Sclerotherapy or filler - which treatment option would be best for rejuvenating my hands? (photos)

Question

Hello, II have met with 2 doctors about hand rejuvenation. I initially asked about sclerotherapy because I saw good before and after pics for that. However, one doctor said yes, he would do it; while the other doctor said, no he would not do it. They both told me about the risks of sclerotherapy on bulging veins on the hands, but I'm still wondering which would be better (sclerotherapy or filler - and if filler, what kind) thank you so much (54 F)

Nelson Lee Novick, MD · Answer

As a rule, I do not suggest sclerotherapy for prominent veins on the backs of the hands for a couple of reasons. For one, the veins have become prominent due to the loss of volume in the surrounding and overlying skin. So, it is logically more appropriate to restore the lost volume (which can be relatively easily done with a robust HA volumizing filler), rather than shrink the veins with sclerotherapy. This approach addresses the underlying cause of the problem, which sclerotherapy does not. 
What's more should the need ever arise medically to use those veins for blood tests or IVs, which is not uncommon when treating certain more serious medical conditions, these important veins would no longer be available. 
You would be wise to consult with an experienced, board certified cosmetic dermatologist filler expert. Hope this helps and best of luck.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Ajaya Kashyap, MD · Answer

Thank you for your query. Sclerotherapy is infrequently done for the hand veins but it can be safely done for limited number of veins. Filling with hyaluronic acid fillers or autologous fat is often preferred . I prefer the latter and it gives very good rejuvenation. Please find an experienced Board certified Plastic surgeon who can examine you and help you with all your concerns.All the best!

Eric M. Joseph, MD · Answer

Based on your photos, I would not recommend sclerotherapy. Your veins have become more prominent as you have lost volume in your hands. We have had lovely results rejuvenating the back of people's hands with microdroplet Silikon-1000, a permanent soft tissue filler. I hope this helps. Sincerely, Dr Joseph

Anna Chacon, MD, FAAD · Answer

Choosing between sclerotherapy and fillers for hand rejuvenation depends on several factors, including your specific aesthetic goals, the condition of your hands, and your risk tolerance. Here's a detailed comparison to help you decide:

Sclerotherapy

**Pros:**
- **Effectiveness:** Sclerotherapy can effectively treat prominent veins, making the hands appear smoother and less veiny.
- **Long-lasting Results:** The results can be long-lasting since the treated veins are closed off and absorbed by the body.
- **Minimal Downtime:** Generally, there's minimal downtime associated with the procedure.

**Cons:**
- **Risks:** Potential risks include hyperpigmentation, ulceration, and in rare cases, damage to surrounding tissues.
- **Specialist Requirement:** It requires a skilled practitioner to minimize risks and achieve desirable results.
- **Not for Everyone:** Not all patients are suitable candidates for sclerotherapy, particularly if they have underlying vascular issues or thin skin.

Fillers

**Pros:**
- **Immediate Results:** Fillers provide immediate volume and can significantly improve the appearance of hands by plumping the skin and masking veins and tendons.
- **Versatility:** Fillers can be tailored to individual needs, and different types (e.g., hyaluronic acid-based, Radiesse, or Sculptra) can offer various benefits.
- **Controlled Outcome:** The amount of filler used can be adjusted to achieve the desired look.

**Cons:**
- **Temporary:** Most fillers are temporary and may require repeat treatments to maintain results.
- **Risks:** Potential risks include allergic reactions, lumps, asymmetry, and migration of the filler.
- **Cost:** Depending on the type and amount of filler used, it can be more expensive over time due to the need for repeat treatments.

Types of Fillers

1. **Hyaluronic Acid-Based Fillers (e.g., Juvederm, Restylane):**
   - **Pros:** Immediate results, reversible with hyaluronidase if needed.
   - **Cons:** Typically lasts 6-12 months, may require touch-ups.

2. **Calcium Hydroxylapatite Fillers (e.g., Radiesse):**
   - **Pros:** Provides immediate volume and stimulates collagen production, lasts 12-18 months.
   - **Cons:** Not reversible, may feel firmer under the skin.

3. **Poly-L-Lactic Acid Fillers (e.g., Sculptra):**
   - **Pros:** Stimulates collagen production for gradual, long-lasting results (up to two years).
   - **Cons:** Results are not immediate, requires several treatments to achieve full effect.

Decision Factors

1. **Aesthetic Goals:** If your main concern is prominent veins, sclerotherapy might be more suitable. If you want overall volume and skin plumpness, fillers might be better.
2. **Longevity:** Consider how long you want the results to last. Sclerotherapy offers longer-lasting results for veins, while fillers need to be maintained.
3. **Risk Tolerance:** Weigh the potential risks of each procedure. Fillers generally have a lower risk profile, but sclerotherapy might be more effective for specific issues.
4. **Cost:** Evaluate the cost implications of both treatments over time, considering the need for repeat filler injections.
5. **Doctor's Expertise:** The skill and experience of the doctor are crucial. An experienced practitioner can greatly reduce the risk of complications and improve the outcome.

Discuss your specific goals and concerns with your doctors, considering the pros and cons of each treatment. If you are still uncertain, seek a third opinion from a specialist in hand rejuvenation who can provide further insights based on an in-person evaluation.

Camille Cash, MD · Answer

Renuva is a great option to rejuvenate not only hands, but many areas.  Renuva is different than traditional HA fillers.  It gradually replaces age related fat loss with your body's own fat for longer lasting results.  I encourage you to learn more by visiting my website or meeting with an elite injector near you.

Michelle Copeland, MD, DMD · Answer

Thank you for your question and for sharing your photos. While I would need to examine you to best answer your question, you may be a good candidate for adding fat or filler and Thermage®. Adding your own fat, or a filler like Radiesse, will give more fullness to this area. Thermage® is a non-invasive procedure that uses radiofrequency (RF) to help smoothen, tighten and contour the skin with no downtime. This can be done directly on the back of the hands and you could even come in during your lunch break and return to work after! I will also often combine these treatments with a combination of laser skin treatments to improve the overall quality of the skin. I recommend you speak with a board-certified plastic surgeon because results can be variable depending on who is performing either of these procedures.

Sheryl D. Clark, MD, FAAD · Answer

Hello Linda:

Thank you for your question. I do feel that your hands could benefit from both treatments, but of the two, you will have the most natural results and a safe procedure by having fillers. I believe in treating aesthetic issues by addressing the cause, and your case, the reason your veins are so prominent is because you have lost connective tissue around them. If you have sclerotherapy for the veins, there is quite a bit of atrophy of your dorsal hands, which will still be present. However, with fillers, you will replace connective tissue that has been lost, giving you a plumper and younger appearance by addressing the root cause of the issue. At the same time, the additional volume will disguise the prominent veins.

I hope this is helpful to you, and I’m always available for additional questions.

All the best from New York City!
Sheryl Clark MD, FAAD

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