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from the Summer 2009 issue

During our initial cosmetic consults, we spend most of our time focusing on facial rejuvenation. In follow-up consults where we review the results of those facial procedures, the discussion often turns to “what can I do about my neck?” and “my face looks great, but now let’s talk about these hands.” In a previous Skinny article, Feel Good About Your Neck, we covered the options for rejuvenating your neck. Now let’s talk about rejuvenating the backs of your hands.

The telltale signs of hand aging are thin skin, wrinkles, brown spots, prominent veins and boney appearance. Like most skin damage, a lifetime of sun exposure is the main culprit for these conditions. And our hands get lots of daily sun exposure, including through the windshield of our cars when we’re driving with our hands on the wheel. That exposure causes brown spots and loss of collagen, leading to wrinkles and more easily visible veins on the backs of our hands.

So how can you rejuvenate your hands and reverse sun damage? There are three courses of action. First, and at a bare minimum, you have to stop further damage by wearing a good UVA and UVB blocking sunscreen. Sunscreens with micronized zinc oxide or titanium dioxide are best. We offer some wonderful, elegant sunscreens here at SBA from Obagi, SkinMedica and others. There are also good over-the-counter alternatives. Just make sure that you check the ingredients to assure yourself that it’s a full-spectrum sunscreen with an effective UVA blocker. Remember SPF only measures UVB protection, so that rating is not good enough.

The second thing you can do for your hands is to follow an effective home skin-care regimen. At our Cosmetic Center and at The SPA, our patient care coordinators and our aestheticians can work with you to develop a personalized hand skin-care regimen. There is no charge for this service. You just have to set up your consultation in advance by making an appointment with one of these knowledgeable women.

Generally, a good regimen for the hands includes a morning and an evening routine. In the morning, you can apply hydroquinone, growth factors, antioxidants and sunscreen. In the evening, you can again put on hydroquinone, growth factors and/or antioxidants, and we recommend you add a retinoid to stimulate collagen production. Here is a sample regimen. All of the products are available in our offices. To start your day, apply SkinMedica TNS Body Mist (growth factors) or Essential Serum (growth factors and antioxidants) and Obagi Sunfader (hydroquinone and sunscreen). At night before bedtime, you can use the TNS Body Mist again or Essential Serum followed by SkinMedica EpiQuin Micro (hydroquinone and retinol). The results will be gradual but over the next several months you should see a real improvement in the appearance of your hands – diminished brown spots and a more youthful appearance to your hands.

For those wanting to take a more aggressive, speedier route, we can discuss medical procedure options during your consultation. For brown spots, we can use either intense pulsed light (IPL) or Fraxel fractional laser resurfacing, or we can freeze them with liquid nitrogen. IPL will help reduce brown spots and any redness and improve skin texture. A series of two to three IPL treatments is usually required, but each takes only about 15 minutes. You come in about an hour ahead to have a topical numbing cream applied to make the procedure comfortable and to get photos taken (initial and final visit only). There is no downtime post procedure, so you can resume your normal activities.

With Fraxel, we can use either our re:store or re:pair procedure. Both Fraxel procedures fractionate the laser’s light and create a myriad of microscopic treatment zones, leaving skin around each zone untouched to speed healing and reduce downtime. They also stimulate new collagen growth in the areas treated by the laser. Fraxel re:pair is an ablative procedure, meaning the microscopic treatment zones are actually vaporized, which has the extra benefit of causing the skin to tighten around those zones. Fraxel re:store usually requires a series of four treatments, each taking about 20 minutes; re:pair is usually a one-time-only, 20-minute procedure. Again, you come in about an hour in advance of your treatments for numbing and photos. Re:store treatments are spaced about three to six weeks apart. Because re:pair is ablative, there is more post-treatment care and potentially a little more downtime.

Our final medical procedure for plumping up the hands is to do just that with dermal fillers. These fillers are injected into the skin where needed to restore volume and smooth out the skin. We have many filler options, including hyaluronic acid fillers (Juvéderm®, Restylane®), calcium-based (Radiesse®), and porcine collagen (Evolence®). Our favorite filler for the hands is Radiesse. It gives an immediate effect and stimulates the body to produce new collagen over time. The results last up to a year or more for many patients. Radiesse gives a soft, natural look that feels like the patient’s own tissue. There is little to no downtime following treatment, and we see few side effects. The most common are injection-related, such as mild irritation, edema, swelling, itching, bruising or tenderness at injection sites. The procedure is simple, safe and minimally invasive. Treatment typically takes place with an anesthetic cream applied for about 30 minutes. It usually takes one syringe (1.5cc) per hand. The treated area is molded by the physician after injection. Patients are advised to not mold the filler post-procedure and to refrain from rigorous activity involving the hands for several days.

So that’s the skinny on turning back time for your hands. After you’ve rejuvenated your face and neck, don’t let your hands give your age away.

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