Hand Rejuvenation

When a woman’s hands look older than her face, it’s like she’s wearing a label that reads, “I’ve had facial work.” For years, plastic surgeons have been nipping and tucking the face, eyes, and neck to help combat the signs of aging, yet the hands were an afterthought, helpless against exposure to sun and chemicals, brown spots, uneven skin pigmentation, loss of tissue and elasticity, bony protrusion, “creepiness,” and prominent veins.

Joyce Owen, 62, who works in property management development and design, says she always had prominent veins. The minute she heard about hand rejuvenation, she wanted it. She made an appointment with a well-known Dallas plastic surgeon, who injected her hands with a combination of body fat and Restylane.

But Owen’s first experience with hand rejuvenation was unpleasant. Her hands were bandaged and swollen. “Holding them up was the only way I could stop them from hurting,” she says. After a week, the pain subsided. But the results lasted only three months.

Undeterred, more than one year after her first procedure, Owen gave it another shot with Vincent P. Marin, M.D., a plastic surgeon and clinical instructor in the department of plastic/reconstructive surgery at UT Southwestern Medical Center. He injected 100 percent Restylane into the back of her hand, by the thumb, followed by two more injections, about an inch back from her knuckles. After each injection, Dr. Marin massaged the filler into place and told Owen she could continue the hand massage at home. No bandage, no pain, and great results two months later.

But sometimes it’s not age that ravages our hands. It’s genetics.

Laura Powers, a slender and athletic 38-year-old flight attendant with American Airlines, says her hands have always been “bony.” She cares for hers meticulously with lotions and French manicures, but the best tips in the world never plumped up the backs of her thinly skinned hands.

“It was not a huge priority,” she says, “but they bothered me. I thought it might look better to have them filled.”

Last August, Powers attended a plastic surgery seminar in Dallas and got the chance to do just that. Seven months later, she loves her hands, thanks to a Restylane injection.

“Hands are one of the first places in the body where muscles begin to atrophy,” Marin says. Even worse, as women enter menopause, doctors say decreasing estrogen levels further contribute to thinning skin and dryness. As we get older, we tend to lose volume in some areas and gain it in others, says Mary Hurley, M.D., a Dallas dermatologist in private practice at Presbyterian Hospital of Dallas.

“Some people are so self-conscious, they take extreme measures to hide their aging hands in public,” Marin says. Well, ladies, you can throw away those gloves. Thanks to the latest focus in plastic surgery, hand rejuvenation, your hands will never give away your age.

It was the cult TV phenomenon Nip/Tuck, which premiered in 2003, that first brought hand rejuvenation into the limelight, Marin says. That same year, the American Society for Aesthetic Plastic Surgery predicted an increase in aesthetic procedures designed to reduce the signs of aging in the hands and went so far as to say patients would schedule a hand rejuvenation at the same time as a facelift. In 2005, hyaluronic-acid injectable treatments such as Restylane numbered 1,194,222, up 35 percent from 2004.

The hand rejuvenation procedure is as quick as a manicure, and, according to Dr. Hurley, the focus is on three areas: color, texture, and volume. Done in the doctor’s office just like most facial procedures—sometimes, in conjunction with them—there is minimal downtime. The results last for months and, in some cases, years. Some women want only the fillers. Others with skin discoloration or hyper-pigmentation might try photo rejuvenation or other resurfacing techniques.

Much in the same way they fill tiny wrinkles on the face or enlarge lips, to volumize the hands, physicians plump the depressed areas with Restylane (hyaluronic acid), Juvederm (its newest cousin, brought to us by the makers of Botox), or human fat. Hyaluronic acid is found naturally in the body, but production decreases with age. Juvederm has a slightly different chemistry than Restylane but provides similar results.

Once the filler is injected, the doctor massages it into place. With volume restored, the hand fills with little or no bruising. “My patients look at their hands 10 minutes after their injections and cannot believe it’s the same hand,” Hurley says.

Marin says that generally, most doctors don’t send home patients wearing gloves or bandages; some ask patients to have limited movement for the first 24 hours. Cost is $500 per syringe of Restylane or Juvederm, but fat injections are more costly, because the physician harvests the fat. Unlike most of our hips, there is a variable as to how long it will last once it is injected.

To correct imperfections on the surface of the skin, lasers or other ablative treatments yield positive results. Marin requires patients to resurface their skin at least 10 days prior to volumization, because he believes there is a small, potential risk that treating the filler with lasers or Intense Pulsed Light (IPL) could cause the filler to dissolve more rapidly.

IPL, also known as Fotofacial, is a bright light that targets pigmented cells, causing them to fade gradually over time. The procedure, at a cost of up to $200 per treatment, is done in-office and is relatively pain-free. “For anything brown, like sun spots, or anything red, such as broken blood vessels, this works great on them,” says Hurley, who recommends a series of five.

Thanks to fractional skin resurfacing technology, ablative laser treatments can also remove age spots on the hands effectively and permanently, without the severity of treatments past. (Old laser technology actually burned off the top two layers of skin, which was painful and required significant downtime for healing.) One of the newest techniques is the Harmony Pixel Laser. With Pixel, only 20 percent of the skin surface is affected at a time, recruiting healthy skin to target areas while stimulating collagen and clearing brown spots or scars. Hurley says patients see a 50 to 90 percent improvement in color, quality, and texture of the skin, gradually after three to five treatments, at a cost of $250 to $500 each.

Portrait Plasma skin regeneration utilizes plasma energy, which delivers heat to the skin in the form of nitrogen gas, stimulating layers deep below the surface to replace old, damaged collagen with new, remodeled collagen. What this means for hands: fading brown spots, improved texture, toning, and tightening. Doctors recommend one to three $500 treatments.

So how are Laura Powers’ and Joyce Owen’s hands holding up? Powers has no complaints.

“You see immediate results,” she says, and she would do it again.

Owen is hopeful that this time she’ll enjoy at least nine months of hand rejuvenation from Marin’s technique, and she’s thrilled she’s found a pain-free way to make her hands more attractive.

“This time was so simple—not a bruise mark in one place,” she says. “It’s one of those things you could kind of get addicted to.”

How To Care for Your Hands

Experts say there are many treatment options available to help make hands look younger without pulsed heat, lasers, or fillers. Many of them are topical, such as Retin-A®, glycolic acid derivatives, and bleaching cream, which can fade age spots.

Texture and sunspot pigmentation can be reversed by chemical peels, resulting in a fresh layer of skin with even color and smoother texture. The peel stimulates new cell growth, which will fade brown spots.

Hands down, the most important thing a woman can do is wear sunscreen on her hands and face daily, in lotion or cream form or a powder-based sunscreen.

“Wear sunscreen on your hands every day,” Dr. Mary Hurley advises. “Carry it in your purse. You get so much sun just driving—through the glass with your hands on the steering wheel—or when you walk to your car.”