Changing Hands: A (handy) guide to hand rejuvenation

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Remember those old Palmolive ads, featuring Madge the Manicurist (played by actress Jan Miner), who was always telling women how terrible their hands looked? Well, we have come a long way.

There’s been a good deal of focus on hands during the last few years. Excessive hand washing has become the new norm and many are finding that the resulting dry skin has had an aging effect. Dry skin, of course, is not the only culprit when it comes to aging hands. Sun exposure leads to wrinkling and brown spots while the natural aging process, with its depletion of collagen and fat, results in sagging, thinner skin which allows veins, tendons and bones to become more prominent.

In short, hands are a tell-tale sign of aging and yet, they are often overlooked in rejuvenation regimes. “People get their neck and face done and then their hands are a mismatch,” says board-certified New York City plastic surgeon, David Shafer, MD. Fortunately, there are multiple products and procedures that will turn back the hands of time.

Dr. David Shafer.

Wrinkles, redness and age spots

Dr. Maryam Zamani.

London-based aesthetic doctor, Maryam Zamani, MD likes to address the superficial surface of the skin as a first step. Redness caused by blood vessels and sun-induced hyperpigmentation are treated with light therapies such as IPL (Intense Pulsed Light) and BBL (Broad Band Light). “Those are really good for photoaging,” says the board-certified physician. Fine lines and wrinkles are tackled with a more aggressive treatment — a resurfacing fractional laser like Erbium or CO2.

For board-certified New York City dermatologist, Doris Day, MD, Thulium is the fractional laser of choice. But, she adds a word of caution on the use of lasers: “The skin on the back of the hands is pretty thin so you have to be careful not to use too much energy. These are things that I don’t delegate to an assistant. I think it’s important for the doctor to do these treatments because the body does not heal as well or as quickly as the face – the hands especially – so you have to be very careful.”

Skin tightening and collagen build-up is also achieved with microneedling both with and without radiofrequency. Dr. Shafer is a fan of the Genius device. “The Genius is the top of the line,” says the plastic surgeon. “It’s a newer technology and it’s really fantastic. People get great results.”

This procedure stimulates the production of collagen and elastin by means of deeper subcutaneous delivery of energy via very fine needles. One of the advantages of microneedling, as Dr. Shafer explains, is that it treats a wider range of skin types than lasers because often times, lasers cannot be used to treat darker skin tones.

How microneedling with radiofrequency works.

“So there are a lot of things you can do on the superficial surface of the skin that would help create a more even, smoother skin tone and also bump up and improve collagen and elastin production,” says Dr. Zamani. “I would always start with those modalities first before embarking on skin fillers.”

Volume Loss

Fillers which Dr. Zamani is partial to are so-called skin boosters like Profhilo and Volite. Injected into the middle layer of skin (the dermis), they hydrate the skin from within. While not yet FDA-approved in the United States, these hyaluronic acid treatments have been used in Europe since 2015. “I love it,” says Dr. Zamani of Profhilo. “I use it in the neck and decolletage. And it’s also beautiful in the hands.”

Before & After photos of hands treated with a skin booster

Stateside, oft-used fillers are Juvederm, a hyaluronic acid-based product which “does a really nice job,” according to Dr. Shafer and hyper-diluted Radiesse, a collagen biostimulator. Radiesse not only gives more density to the skin, “especially for that older hand, the golfer’s hand that has had a lot of sun exposure and has lost volume, but it also adds a bit of a white sheen,” explains Dr. Zamani. “Consequently, you actually end up with better texture and skin coloring.”

Before & After photos of hands treated by Dr. Shafer with 1 cc of Radiesse: “You can see the veins are smaller and less visible and the tendons are almost completely disappeared,” says Dr. Shafer.

When it comes to fillers, “you need strength and substance,” advises Dr. Day, meaning that the product has to last, but it also has to have flexibility, especially in highly dynamic areas like the mid-face and hands. And for these qualities, she turns to a new filler called RHA (Resilient Hyaluronic Acid). Made of a type of hyaluronic acid that most closely resembles the kind that naturally occurs in the body, RHA comes in 4 formulas, numbered according to their density and viscosity: RHA 2, RHA 3, RHA 4, and Redensity. It is RHA3 which Dr. Day most often turns to when treating hands.

“RHA 3 is great for the hands because it has some substance but it’s still very soft. I use a canula to inject it and it lasts about a year or two and it looks amazing. Veins are less visible and your hands are smoother, younger. It’s just a great treatment. Patients love it,” says the dermatologist.

Before & After photos of RHA 3 filler administered by Dr. Day.

As for the longevity of the hyaluronic acid fillers like Juvederm and biostimulators like Radiesse, “the FDA indications for them say they last around a year. However, the full effect is not there for a year. The full effect is about 6-8 months,” reveals Dr. Shafer.

A longer lasting filler is your own fat. Fat transfers can last for a decade or more. But, it is a more invasive procedure which involves performing a micro-liposuction to extract a small amount of fat from the abdomen, waist, thighs or knees. The live fat cells, as Dr. Shafer explains, are then separated from other components and injected underneath the skin. Some of the fat will be absorbed by the body with approximately 60% – 80% remaining. “Once that fat takes, it has the potential to last forever. So, definitely, that’s an advantage,” says Dr. Shafer.

One caveat is that these fat cells will expand and shrink as you gain and lose weight, so it’s important to maintain a stable weight after this procedure. “If your weight stays within 10-15 lbs, you’ll be fine,” says Dr. Shafer. “But if you have a massive weight gain, your hands will look a little odd.”

Another limitation is that the aging process continues, as Dr. Zamani points out, and with that comes the attendant loss of more fat. So, the procedure may need to be repeated.

An effective add-on to fat transfer is nanofat injections. Nanofat is a super-processing of the fat that has already been extracted, which yields stem cells. These stem cells are then injected back into the skin. “If you’re going to do fat,” says Dr. Zamani, “you should do both fat transfer and nanofat. The reason I love nanofat is because of all of its stem cells that promote collagen and elastin production. They do go hand in hand.” It definitely does work,” adds Dr. Shafer. “It stimulates you to grow new tissue.”

Lastly, PRP (Platelet Rich Plasma)derived from your own blood, is another effective secondary procedure. “I like PRP as well to help volumize, especially for the patient who’s a little more fearful of potentially using dermal fillers – someone who might have autoimmune issues who doesn’t want to use a dermal filler and might have contraindications,” says Dr. Zamani.

Bulging Veins

What about sclerotherapy?

Dr. Doris Day.

For the elimination of the larger blue veins, patients are typically sent to vein centers for treatment. However, this is not a procedure favored by some doctors. “I don’t like to get rid of veins in the hands because I don’t know if one day you’ll need to have an IV in that area,” explains Dr. Day. “But, there are many doctors who do it and it can be done safely.”

Also, it’s important to keep in mind, as Dr. Shafer points out, that “often times, when you put the volume back underneath the skin with a dermal filler, the veins will shrink because the pressure from the filler minimizes the diameter of the veins.”

From lasers and light therapies to microneedling, fillers and fat transfer, there is no shortage of procedures for achieving and maintaining youthful looking hands. Madge the Manicurist would surely have approved.

Handy Tips

Dr. Zamani: The best way to prevent photoaging is to protect skin with high SPF.

Dr. Shafer: For skin quality in general, I recommend a healthy diet, not smoking, staying well hydrated, protecting from harmful sunrays (UVA & UVB rays) and also moisturizing – using good quality skin creams. Using any medical grade or high quality skin rejuvenation creams or serums can give you long term benefits.

Also, you have to be really careful about who’s treating you. Some people fall prey to non-FDA-approved fillers or fillers that may be from other countries and imported here.

Dr. Day: I think home care is a critical part of skin care for the hands. Don’t over wash, don’t use super hot water and then moisturize as much as you can. And if possible, soak your hands for 5 minutes in lukewarm water with a little bit of honey and avocado oil and then rinse that off, apply an ointment and then wear thin white cotton gloves. That will really hydrate your hands so nicely. Good hydration will help your hands age better because when your skin is moist and healthy, it’s less stressed and is better able to repair from sun damage.

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