What is the Best Chemical Peel for Crepy Hands and Arms?

Question

My hands and arms are in need of help. They are crepy and wrinkly and have alot of brown spots. Is a chemcial peel safe and which one?

Timothy Jochen, MD · Answer

For crepey skin and brown spots on the hands I recommend the fractionated C02 laser because it has heat which provides tissue tightening and it’s also ablative so it will help to lift off the brown discoloration. This is really the best option for eliminating crepey skin. The TCA peel would be the best in the category of chemical peels because it is a medium depth peel so you may get some collagen stimulation which may not take place with other peels like the Beta, Jessner or Glycolic peels. Those peels really aren’t strong enough to stimulate collagen and they don’t penetrate deep enough. For the crepey skin, you may want to add a filler to restore volume. My favorite filler for the hands is Radiesse because it is longer lasting and definitely more cost effective in comparison to hyaluronic acid fillers.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis. We see atrophic and hypertrophic scars, as well as scars that have hypo and hyperpigmentation. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to discuss the best treatment options for your type of skin. .

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Monika Kiripolsky, MD · Answer

Oftentimes, a combination of treatments will give you the best results. I am a big proponent of laser treatments for the concerns that you've mentioned. You have several options and I'd really have to see you to best guide you in terms of which treatment(s) to choose. However, I will help as best as I can as per your description.

	Also, every physician has different opinions as to the pro's and con's of the various treatment options available . . . that's what makes medicine diverse and fun. With that in mind, my discussion below highlights my opinions and I encourage you to talk to as many doctors as you need to in order to feel comfortable in the treatment(s) that you ultimately choose.

	For the brown spots, I would recommend treatment with either the IPL (intense pulse light) device, a Q-switched ruby laser, or a Q-switched alexandrite laser. Each of these use specific wavelengths of light to selectively target the melanin pigment (the brown spots are caused by excess melanin being made and deposited in your skin). These treatments also may cause a bit of skin "tightening" (increased collagen production/reorganization), however, in my experience the amount of skin "tightening" from them is minimal.

	There are also topical treatments for the brown spots. Products containing hydroquinone slow down the production of brown pigment (melanin) by the pigment producing cells (melanocytes). This is a great treatment option, but, typically takes about two months to show a noticeable improvement. Another topical treatment that would help lighten the brown spots AND tighten the skin (by stimulating collagen production) is a topical vitamin A derivative (retinoid, retinol, etc). There are several other topical creams/lotions/gels that also lighten the brown spots (azeleic acid, vitamin C derivatives, alpha-hydroxy acids, and more). However, those that I have mentioned are the main ones that I recommend to my patients.

	Various types of chemical peels are also available to help even out the skin pigment (trichloracetic acid, glycolic acid, salicylic acid, lactic acid, and several more).

	For the crepy appearance of your skin, I'd recommend daily use of a topical vitamin A derivative (see description above). This causes more collagen to be produced. As we age, our skin doesn't make as much collagen (nor does it make as much of a substance called "elastin"); also, the collagen and elastin that is produced is not as good in terms of quality as it is in younger people's skin. The combination of these factors result in the skin appearing thin and "crepy". It also causes us to bruise easier (lack of "insulation" around our blood vessels which protects them when we bump into things).

	Also, in terms of improving the thickness and elasticity of the skin, I'd recommend considering a series of radiofrequency (+/- infrared) treatments and/or treatment with a fractionated carbon dioxide laser. You will have some down-time with each of these (more so with the fractionated carbon dioxide laser). However, in my opinion, this yields a much better result than some of the non-ablative laser treatments offered right now.

	Hope this helps!

Michele S. Green, MD · Answer

A combination of Fraxel Laser and fillers such as Restylane or Radiesse can help rejuvenate the skin and hands and make them look younger.  Aquagold is also unique in combining Botox and Restylane to penetrate the hands and make them look younger as well.  Best, Dr. Green

What is the Best Chemical Peel for Crepy Hands and Arms?

Answers (4)

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