From Our 2008 Archives
Aging Hands? Docs Put Beauty Within Reach
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Topical Treatments, Lasers, and Fillers Can Help Turn Back the Hands of Time
Reviewed By Louise Chang, MD
May 8, 2008 (San Diego) — If your face looks younger than your years but your hands aren't keeping up, there's help.
If you've got the funds, plastic surgeons have a host of solutions to make your hands look young again — or at least be a closer match to your face.
"The best place to guess someone's age is their hands," says Danny Vleggaar, MD, a physician at Clinique Vert Pre in Geneva, Switzerland, and part of a panel of plastic surgeons discussing new options for rejuvenating aging hands at the annual meeting of the American Society for Aesthetic Plastic Surgery in San Diego.
Pigment changes, age spots, texture changes, loss of fat, contour changes, and prominent veins all contribute to make the hands look older, Vleggaar and his colleagues say.
To turn back the clock, plastic surgeons are offering topical treatments, lasers, and soft tissue fillers, the same ones that refresh the face.
Topical and Laser Treatments for the Aging Hand
Topical treatments include tretinoin, says Barry E. DiBernardo, MD, a plastic surgeon in Montclair, N.J., and another panel member. Chemical peels can also improve the appearance of the skin on the hands, he and others say.
Laser treatment can also improve the hand's appearance. "Feathering" the effect of the laser near the wrist can help prevent a "line of demarcation," says DiBernardo, who works as a consultant for filler and laser manufacturers.
Filler Treatments for the Aging Hand
Fillers approved for use in the face are being used to restore the lost volume in the hands that often accompanies aging.
DiBernardo mixes the filler Radiesse with lidocaine, an anesthetic, and injects it to help restore a more youthful contour. Once injected, he massages the hand to distribute the filler evenly.
"It will take one or two syringes [of filler] per hand if there is significant contour to improve," he says.
If patients are happy with the fillers, DiBernardo says he sometimes switches to autologous fat injections (fat collected from your own body) the next time if the patient agrees. The fat is typically longer lasting, he says.
Another filler, Sculptra, may last longer than other fillers, up to two or three years, says Vleggaar, who has presented studies about the filler at professional meetings and works as a consultant for Sculptra's manufacturer and other companies.
Treating the Veins in Aging Hands
Another alternative is laser removal of unwanted hand veins, a technique favored by Roxanne Guy, MD, a plastic surgeon in Melbourne, Fla., and another speaker.
In her study of the technique, called laser ablation, she and a colleague performed the treatment on 28 women and 54 hands in all, reporting the results in Plastic & Reconstructive Surgery. A laser is placed on the tip of a wire, which is threaded into the vein. As the wire is slowly pulled out, the laser energy heats the veins and damages the vessel wall's inner lining. Over the next few weeks, the vein dies.
The patients, aged 41 to 68, were followed for up to 31 months. "Patient satisfaction was high," Guy says. Post-procedure swelling, which was expected, usually resolved within two weeks, she says. On average, most patients had four veins per hand treated. One woman had a skin burn where the laser exited. Even so, all 28 said they were satisfied with the results, Guy says.
Aging Hand: Caveats
Not everyone is a candidate to rejuvenate their hands, Vleggaar says. Among the conditions that may disqualify a patient, he says, are osteoarthritis, rheumatoid arthritis, hand tremors, or Parkinson's disease.
Not everyone thinks the dermal fillers should be used in the hands. On its web site, the Physicians Coalition for Injectable Safety states that dermal fillers shouldn't be used in the hands. Fat injections in the hands, however, are viewed as acceptable by the American Society for Aesthetic Plastic Surgery.
What Price for Pretty Hands?
"It can get quite costly, between lasers and injectables, to treat a hand," DiBernardo says. "Overall, the cost could be $3,000-$5,000, if you did everything."
For patients on a budget, DiBernardo suggests they "set up a treatment protocol according to the problem you would like to tackle."
Or if you want the most return for just one treatment, he suggests correcting the contour with filler. "It's a very dramatic result and you can see it right away." Most patients who have their pigment problems treated seem happy too, he says.
While the fillers are temporary, Guy says she believes her vein removal procedure is permanent, "but we have only followed these people for a couple years."
Second Opinion: Aging Hands
Skin treatments with lasers or a technique known as intense pulsed light (IPL) therapy may be the best bets for hand rejuvenation, says Jack Friedland, MD, a Scottsdale, Ariz., plastic surgeon not involved in the panel discussion.
Lasers or IPL ''that treat brown pigmented spots for removal work," he tells WebMD.
He says he is not convinced that the fillers used in the hand give a completely natural look.
Aging Hands: The Jewelry Alternative
Another alternative for younger-looking hands? Wear jewelry.
In a survey, published in Plastic & Reconstructive Surgery and cited by Guy, hands with jewelry were rated as younger looking by observers than those without, although the differences weren't significant.
SOURCES: Roxanne J. Guy, MD, plastic surgeon, Melbourne, Fla. Jack A. Friedland, MD, plastic surgeon, Scottsdale, Ariz. Danny Vleggaar, MD, physician, Clinique Vert Pre, Geneva, Switzerland. Barry E. DiBernardo, MD, plastic surgeon, Montclair, N.J.; clinical associate professor of plastic surgery, University of Medicine & Dentistry of New Jersey. Bains, R. Plastic & Reconstructive Surgery, June 2006; vol 117: pp 2212-2218. Guy, R. Shamma, A. Plastic and Reconstructive Surgery, December 2007; vol 120: pp 2017-2024. Physicians Coalition for Injectable Safety. American Society for Aesthetic Plastic Surgery. American Society for Aesthetic Plastic Surgery Annual Meeting, San Diego, May 2-6, 2008.
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