Chest Wrinkles: Sleep Lines vs Sun Damage, Do Silicone Pads Work, and What Treatments Show
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Chest wrinkles are lines on the décolletage, the skin between the neck and the breasts. Chest studies link them mainly to sun damage, while pressure "sleep lines" are described only in facial research. No study we found tests silicone chest pads. The best chest data are for in-office procedures, from small studies without untreated control groups.
Evidence: Limited.
Key takeaways
- Sun damage shows up on the chest as laxity and wrinkles. That's the starting premise of a 24-person microfocused ultrasound study of the décolletage (Fabi et al., 2013).
- Tretinoin didn't beat its own base on the chest. In a randomized, double-blind, vehicle-controlled trial with 29 completers, tretinoin 0.05% lotion and its moisturizing vehicle both improved photodamage by 30 to 40% at day 180 (Wood et al., 2022).
- A retinal-plus-peptide serum improved chest fine lines by 19% at week 8 in an uncontrolled study of 32 women (Konisky et al., 2024).
- Poly-L-lactic acid (PLLA) has the strongest procedure numbers. In a 30-woman randomized study comparing two dilutions, 93.8% and 78.6% improved by at least 1 point at month 9 (Joseph et al., 2026).
- No study tests silicone chest pads. The only support is indirect: a facial commentary says sleep lines need a change in sleeping position (Fulton & Gaminchi, 1999).
For where chest care fits in a full routine, see our step-by-step skincare routine order. For lines on the face, see forehead wrinkles.
What are chest wrinkles?
Chest wrinkles are lines and creases on the décolletage, usually from sun damage and sometimes from sleep pressure. Reviews describe photodamaged chest skin as a cluster of changes, not just lines.
Peterson and Kilmer's 2016 review lists the features of a photodamaged chest as laxity (loose skin), lines and wrinkles, hyperpigmentation, redness, rough texture, atrophy (thinning) and telangiectasias, which are small visible blood vessels (Peterson & Kilmer, 2016). A 2018 PLLA study describes the décolletage as being "commonly subject to photodamage," which shows up as wrinkles and crepiness (Wilkerson & Goldberg, 2018).
Chest wrinkles also have their own grading tool. The Fabi-Bolton scale runs from 1 (wrinkles absent) to 5 (very deep wrinkles with redundant folds). In a pilot validation using photos from 28 volunteers, 16 were selected to cover the full range, and the scale showed "very little interrater variability" (Fabi et al., 2012). Many of the studies below use it.
Evidence: Limited (reviews and one small validation study).
Are chest wrinkles from sleeping or from sun damage?
Chest wrinkles can come from either, but only sun damage has chest-specific research. Sleep lines are described in facial studies, so applying them to the chest is an extrapolation.
Anson et al. explain that wrinkles form where "fault lines" develop in aging skin. Facial expression can cause these lines, and so can mechanical compression during sleep. They add that expression and sleep wrinkles "differ in etiology, location, and anatomical pattern," with compression, shear and stress forces acting in side or front sleeping positions (Anson et al., 2016). A cheek-wrinkle classification also lists sleep wrinkles as a separate type, next to laxity wrinkles (Peng & Peng, 2023).
To make sleep lines easier to see, Fulton and Gaminchi describe a "pillow or hand test": pressing a pillow or hand against the skin to accentuate them (Fulton & Gaminchi, 1999). That test was described on the face, not the chest.
| Feature | Sleep lines | Sun-damage wrinkles |
|---|---|---|
| Studied on the chest? | No; facial research only | Yes; several small chest studies |
| Described cause | Compression in side or front sleeping (Anson 2016) | Photodamage (Fabi 2013) |
| How they show | Accentuated by pillow contact (Fulton 1999) | Lines plus laxity, pigment, redness, roughness (Peterson 2016) |
| Approaches discussed | Changing sleep position, or subcision and resurfacing (face) | Tretinoin, PLLA, ultrasound, fillers, lasers |
Bottom line: A dermatologist can tell which pattern you have. Sources: Anson 2016, Fulton 1999, Peterson 2016.
Evidence: Expert opinion, extrapolated from the face to the chest.
Do silicone chest wrinkle pads work?
We don't know. We found no study testing silicone chest pads or any other anti-wrinkle pad.
The idea behind pads is that reducing skin-on-skin pressure at night might limit sleep lines. The closest support is facial: Fulton and Gaminchi write that to treat sleep lines, "the sleeping position must be altered," or the underlying tissue attachments can be released surgically, along with skin resurfacing (Fulton & Gaminchi, 1999). That commentary doesn't mention pads.
Pads also wouldn't address sun damage, which the chest studies treat as the main driver. Any claim about wearing pads nightly for a set number of weeks is a brand claim or clinic convention, not a study finding.
Evidence: No studies found (indirect expert opinion only).
Does tretinoin help chest wrinkles?
Tretinoin is the only topical with a controlled chest trial, and its base lotion did as well as the active drug. Tretinoin is a prescription retinoid, a vitamin A derivative.
Wood et al. ran a prospective, randomized, double-blind, vehicle-controlled trial of tretinoin 0.05% lotion on the chest. Of the 29 patients who completed it (average age 54.42, range 37 to 66, Fitzpatrick skin types II to IV), both the active and vehicle groups showed 30 to 40% improvement at day 180 by a blinded evaluator. The Fabi-Bolton wrinkle scale improved but showed "no statistical significance at any time point" (Wood et al., 2022).
The vehicle contained sodium hyaluronate, soluble collagen and glycerin, which are hydrating ingredients. At day 90, the tretinoin group had significantly more redness than the vehicle group (P < 0.001), though both were mild; by day 180 they were similar. Both groups were equally satisfied. Funding was not reported in the abstract.
The honest takeaway: moisturizing and the routine itself may explain much of the visible change. The abstract's background says retinoid irritation usually resolves after about one month, but the trial didn't test that. For face data, see does tretinoin help with wrinkles. Tretinoin decisions, including use in pregnancy or breastfeeding, belong with your prescriber.
Evidence: Limited (one small RCT; active not separated from vehicle).
Can peptides or retinal help chest wrinkles?
A retinal serum with peptides improved chest fine lines in one uncontrolled study, but peptides weren't tested alone. Retinal (retinaldehyde) is an over-the-counter retinoid.
Konisky et al. enrolled 32 women; 47% had skin of color (Fitzpatrick III to VI) and 57% had sensitive skin. They applied a 0.1% retinal serum with peptides, ceramides and lipids 3 nights a week to the face, neck and chest for 8 weeks. Chest fine lines improved 11% at week 2 (P = 0.0005) and 19% at week 8 (P < 0.0001), and patch testing showed no irritation (Konisky et al., 2024).
There was no control group. The tested product is from Dr. Whitney Bowe Beauty, and Bowe WP is a listed co-author; funding and conflicts were not reported in the abstract. For how the two ingredient types compare, see our peptide and retinoid comparison and our peptide ingredients ranked by evidence.
Evidence: Early / preliminary.
Which chest wrinkle treatment has the best in-office evidence?
PLLA and microfocused ultrasound have the most chest-specific data, but every study is small and none had an untreated control group. Doses below are what each study used, not recommendations.
PLLA is an injectable "biostimulator" meant to prompt collagen production. Microfocused ultrasound with visualization (MFU-V) delivers focused ultrasound energy below the skin surface.
| Fabi 2013 (MFU-V) | 24 | 180 days | 1 MFU-V session | 46% (day 90) and 62% (day 180) improved 1 to 2 points; masked assessment 71% at day 90 |
| Fabi 2020 (MFU-V) | 20 enrolled, 15 completed | 360 days | 3 transducer depths | Dynamic and at-rest wrinkle scores still significantly lower at days 180 and 360 |
| Wilkerson 2018 (PLLA) | 25 women | 6 months after last treatment | 1 vial per treatment, 3 treatments | 1+ point: 83% / 74% at 1 month, 90% / 57% at 6 months (investigator / subject) |
| Joseph 2026 (PLLA) | 30 women | 9 months | 8 mL vs 17 mL reconstitution, up to 4 treatments 1 month apart | 1+ point at month 9: 93.8% (8 mL), 78.6% (17 mL) |
| Alessandrini 2018 (HA) | 15 women | 120 days | 3 sets of HA-ACP injections, 3 weeks apart | Fabi-Bolton improved at 120 days (p < 0.05) |
| Massidda 2023 (CaHA) | 50 | Not reported in the abstract | Varied dilutions of Radiesse | Average improvement 81.6%, all body areas combined |
| Wu 2016 (picosecond laser) | 20 | 3 months | 4 sessions, 3 weeks apart | Wrinkles significant at 1 month, not at 3 months (P = 0.08) |
Fabi 2013 (MFU-V)
Result: 46% (day 90) and 62% (day 180) improved 1 to 2 points; masked assessment 71% at day 90
Single-center, uncontrolled, Fitzpatrick I and II only. Chest-lift distance fell from 20.9 to 19.5 cm. PubMed lists non-US-government research support; funder not named in the abstract.
Fabi 2020 (MFU-V)
Result: Dynamic and at-rest wrinkle scores still significantly lower at days 180 and 360
Women aged 44 to 71, uncontrolled, Merz Décolletage Wrinkle Scales. The abstract lists visits on days 6, 12, 180 and 360 but also reports day 90 results. Funding not reported in the abstract.
Wilkerson 2018 (PLLA)
Result: 1+ point: 83% / 74% at 1 month, 90% / 57% at 6 months (investigator / subject)
Open-label, uncontrolled, ages 40 to 70, Fabi-Bolton scale. PubMed lists Galderma, maker of the PLLA product Sculptra, as a funder.
Joseph 2026 (PLLA)
Result: 1+ point at month 9: 93.8% (8 mL), 78.6% (17 mL)
Open-label, randomized between dilutions, no untreated group. Product is Sculptra (Galderma), scored on the Galderma Décolletage Scale. One treatment-related adverse event, none serious. Funding not reported in the abstract.
Alessandrini 2018 (HA)
Result: Fabi-Bolton improved at 120 days (p < 0.05)
Pilot, uncontrolled, ages 30 to 65. Effect held between days 80 and 120. Side effects were short-lived. Funding not reported in the abstract.
Massidda 2023 (CaHA)
Result: Average improvement 81.6%, all body areas combined
Case series across face, neck, décolletage and hands; chest results not separated. Author reports no conflicts.
Wu 2016 (picosecond laser)
Result: Wrinkles significant at 1 month, not at 3 months (P = 0.08)
Open-label, Fitzpatrick I to IV, 755 nm alexandrite with lens array. Pigment, rough spots and texture improved at both visits. Pain 3.6/10. PubMed lists non-US-government research support.
Fabi-Bolton, Merz and Galderma scales differ, so numbers can't be compared across studies.
Show data table
| Rater and time point | % improved |
|---|---|
| Investigator, 1 month | 83% of subjects |
| Subject, 1 month | 74% of subjects |
| Investigator, 6 months | 90% of subjects |
| Subject, 6 months | 57% of subjects |
Note the gap between raters: at 6 months, investigators judged far more women improved than the women themselves did. Calcium hydroxylapatite (CaHA) diluted for skin laxity is an off-label use, per a global consensus panel, which also warns that too-superficial injections of less-diluted CaHA can cause more side effects in thinner and darker skin (Goldie et al., 2018). For how the two biostimulators differ, see Sculptra vs Radiesse.
Three of these studies share a first author, so much of the chest-specific evidence comes from a small number of research groups.
Evidence: Early / preliminary.
Can you combine chest wrinkle treatments?
There's very little published evidence on combining them. Peterson and Kilmer searched MEDLINE and found "few articles" on combination therapy for the chest (Peterson & Kilmer, 2016).
Their review lists PLLA, HA, chemical peels, intense pulsed light, vascular lasers, photodynamic therapy, fractional lasers and microfocused ultrasound as options. The authors say that in their practice, same-day combinations can be done safely and often give the best outcome. That's their clinical experience, not a trial result.
Evidence: Expert opinion.
How long do chest wrinkle treatment results last?
Study follow-up ranges from 8 weeks to 360 days, and laser wrinkle gains faded fastest. Only the timings below come from studies; any other wait or retreatment interval is clinic convention.
Study-supported timings for chest wrinkles
- Week 2Early serum change
Chest fine lines 11% better with retinal plus peptides (Konisky 2024).
- Week 8Serum endpoint
Chest fine lines 19% better (Konisky 2024).
- 1 monthPLLA and laser check
83% improved by investigator (Wilkerson 2018); laser wrinkle gain significant (Wu 2016).
- Day 90 / 3 monthsMixed results
MFU-V 46% improved (Fabi 2013); tretinoin redness peaks (Wood 2022); laser wrinkle gain no longer significant (Wu 2016).
- 80 to 120 daysHA held
HA-ACP effect unchanged between visits (Alessandrini 2018).
- Day 180 / 6 monthsMid-term
MFU-V 62% (Fabi 2013); tretinoin and vehicle 30 to 40% (Wood 2022); PLLA 90% / 57% (Wilkerson 2018).
- Month 9PLLA endpoint
93.8% and 78.6% improved (Joseph 2026).
- Day 360Longest follow-up
MFU-V wrinkle scores still significantly lower (Fabi 2020).
Evidence: Early / preliminary.
How can you help prevent chest wrinkles?
No chest prevention trial is in our sources, so prevention advice here is general. Daily sunscreen on an exposed chest is standard dermatology advice.
Hussein et al.'s 2025 review lists UV radiation, pollution, diet, smoking, alcohol, sleep patterns and skincare practices among the external factors that drive skin aging; the authors declare no conflicts (Hussein et al., 2025). Because chest studies frame wrinkles as photodamage, sun protection is the logical first step. For practical sunscreen questions, see SPF 30 vs 50 and how often to reapply sunscreen.
Evidence: Expert opinion.
Are chest wrinkles the same as neck lines or loose skin?
No. They overlap in the same region but are studied separately.
- Horizontal creases and vertical bands on the neck are covered in neck lines.
- Sagging after weight loss is covered in loose skin after weight loss.
- Neck changes linked to GLP-1 weight loss are covered in Ozempic neck.
What about red light and at-home devices for chest wrinkles?
No study in our sources tests red light, microneedling or at-home devices on chest wrinkles. For face data, see red light therapy for wrinkles.
Where the evidence stops
- No pad studies. Silicone chest pads are untested.
- No chest sleep-line study. All sleep-line evidence is facial.
- One topical RCT, and it didn't separate drug from base. No controlled chest trial of OTC retinol, retinal or peptides.
- Peptides untested alone on the chest.
- No untreated controls or head-to-head trials for procedures, and several use manufacturer-named scales.
- Narrow skin-type range in some studies (Fitzpatrick I and II only in the first MFU-V study).
- No chest sunscreen trial, prevalence or age-of-onset data.
FAQ
What causes chest wrinkles?
Chest studies describe wrinkles and laxity as signs of sun damage on the chest. A 2025 review lists UV radiation, pollution, smoking, alcohol, diet and sleep patterns among the outside factors that speed up skin aging.
Are my chest lines from sleeping on my side?
They may be, but no study has tested this on the chest. Facial research describes sleep wrinkles caused by compression in side or front sleeping positions, and says they differ from expression lines in cause, location and pattern.
Do silicone chest wrinkle pads work?
We found no study testing silicone chest pads or any other anti-wrinkle pad. For facial sleep lines, one commentary says the sleeping position must be altered to treat them, so the idea behind pads is plausible but unproven.
Does tretinoin help chest wrinkles?
In a randomized, double-blind trial with 29 completers, tretinoin 0.05% lotion and its moisturizing base both improved chest photodamage by 30 to 40% at day 180. The chest wrinkle scale showed no significant change at any time point, and the active lotion caused more mild redness at day 90.
Can peptides or retinal improve chest wrinkles?
In a study of 32 women using a retinal serum that also contained peptides, chest fine lines improved by 19% at week 8. There was no control group and peptides were not tested on their own, so the result can't be credited to peptides.
What in-office treatment has the best chest data?
Poly-L-lactic acid and microfocused ultrasound have the most chest-specific numbers, but no study had an untreated control group. In one poly-L-lactic acid study, 93.8% and 78.6% of women in two dilution groups improved by at least 1 point at month 9, and after one ultrasound session 62% improved by 1 to 2 points at day 180.
Do laser results on chest wrinkles last?
In one 20-person picosecond laser study, wrinkle improvement was significant at 1 month but not at 3 months. Gains in pigment, rough spots and texture held at both follow-ups.
Have chest wrinkle treatments been studied in darker skin?
Only partly. The first ultrasound study enrolled only Fitzpatrick skin types I and II, and a consensus panel warns that too-superficial injections of less-diluted calcium hydroxylapatite can cause more side effects in thinner and darker skin. A dermatologist can advise on your skin type.
References
- Fabi S, et al. The Fabi-Bolton chest wrinkle scale: a pilot validation study. J Cosmet Dermatol. 2012. Validation study, photos from 28 volunteers (16 selected); funding not reported in the abstract. https://pubmed.ncbi.nlm.nih.gov/22938008/
- Fabi SG, et al. Evaluation of microfocused ultrasound with visualization for lifting, tightening, and wrinkle reduction of the décolletage. J Am Acad Dermatol. 2013. Single-center, uncontrolled, n=24, 180 days, Fitzpatrick I and II; non-US-government research support listed, funder not named in the abstract. https://pubmed.ncbi.nlm.nih.gov/24054759/
- Fabi SG, et al. Clinical Trial Evaluating the Long-Term Efficacy of Microfocused Ultrasound With Visualization for Décolleté Rejuvenation. J Drugs Dermatol. 2020. Uncontrolled clinical trial, 20 enrolled, 15 completed, 360 days; funding not reported in the abstract. https://pubmed.ncbi.nlm.nih.gov/33196752/
- Wood E, et al. A Prospective, Randomized, Double-Blind, Vehicle-Controlled Study Evaluating the Efficacy, Safety, and Patient Satisfaction of Tretinoin 0.05% Lotion for Chest Rejuvenation. J Drugs Dermatol. 2022. Double-blind vehicle-controlled RCT, 29 completed, 180 days; funding not reported in the abstract. https://pubmed.ncbi.nlm.nih.gov/35674757/
- Konisky H, et al. The Clinical Efficacy and Tolerability of a Novel Retinaldehyde Serum with Firming Peptides to Improve Skin Texture and Signs of Photoaging. J Drugs Dermatol. 2024. Uncontrolled, n=32 women, 8 weeks; product from Dr. Whitney Bowe Beauty, co-author Bowe WP; funding and conflicts not reported in the abstract. https://pubmed.ncbi.nlm.nih.gov/39496127/
- Wilkerson EC, Goldberg DJ. Poly-L-lactic acid for the Improvement of photodamage and rhytids of the décolletage. J Cosmet Dermatol. 2018. Open-label, n=25 women, 6 months after last treatment; PubMed lists Galderma (Sculptra's maker) as a funder. https://pubmed.ncbi.nlm.nih.gov/29119683/
- Joseph J, et al. Safety and Effectiveness of Two Reconstitution Volumes of Poly-L-Lactic Acid for Correction of Décolletage Wrinkles. J Drugs Dermatol. 2026. Open-label, randomized between two dilutions, n=30 women, 9 months; Sculptra (Galderma) and Galderma scale; funding not reported in the abstract. https://pubmed.ncbi.nlm.nih.gov/42235050/
- Alessandrini A, Tretyakova K. The Rejuvenating Effect and Tolerability of an Auto-Cross-Linked Hyaluronic Acid on Décolletage: A Pilot Prospective Study. Aesthetic Plast Surg. 2018. Pilot, uncontrolled, n=15 women, 120 days; funding not reported in the abstract. https://pubmed.ncbi.nlm.nih.gov/29218478/
- Massidda E. Starting Point for Protocols on the Use of Hyperdiluted Calcium Hydroxylapatite (Radiesse(®)) for Optimizing Age-Related Biostimulation and Rejuvenation of Face, Neck, Décolletage and Hands: A Case Series Report. Clin Cosmet Investig Dermatol. 2023. Case series, n=50, multiple body areas; author reports no conflicts. https://pubmed.ncbi.nlm.nih.gov/38050476/
- Goldie K, et al. Global Consensus Guidelines for the Injection of Diluted and Hyperdiluted Calcium Hydroxylapatite for Skin Tightening. Dermatol Surg. 2018. Expert consensus and review; funding not reported in the abstract. https://pubmed.ncbi.nlm.nih.gov/30358631/
- Wu DC, et al. Evaluation of the safety and efficacy of the picosecond alexandrite laser with specialized lens array for treatment of the photoaging décolletage. Lasers Surg Med. 2016. Open-label, n=20, 3 months, Fitzpatrick I to IV; non-US-government research support listed. https://pubmed.ncbi.nlm.nih.gov/26445089/
- Peterson JD, Kilmer SL. Three-Dimensional Rejuvenation of the Décolletage. Dermatol Surg. 2016. Review plus authors' clinical experience; funding not reported in the abstract. https://pubmed.ncbi.nlm.nih.gov/27128235/
- Anson G, et al. Sleep Wrinkles: Facial Aging and Facial Distortion During Sleep. Aesthet Surg J. 2016. Review (face); funding not reported in the abstract. https://pubmed.ncbi.nlm.nih.gov/27329660/
- Fulton JE Jr, Gaminchi F. Sleep lines. Dermatol Surg. 1999. Clinical commentary (face); funding not reported in the abstract. https://pubmed.ncbi.nlm.nih.gov/9935097/
- Peng JH, Peng HP. Cheek wrinkles revisited: Etiological classifications and nonsurgical treatment options. J Cosmet Dermatol. 2023. Classification article (cheek); funding not reported in the abstract. https://pubmed.ncbi.nlm.nih.gov/36994554/
- Hussein RS, et al. Influences on Skin and Intrinsic Aging: Biological, Environmental, and Therapeutic Insights. J Cosmet Dermatol. 2025. Narrative review; authors declare no conflicts. https://pubmed.ncbi.nlm.nih.gov/39604792/
Disclosure: This article is for general information only. It is not medical advice. Peptide Skincare has no affiliate links in this article and received no payment from any manufacturer mentioned. Injectables, lasers and energy devices are medical procedures; ask a dermatologist, and talk to a prescriber about tretinoin.