Dear sunshine247, Wrinkles on the knuckles and hands are often the neglected area in rejuvenation programs. Many people will invest time, energy, and money in their face, neck, and chest treatments only to realize that the sun-damaged skin on their hands and arms have become the age giveaway. Hands and arms are best treated with a combination program that includes an anti-aging skin care program, dermal filler, IPL, and CO2 laser. The skin of the hand is very thin and thus deserves special attention. Aggressive CO2 could easily cause full thickness skin injury, resulting in scarring, hyper-pigmentation, or loss of pigment. Low power, fractionated CO2 can provide amazing results. An experienced treating physician can ensure a safe, comfortable, effective treatment. I recommend a skin care program for at least 6 weeks to get the skin ready, dermal filler to support the tissues, and then IPL - if sun damage pigment is part of the issue - or CO2, if pigment and skin tightening is required. The lasers I use are the Palomar 500 IPL and the Deka SmartXide CO2. I remain confident in these lasers delivering exceptional results. ZO and SkinMedica are two companies that offer excellent de-pigmentation/anti-aging skin care products. Radiesse also provides nice results and is a non-HA filler that's approved for hand treatments. If an HA filler is used, the quality of the skin will need to be factored in when determining the appropriate product. Good luck from Vancouver Canada.