cheeks. “Elephant butt” refers to the loose flaps of skin on one’s bottom that fall down towards the back of the legs. One might perceive a rippling sensation in the shower when the force of the water distorts the less-than-firm tissues.
DEALING WITH THE DROOPS
Acceptance: The default option. When one first notices their own droop or sag, they may experience in some diminished manner the stages of grief as delineated by Elisabeth Kugler-Ross:
Denial: “What? That can’t be happening to me.”
Anger: “Damn it.”
Bargaining: “Well, I’m getting older and this happens, so if I take certain measures maybe I can make it better.”
Depression: “It saddens me to see the physical evidence of my aging and this reminds me of my mortality.”
Acceptance: “It is what it is, and I’m going to have to learn to embrace it. Life will go on. There are bigger fish to fry.”
Other Means of Dealing with Droop
–Healthy lifestyle approach: Healthy eating habits (whole foods with plant-based emphasis, avoiding junk foods, fast foods, highly processed foods), staying physically active with plenty of exercise, staying well hydrated (this can have quite a beneficial effect, the difference between a drooping houseplant and a hydrated and supple one), consuming alcohol in moderation, handling stress effectively, avoidance of tobacco, avoidance of excessive sun exposure, obtaining sufficient sleep. In terms of exercise, focusing on specific exercises to strengthen the underlying muscles can be helpful, e.g., for the drooping derriere, squats, lunges, deadlifts, etc. Resistance exercises combined with aerobic exercises are a powerful combination.
–Skin firming creams: I am not qualified to pontificate on this topic that I know little about, but the bottom line is to keep one’s skin supple and moisturized. Retinol is a key ingredient in many of the skin firming products.
–Massage: Massage has a stimulating effect on skin, subcutaneous tissues and muscle and is capable of improving blood flow and possibly stimulating the fibroblasts that produce collagen and elastin. No matter what the results in terms of body sagging, massage unquestionably feels great.
–Mechanical devices: home rollers, micro-massagers, etc.
–Non-invasive cosmetic procedures: Lasers, radio-frequency, ultrasound, micro-needling, etc., are techniques used by cosmetic dermatologists.
–CoolSculpting: This cooling process may reduce spot accumulations of fatty tissue by freezing and destroying fat cells.
–Liposuction: This is a surgical technique to suck fat cells out of the body and contour the particular area of concern.
–Plastic surgery: If all else fails, there is always your friendly plastic surgeon to come to the rescue. For a substantial fee, any droopy area of the body can be addressed, including eyelid lift, face lift, neck lift, breast lift, reduction abdominoplasty (“tummy tuck”), etc. More men than ever before are seeking cosmetic upgrades, utilizing fillers, Botox, and plastic surgery.