Aging Hands: The Usual Suspects
With maturity and sun exposure, the skin loses its elastin, collagen and volume and this can be noticeable on the backs of the hands, which undergo similar changes that the face and neck do. Over time, the veins and bony prominences become more apparent with the loss of tissue and thinning of the skin. Brown spots in this area can also increase in number and size over time. The backs of the hands, just like the face and neck, are often highly exposed areas on the body so it’s important to make sure they appear as youthful as the face, neck and décolletage and there are many ways this can be done.
What’s The Average Age Of A Typical Hand Rejuvenation Patient?
Most patients inquiring about these types of procedures are over 40. That being said, brown spots and volume loss, while more common in the more mature patient, can certainly occur in those younger than 40. As with fillers in the face, if you start at an earlier but appropriate age, patients generally require less product to achieve their goal and after that, it just becomes a matter of maintenance. Similarly with brown spots, if you treat them with a laser or light-based device and remove brown spots as soon as you notice them, it can be “easier” to treat because there are usually less of them to treat. Over time, they will often recur but having a good skin care and sun protection regimen in place will help to prevent that.
What Treatments Are Used To Help Rejuvenate Hands?
There are multiple treatments that can be used to rejuvenate the hands. If a patient is concerned about volume loss or prominent veins/bony areas on the backs of he hands, I like to start with Radiesse, which is a dermal filler that is injected into the skin. This treatment is now FDA approved for hand rejuvenation. The results are instantaneous and within minutes, the hands can appear revived, smoother, fuller, softer and more youthful.
If a patient is concerned about sunspots or brown spots, light or laser-based treatments can be used to remove these. Sometimes one treatment does the trick but it can often require more than one.
I also like microneedling with platelet rich plasma, which utilizes the patient’s own growth factors to stimulate collagen production. This doesn’t target brown spots but it helps with overall skin quality and rejuvenation.
If a patient chooses to undergo something that treats brown spots and can simultaneously improve the quality of the skin, a laser treatment like Profractional or Fraxel can be used.
When these are combined with Radiesse, the results can be impressive and you can take years off the hands!
What’s The Pain Factor?
A lot of practitioners mix lidocaine with Radiesse, including myself, so there is some numbing medicine in the injections, which makes the injections much more comfortable for patients.
The laser or light-based treatments generally have a few transient “zaps” while the procedure is underway, which can feel uncomfortable while it is occurring. There is a range of devices and settings used, but for most patients, this is transient. If you choose to undergo a procedure like Fraxel or Profractional laser treatment or microneedling, you will typically be numbed prior to the procedure. Afterwards, there is often some tenderness and swelling.
Your physician should advise you as to what to expect during and after the procedure that you ultimately choose.
What’s The Downtime?
With injections to plump up the backs of the hands, downtime is often minimal. The results are instant but I generally advise patients not to overdo it with activity for the first day, to help prevent swelling and discomfort.
Downtime with microneedling and platelet rich plasma is generally a day or two but this depends on the operator settings and how aggressively they treat.
Downtime with light or laser-based treatments is a bit more variable and depends on what type of treatment you undergo, but generally patients undergoing light based treatments can resume normal activity that day. I always recommend sun protection and sunscreen daily pre- and post-treatment.
How Long Does It Last?
When injected into the hands, Radiesse can last quite awhile—often up to a year.
Sometimes when treating the backs of the hands for brown or sun spots, it may take a few treatments with either a light-based or laser device. Once this is completed, results can also last anywhere from a few months to years, especially if a patient practices good sun protection consistently.
How Much Does It Cost?
This depends on a number of factors. In terms of the injections with Radiesse, if you have more volume loss, you will require more product or syringes. Patients requiring less can often get away with using one syringe shared between the two hands but if more is needed, two syringes will be required to treat both hands. The price of each syringe varies based on geographic location and practitioner providing the treatment.
Similar rules apply for brown spots/sun spots: if you have more to treat, it may require more than one session to achieve your goal. Inquire with your own dermatologist or plastic surgeon for more specifics about pricing.
What Are The Risks?
Some of the more common side effects of Radiesse injections include mild swelling, bruising, itch, and/or slight tenderness, all of which are generally temporary and resolve within a few days to at most, a few weeks. Much less common side effects are infection, injection into a blood vessel with skin necrosis, and/or lumps or uneven results. While these side effects are possible, with appropriate technique and skin prep (with topical antiseptics) prior to the procedure, the risks of these events occurring is low. I always recommend that patients limit hand use for the first day after the procedure and apply soft ice packs to the area. It’s also important to encourage avoidance of blood thinners (unless medically necessary) as well as alcohol, which can increase swelling and bruising. During a consultation prior to undergoing the injections, your provider can review your medical history and review side effects.
Some of the more common side effects of light or laser-based treatments to remove brown spots on the backs of the hands include transient redness, tenderness, swelling, and temporary darkening of the brown spots before they fall off. Less common side effects would be discoloration (lightening or darkening of the treated skin) and in very rare cases, blister formation and scarring can occur.
After microneedling, the treated area can be itchy, feel taut and can be slightly red for a few days but this is usually less impressive than what the skin appears like after Profractional or Fraxel.
I recommend that all lesions should be evaluated by a qualified dermatologist prior to removal with a light or laser-based device to ensure that it is a benign lesion and not something concerning that would require a biopsy or a different treatment.
There are a ton of laser and light-based devices so it’s important that any patient talk to their dermatologist or plastic surgeon for a full range of the risks and benefits and to get an idea of what to expect prior to undergoing any treatments and to ensure they are a good candidate for the procedure.
Who Shouldn’t Get Hand Rejuvenation Treatments?
Patients with arthritis in the hands and prior hand injuries should inform their provider before undergoing treatment with Radiesse, as these patients may not be the best candidates. Similarly, patients with bleeding disorders and those who are pregnant or nursing or have allergies to any component of the product should not undergo treatment with Radiesse.
If you have a history of keloid scarring, it is advised to avoid this product as well.
Patients with a tan or recent sun exposure should avoid treatment with most light or laser-based devices or microneedling. Good sun protection and sunscreen is key. If a patient has had a fair amount of sun exposure, I’ll have them practice good sun protection and re-evaluate in a couple of weeks. It’s also important to have a good skin care regimen in place before and after treatment that includes an appropriate sunscreen, which will help to prevent the recurrence of brown spots.
Can you Recommend Preventative Measures To Avoid Hand Aging?
I always like to encourage gentle skin care. It’s important to keep the skin youthful and I’m happy to share a few tips. I like to apply an antioxidant to the area like Skinceuticals CE ferulic or Phloretin in the morning and following that up with sunscreen with at least SPF 30. Keeping the skin hydrated with a gentle moisturizer after hand washing helps to keep the skin plump and soft.
Can Any Dermatologist Or Surgeon Perform This Procedure?
These procedures are best performed by qualified practitioners such as a dermatologist or plastic surgeon who is familiar and comfortable with treating the hands. My advice: do your research and go to someone you trust!
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