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With time, the hands can also suffer the same issues of volume depletion as the face. The veins begin to show in a stark relief pattern. Solar lentigenes (sun spots) can also appear on the hand as well as a loss of skin elasticity.
Certainly one of the simplest preventative measures for the pigmentation would be to remember to apply sunscreen on the hands as well. Topical hydroquinone and low strength retinoids can also help improve the dyschromia and thinning collagen. But when topicals are not enough there are other aesthetic procedures which may help.
1. Volume Loss
To address the issue of volume loss, fillers can be utilized. I like Radiesse for the hands or one of the hyaluronic acids like Restylane or Juvederm. Although I am a big fan of Sculptra, I find that for the hands, this is not the best choice. Even when diluted appropriately, granulomas may still occur with Sculptra because of the thin skin overlying the hands.
Topical hydroquinone can be utilized at night to help fade the pigmentation. Make sure to use your UVA stable, UVB sunscreen in the morning, because pigment can return with unprotected sun exposure. (Refer to sunscreen essentials post for the important sunscreen ingredients).
I have also used IPL (intense pulsed light) to the hands. Because the hands are quite sensitive, it is important to use low fluences and I typically tell patients that it takes around 3 treatments spaced every 4 weeks to achieve good results.
3. Loss of Elasticity
I address this with a very light fractional CO2 laser. I actually do an IPL first for the pigmentation, followed by a low setting of fractional CO2. Patients do wear aquaphor post procedure for about 2 days (rather than four with face fractional CO2) because the settings are much milder than what I use for the face.
It is vitally important NOT to wear any latex gloves for the first week. I had one patient wear latex gloves over their aquaphor at night for the two nights so that she wouldn’t get the aquaphor everywhere and she developed a horrible contact dermatitis. Whenever the epithelial barrier has been violated as with the vaporization effect of CO2 laser, then the skin becomes quite sensitive to topical application of products other than petroleum gel and certainly can become sensitized to latex.
The hands can definitely show age, just like the eyes and neck, so remember to take good care of them!
Until next time….
Tags: Fractional CO2, hand rejuvenation, hydroquinone, IPL, Juvederm, Radiesse, Restylane, sunscreen