Thank you for your question, and the photos. We get this question often. Radiesse is supposed to last 1 year. Those who move their hands excessively will have it wear off sooner. Each patient is different, and may need more or less product. In Las Vegas, we get many card dealers who take pride in the appearance of their hands, as that is what the public sees. Often the aging had will have more visible vessels and tendons. The hands may also have solar damage, or just aging changes to the skin. We often will inject patients with Radiesse to add volume to the hands and decrease the harsh appearance of the vessels and tendons. Radiesse is FDA approved for this. We often will follow this up with appropriate peels to help smooth the coloration and give the skin a more vibrant look. Best to see a Board Certified Plastic Surgeon. They have had multiple years of hand surgery training, and know hand anatomy and function well. Some, (like our office), have had additional hand fellowship training. They are also well versed in how to best treat the skin, as they diagnose and operate on it.