Anti-ageing treatments for thin, dry skin

First the numbers. A 2019 study measuring 53 cadavers from Korea and Thailand recorded facial skin thickness by site together with the thickness of the fat beneath it.

The difference between those two rows is where this article starts. The difference in the thickness of the skin itself is smaller than one would think, and the difference in the fat beneath it is far larger.

In other words, much of what you feel as “my skin is thin” is a matter of what lies beneath it and how much of it there is, rather than the skin itself. Vessels showing through on the back of the hand or under the eye is often less because the skin there is especially thin than because there is little supporting it underneath.

And there is no baseline for “thin skin”. We could not find a definition saying that below so many millimetres counts as thin. The word ‘thin’ as used in clinic is not a measurement but a judgement based on observation and palpation.

Does facial skin get thinner with age

It depends on the site and the sex. In a study of 118 subjects measuring eight facial sites with high-frequency ultrasound, women thinned with age at the forehead · glabella · malar area · submandibular area, whereas in men an age correlation appeared at only one site, the malar dermis. In the same study men had significantly thicker epidermis and dermis.

The original source of the common sentence “collagen falls by about 1% a year” is a 1975 study measuring the forearm, not the face, and we could not find a study re-measuring that slope on the face.

People often speak of “thin and dry” as one thing, but what is actually measured are different layers.

It is true that they often occur together. In a study measuring 223 nursing home residents (mean age 83.6), the prevalence of xerosis was 99.1%. With age the dermis thins and stratum corneum function declines, so they appear together.

But the two axes do not always move together. In the same study, transepidermal water loss in the older subjects was not especially high, and in a meta-analysis pooling 167 papers people over 65 were in fact consistently lower than those aged 18 to 64.

So you should not read this as a causal chain of “thin, therefore dry” or “dry, therefore thin”. In the consulting room we check the two separately, because the order of what we do depends on which is the greater problem now.

In a 2025 study measuring the periorbital area of 65 Korean women layer by layer, wrinkles correlated with dermal elasticity and sagging with epidermal hydration. The sample is small and the correlation coefficients are in the 0.3 range, so no strong conclusion can be drawn, but it suggests that the two axes may be linked to different outcomes.

Let us write down first the most important thing we established while preparing this article.

We could barely find a study that took ‘thin skin’ as an independent variable, stratified patients by it and compared treatment outcomes. That is, there is essentially no data demonstrating that “for thin skin A is better and for thick skin B is better”.

Why this is a problem is that such statements are nonetheless very common. Sentences like “for thin skin, this treatment” or “for sensitive skin, that treatment” mostly come from clinical experience, not from comparative trials.

That does not mean experience is worthless. We simply think it is better to distinguish experience from evidence when we speak. That way you can judge for yourself that “this part is settled and that part is not yet”.

And there is a study in which thickness did not predict the outcome

It followed 25 patients who had received radiofrequency lifting for 12 months.

How should this be read? We have settled it as not a contradiction but a difference of role.

• Thickness is a variable of planning — we look at it when deciding at what depth and how much to deliver
• The degree of sagging is a variable of expectation — we look at it when gauging how much improvement there will be

So the statement “lifting works less well on thin skin” has no evidence behind it. In this study what separated the outcomes was not thickness but how much the tissue moved.

The evidence on the efficacy side is weak; the evidence on the safety side is clear.

The last two rows connect directly to thin skin.

The focal depth of an ultrasound device is set by the cartridge. The adjustment increment is generally 1.5 mm. But as seen above, the thickness of the fat at that spot varies from person to person from 1.61 mm to 5.14 mm. In other words the anatomical variation is larger than the adjustment increment.

On the radiofrequency side the direction is the same. Fat conducts electricity far less well than dermis (around 1 MHz, dermis 0.25 against fat 0.03, about eightfold), and in a study using porcine tissue together with simulation, the thinner the fat layer, the higher the temperature rose.

In sum, the reason for caution with thin skin and little fat is not “because it works less well” but “because the same settings act more strongly”. That is why in thin areas we adjust depth and delivery density first, rather than output.

To add honestly, though, we could not find a study measuring directly in humans that an individual’s fat thickness actually causes the focus to fall outside its target. The above is inferred from phantom · cadaver experiments and physical properties. A 2026 study observing 20 subjects over 60 for 16 weeks does support the direction of individualisation, but the differences were 0.19 to 0.20 mm, below a millimetre, with no correction for multiple comparisons, and the paper gives no rule for choosing a cartridge from the measurements, so it cannot be reproduced.

There is far more data here. A few of the results are not what one would expect, though.

The third row matters most in practice. If you are older, recovery does not fail; it starts about a day later. That day becomes a real variable when setting intervals between treatments.

And the second row — improving hydration by applying a moisturiser does not mean the barrier has been repaired. The two parameters move independently. It is better to separate out which one is the problem than to lump it all together as “dehydrated underneath”.

One addition on the last row: the claim that “Korean skin is unusually weak” conflicts with this measured data. Compared under the same conditions, the Suwon women had the lowest transepidermal water loss.

Skin boosters are commonly recommended for thin, dry skin. We checked the evidence.

A review published in 2024 sets it out by class.

• Hyaluronic acid class — evidence on elasticity · hydration · texture parameters
• Polynucleotide (PN · PDRN) class — a randomised trial in acne scarring, a periorbital split-face trial
• Poly-L-lactic acid class — a periorbital phase 3 randomised trial, dermal thickness confirmed on biopsy

What to note here is what the endpoints were. Mostly they were skin quality parameters. That is, they are data showing that “hydration · elasticity · texture improved”, not data showing that “results were better in patients with thin skin”.

This connects back to the problem set out above. Since there is no study stratifying by thin skin for comparison, there is no basis for saying “this is particularly good for thin skin” either.

The direction is reasonable, however. There is no reason why an approach that replenishes the raw materials of the dermis would not suit a thin dermis, and it carries a larger safety margin than treatments where the depth setting is decisive, such as heat or ultrasound. This is not evidence but a judgement, and we mark it as such.

On topical retinoids

This is an ingredient well known for increasing dermal thickness. But in the literature increased epidermal thickness and dermal collagen formation are reported as different parameters, so we could not verify on this occasion a measured value in the form “dermal thickness increased by so many per cent”. If we can verify it, we will set it out separately.

In the final stage of researching this article our access to the literature was restricted. The individual figures in this section are therefore compiled through the review, and we could not check each original paper one by one. We record that fact.

We will set out separately what comes from evidence and what is judgement.

What comes from evidence

• We check thickness and fat volume before starting — not in order to predict the effect but in order to choose the depth. The cause of fat atrophy is described as “inappropriate choice of depth”
• In thin areas we adjust depth and density before output — there is experimental evidence that the thinner the fat layer, the higher the temperature rose
• We do not lower expectations just because the skin is thin — in the 12-month follow-up study, what predicted response was not thickness but tissue mobility
• If you are older we leave longer intervals between treatments — barrier recovery starts about a day later
• For home care we ask people to cut down on hot water and excessive washing — in the measurements these are the two most clearly harmful

What comes from judgement (this is not evidence)

• For thin, dry skin we consider an approach that replenishes the raw materials of the dermis before treatments where the depth setting is decisive — a judgement that the safety margin is larger, not the result of a comparative trial
• We do not stack several things at once — a judgement that it is better not to add the next insult while recovery is under way
• We stabilise the state of the barrier before starting — there is no trial comparing this order

This is why Miso Clinic keeps six boosters of differing composition and three lifting devices together. Because the literature contains no single right answer for thin skin, there is no way to proceed other than to hold options and decide case by case. If you have only one thing, you end up using that one thing whatever skin comes through the door.

The reason there is no sentence in this article saying “for thin, dry skin this is the answer” is that we could not find the evidence to write one. What we can say with certainty instead is this — what needs care with thin skin is not the effect but the settings, and to decide those settings you have to measure before you start.

Written and reviewed by Lee Chi-Hak, MD, medical director of Miso Clinic in Daegu, South Korea. Every study cited above is given together with its design, its size and the limitations the authors themselves recorded, and where we could not find data, we have said that we could not find any.