Non-Surgical Hand Rejuvenation -- The Winning Hand

Nelson Lee Novick, MD
Article by
New York Dermatologic Surgeon

Next to the face, your hands are the most continuously exposed area of the body. You can’t hide them in clothes or behind high collars, like a chest or a neck, and, if you are lucky enough that your face does not betray your age, your hands can give it away like the rings of a tree. According to an Allure magazine article, it was not that long ago that the hand was called the “last virgin body part” because so little was or could be done to rejuvenate it. Fortunately, all that has all changed.

Arguably, the hands are the most abused part of the body. Since they are exposed to so much sunlight, weathering, and plain wear and tear, they are one of the first areas of your skin to show signs of aging. Genetics, gravity, and the passage of time contribute to the toll. What is clear, however, is that many of the changes we once associated with chronologic aging of the skin are actually the result of shifts or loss in volume in the fatty layer below it, the so-called subcutaneous fat.

The backs of the hands of young people are unwrinkled and plump and are not mottled with dark patches and splotches. By contrast, older-looking hands appear spotted, frail, thin, boney, and wrinkled, with clearly visible tendons, and bulging veins. So, anything we can do to lighten or eliminate dark spots, mask the tendons and bones, and diminish the prominence of the blood vessels can wipe years off the apparent age of your hands.

It is only relatively recently that we have come to appreciate that restoring volume to the backs of the hands is a must for achieving a more youthful appearance. Volume loss around the bones, blood vessels, and tendons is largely responsible for the prominence of these structures over time and the appearance of frailty and wasting.

Autologous fat transfer, a technique in which fat is harvested--by liposuction--from the abdomen, buttocks or thighs and then reinjected elsewhere in the body, was first used for hand rejuvenation more than a decade ago. The downside of fat injections is that they necessitate first a minor surgical procedure, i.e. the liposuction,before the subseqent injections themselves into the hands.

More recently, cosmetic dermasurgeons have turned to newer, synthetic fillers and volumizers to restore aging hands. Perlane and Juvederm UltraPlus, both hyaluronic acid derivatives, are excellent choices for hand rejuvenation. These materials impart a very smooth, pillowy texture and natural appearance, in large measure due to their enormous affinity for attracting and binding large amounts of water within the skin. Radiesse, a semipermanent volumizing agent composed of the bonelike material, calcium hydroxylapatite, has also been sucessfully used for this purpose.

Before treatment, the wrist and the channels between the bones on the backs of the hands are numbed with local anesthesia. The selected material is then injected directly into the troughs between the bones on the backs of the hand to plump and re-elevate them. Finally, the treated areas are massaged and molded into place to ensure smoothness and uniform coverage of the underlying structures. The entire procedure for both hands usually takes no more than fifteen or twenty minutes.

Following treatment, there may be some redness, mild swelling, and tenderness, which can last for about 24 to 48 hours. To minimize swelling, strenous excercise is best avoided during this time and the hands should be kept elevated as much as possible. Slight bruising is also possible, which can persist for several days, but in most cases, the bruises are easily masked with an appropriate coverup makeup. The esthetic benefits of the treatment are immediate, and more than 90 percent of patients are extremely gratified with the results after just one or two sessions.

With hyaluronic acid fillers, improvement generally lasts several months before a touch-up is needed. Results with Radiesse may last between 8 and 12 months. The accompanying figures illustrate the softening of the bony prominences and the blood vessels with the use of Radiesse.to fill the troughs between the digits. Fees for fillers and volumizers range from $1000-$2000, depending upon the material chosen and the region of the country.

Overall, volume replacement by itself is frequently sufficient for masking boneyness, and patent tendons and blood vessels. Occasionally, however, particularly prominent, bulging blood vessels will remain a problem even after sufficient volumizing. In these instances, sclerotherapy can be useful.

Sclerotherapy is just a fancy way of describing the injection of a liquid sclerosing (scar-promoting) agent, directly into the unwanted blood vessels, in order to cause them to shrink and eventually disappear entirely. It does so by irritating the inner lining walls of the blood vessels, which in turn causes them to narrow, then seal, and finally to scar down. Hypertonic saline, a superconcentrated salt solution, is most often used for this purpose, although other sclerosants are now being tried successfully.

Neither topical nor local anesthesia is usually necessary. However, you may experience a slight burning sensation as the sclerosant enters the vessels. Sometimes a tourniquet is applied around the wrist area or an assistant may grip your arm tightly in order to compress surrounding vessels and keep the sclerosant from spreading too far afield of the hands, thus ensuring maximum contact time with the salt solution. Several treatments spaced at monthly intervals may be neccesary to achieve the desired results.
Liver spots, or solar lentigines, which are believed to result from an interplay of genetic predisposition and chronic sun exposure. are unsightly, flat, dark, freckle-like patches that appear gradually on the backs of the hands. They have nothing whatever to do with the liver or diseases of that organ and probably got their nickname from the their deep brown color and the occasional resemblence of their shapes to that of the live. These spots respond to a variety of methods that include cryotherapy (the use of freezing solutions like liquid nitrogen), radiowaves, or laser therapy.

I prefer to treat them with a series of six or more mild chemical peels spaced at two to four week intevals. Glycolic acid and beta hydroxyacids work well for fading mild cases. In my experience, stronger peels, such as the Golden Peel Plus (see article on Non-Surgical Chest Enhancement/Breastlifts) are needed for more stubborn cases and pose little risk of scarring or permanent discoloration (which are risks when alternative medium strength peels are used to treat the delicate skin of the backs of the hands).

Happily, you no longer have to stare at your hands and feel depressed. You needn’t continue to lament, “They can never guess my age until they look at my hands.” A variety of simple, non-surgical techniques now available can go a long way to rejuvenating their appearance and your overall look, in just a matter of minutes.