Kenneth Beer, M.D. is a board-certified dermatologist and dermatopathologist in Palm Beach, Fla., and the director of, an online skincare company. He is also the director of The Cosmetic Bootcamp, which trains physicians in best practices for cosmetic medicine. Dr. Beer is an instructor in dermatology at the University of Miami, and he is an A.B. Duke Scholar at Duke University. He obtained his medical degree from the University of Pennsylvania School of Medicine, and received his dermatology and dermatophathology training at the University of Chicago. Visit Dr. Beer's office at

Lending Hands a Youthful Look

Wednesday, 30 June 2010 02:37 PM

Facial rejuvenation is the most common reason for visiting a plastic surgeon or cosmetic dermatologist. Surgery, injections with Botox or Dysport, fillers, lasers, chemical peels and topical medications are among the options for making the face look younger and healthier. Once this is accomplished, patients tend to focus on two areas that contrast with the face: the hands and the neck.

Let’s look at hand rejuvenation today, and the three aspects of the aging hand that make it stand out as old: bony-appearing surface, brown spots and prominent veins.

Restoring Volume

Stringy hands are generally the result of volume loss. Without the usual layer of tissue acting as a buffer, the tendons and bones are visible through the atrophic skin on the back of the hands.

To help restore a more youthful appearance, injections of fat, Radiesse, Perlane or other materials may be used to build up the layer between the bones and the skin. The amount of material and number of sessions needed depend on how empty this area is, so these treatments may be costly. However, they tend to produce nice results when completed, and the improvement can last up to a year, depending on the treatment type.

Another injectable gaining attention for hand rejuvenation is Sculptra, which stimulates collagen growth. Several sessions are required at approximately one-month intervals. Since Sculptra relies upon the individual’s ability to produce collagen, there is no way to know prior to treatment whether it will be successful. One other cautionary note: It may cause small lumps and bumps to form.

Lightening Dark Spots

Brown spots on the hands are usually freckles (lentigines). These may be lightened with lasers, intense pulsed lights, nitrogen, chemical peels or topicals.

The first two involve focusing light energy into the pigment of the dark spots without targeting the adjacent skin (which also has pigment). Certain lasers are better than others for this, but no matter which laser or IPL is used, several treatments are required.

One of my favorite ways of treating freckles is to use nitrogen; this inhibits the pigment cells, which are very sensitive to cold. As with other treatments, adjacent skin is also susceptible so I try to treat the areas gently.

Chemical peels include salicylic acid, glycolic acid, trichloroacetic acid, and others. After several peel sessions, pigment tends to lift away and the areas look significantly more youthful. Usually, this improves the tone and texture of the skin as well.

Topical prescriptions such as Retin A, TriLuma and hydroquinone may be used to lighten the dark spots, but each requires daily use and it can take months to see results.

Closing Prominent Veins
Treatment of the hand veins is somewhat controversial and some physicians do not perform this (I do not). Treating these prominent vessels may involve injections or laser treatments to seal them.

Injections involve a solution to cause a mild irritation, which in turn causes the vessel to close. Typically these injections utilize strong salt water, glycerin compounds or an agent known as polidochanol. This latter product has been used for more than a decade in Europe and was recently approved in the United States.

A laser or other energy source can also be used to heat the vessel wall and seal it. The laser or ultrasound device may be inserted directly into the vessel via a small incision or placed above it, outside the skin. Energy is focused onto the vessel wall to heat it up and once this is done, the treatment is complete.

When considering hand rejuvenation, think about what your priorities are and how much expense and risk you are prepared to take. Treatments for aging hands are so diverse that it is likely that one will be appropriate for you.

© HealthDay

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Wednesday, 30 June 2010 02:37 PM
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