As Temperatures and Hemlines Rise, an Oft-Overlooked Body Part Arrives in the Dermatologist's Office

“I have a question,” announces Trinny Woodall. I’m in her suite at the Crosby Street Hotel in SoHo, where we are lounging on a floral couch, busily sampling cosmetics from her namesake line. “You write about beauty,” she says, yanking up her cream-colored, silver-sequined ASOS bell-bottoms to expose her knees. “Can anything be done about this?” She playfully squishes the loose flesh around them. “My knees can have a conversation with each other,” the 58-year-old laments. I vow to investigate—“for the sake of journalism,” I tell her, although admittedly there is a certain level of personal interest. While I try to maintain my limbs with near-daily exercise, I’ve noticed that over the years, the real estate above my knees has grown pouchy, and rife with what I’ve termed “creeping crepe.”

Knees are paid little aesthetic attention: Yves Saint Laurent once remarked, bluntly, “I don’t really like knees.” Instead, these hardworking joints are typically appreciated exclusively for function. (Never have I noticed them more than when I was hobbled by runner’s knee a few years ago.) But the skin that surrounds them—which is loose to begin with to allow for proper movement, and can grow ever slacker thanks to wear and tear and gravity—is hard to ignore come summer, when temperatures and hemlines are up, up, up. (Miu Miu’s popular Y2K-era miniskirt now has its own Instagram account.) Knee rejuvenation doesn’t tend to make it onto self-care priority lists; but that may be because we just haven’t given it much, if any, thought. “Most people don’t know that these treatments exist,” Beverly Hills dermatologist Harold Lancer, MD, says of a host of minimally invasive procedures designed to restore, tone, and smooth this oft-overlooked area. “I think there would be huge interest from the public if they were more aware.”

Consider me interested. After a brief winter trip to the Chilean desert left me sweating through heavy trail pants in an effort to conceal my aforementioned crepe, I book into Idriss Dermatology, New York City dermatologist Shereene Idriss, MD,’s new Bryant Park office. “It doesn’t matter how muscular or how skinny you are. After a certain age, they’re going to drop,” the lively 38-year-old deadpans as Dua Lipa’s “IDGAF” plays in the waiting area, explaining that by their mid-40s, her patients reliably start asking about their knees. Once inside a treatment room, Idriss grabs my thighs, pale as cave fish. “Oooh,” she says delightedly. “Your legs have not seen the daylight in a long time!” She inspects the skin. “Address the color first, which nobody thinks about,” she says, pointing out a tangle of spider veins. “Your knees may be as tight as human Spanx, but if your color isn’t uniform, it doesn’t matter.” Idriss suggests sclerotherapy—relatively painless, highly effective injections of saline or other solutions—followed by a combination of tightening treatments and biostimulatory fillers to help the area generate its own collagen. “My favorite is Ultherapy, which uses ultrasound-energy heat to stimulate muscle contraction and new collagen formation, along with hyperdilute Radiesse, which I find is the most durable,” she says of the specialized filler that creates a rejuvenated appearance around the knee.

I poll various doctors for their preferred knee treatments in search of some consensus; all supply different answers. Ashish C. Bhatia, MD, associate professor of clinical dermatology at Northwestern University in Chicago, is keen on the new Secret PRO, a dual-​purpose machine that’s both a microneedle radio-frequency device and a fractional CO₂ laser, which stimulates new collagen production and vaporizes old collagen so that the body can regenerate its own. Three monthly treatments yield significant results, he insists, adding that until we had some of these new tools, which have recently been applied to the knees, there wasn’t much we could do. “People would just stop wearing shorts and skirts,” he says—which is exactly what happened to Evee Georgiadis. Georgiadis, 58, was ultimately compelled to visit Macrene Alexiades, MD, who practices in Manhattan and the Hamptons and who uses Profound, a radio-­frequency micro-needling device she has both studied and written about, specifically in two publications that directly addressed the knees. “You need a strong constitution because there may be bruising, but a single treatment works really well on laxity and fat deposits,” Alexiades tells me. Georgiadis confirms as much. “I will say that Profound is not fun. It hurts, even though Macrene numbed me,” she admits. “But it’s so worth it. I have the legs that I did in my late 30s. It’s mind-​blowing. The laxity is way, way less. I’m wearing shorts again for the first time in 20 years.”

Lancer likes PlasmaSculpt, a blend of Sculptra (a collagen-stimulating injectable volume replacement) and the patient’s own blood plasma, “because it allows for artistic mixing, and you totally avoid the potential for irregularity or lumpiness,” he explains, recommending two to three treatments for optimal results. Intrigued as I am by the idea of artistically mixing my own blood into a skin-smoothing, tightening concoction, I settle on a compelling new device called Sofwave finessed by New York–based dermatologist Blair Murphy-Rose, MD. Sofwave, Murphy-Rose tells me when we meet in her Midtown office, is a noninvasive, no-downtime ultrasound device that reaches a noteworthy 1.5 millimeters deep. “It coagulates the tissue, which causes an immediate tightening of fibers, and then very powerfully stimulates collagen and elastin production, which we lose at an estimated 1 percent a year,” she explains while numbing above my knee for 45 minutes, and then wielding the long and narrow handpiece in targeted strokes. Results peak at six to eight months, Murphy-Rose goes on, but if I’m pleased with the $3,000 session, I may never need another. Thirty minutes later, I hop off the chair, slightly pink but pain-free.

After two months, I can report that the vicinity around my knees is markedly tighter and smoother. My crepe is on the wane, too—and my color is nearly uniform (per Idriss’s advice, I booked a sclerotherapy appointment with Rosemarie Ingleton, MD, who had previously worked wonders on my below-the-knee veins). And much to my own shock, I have also begun applying retinols—which boost skin-cell turnover and growth, and are more commonly applied to the face—to my knees, which has made a clear difference. “Skin care has always been about the face, neck, and chest, but body is the next frontier,” confirms Idriss, who often counsels her patients to add their favorite face retinol to body lotion (her preferred cocktail is Aveeno body lotion with a few pumps of L’Oréal Revitalift Derm Intensives 0.3 % pure retinol). But I saw the most dramatic results with Alastin’s TransFORM Body Treatment, a creamy salve that is packed with retexturizing, elastin-boosting peptides and designed to target specific areas as a companion to in-office procedures; it made the skin above my knees velvety smooth, something I never thought I’d be so diligent about maintaining. Speaking of, there is one more step pretty much every expert I speak with insists is necessary if I want to continue seeing the results of my Sofwave treatment: wear sunscreen—which I fully intend on doing all summer long, knees exposed, wide-brimmed-hat-clad head held high.