SCN: We don’t typically think of our hands when it comes to cosmetic procedures; why do you think women are now focusing on their hands?

Doctor: Next to the face, your hands are the most continuously exposed area of the body. You can’t hide them in clothes or behind high collars, like a chest or a neck, and, if you’re lucky enough that your face doesn’t betray your age, your hands can give it away like the rings of a tree. According to an Allure magazine article, it wasn’t that long ago that the hand was called the “last virgin body part” because so little was or could be done to rejuvenate it. Fortunately, this has changed.

Arguably, the hands are the most abused part of the body. Since they’re exposed to so much sunlight, weathering and plain wear and tear, hands are one of the first areas of your skin to show signs of aging. Genetics, gravity and the passage of time contribute to the toll. What is clear, however, is that many of the changes we once associated with chronologic aging of the skin are actually the result of a shift or loss of volume in the fatty layer below it, the so-called subcutaneous fat.

SCN: What can be done to create younger-looking hands?

Doctor: The backs of the hands of young people are unwrinkled and plump and aren’t mottled with dark patches and splotches. By contrast, older-looking hands appear spotted, frail, thin, bony and wrinkled, with clearly visible tendons and bulging veins. So, anything we can do to lighten or eliminate dark spots, mask the tendons and bones and diminish the prominence of the blood vessels can wipe years off the apparent age of your hands.

It’s only relatively recently that we’ve come to appreciate that restoring volume to the backs of the hands is a must for achieving a more youthful appearance. Volume loss around the bones, blood vessels and tendons is largely responsible for the prominence of these structures over time and the appearance of frailty and wasting.

SCN: What technique would you use in the past to restore volume to the hands?

Doctor: Autologous fat transfer, a technique in which fat is harvested — by liposuction — from the abdomen, buttocks or thighs and then re-injected elsewhere in the body, was first used for hand rejuvenation more than a decade ago. The downside of fat injections is that they first require liposuction before the injections into the hands can even take place.

SCN: So, what treatments are available today?

Doctor: More recently, cosmetic dermasurgeons have turned to newer, synthetic fillers and volumizers to restore aging hands. Perlane and Juvederm-UltraPlus, both hyaluronic acid derivatives, are excellent choices for hand rejuvenation.

These materials impart a very smooth, pillowy texture and natural appearance, in large part due to their enormous affinity for attracting and binding large amounts of water within the skin. Radiesse—a semi-permanent volumizing agent composed of the bonelike material, calcium hydroxylapatite — has also been successfully used for this purpose.

SCN: Please take us through how a typical treatment works.

Doctor: Before treatment, the wrist and the channels between the bones on the backs of the hands are numbed with local anesthesia. The selected material is then injected directly into the troughs between the bones on the backs of the hand to plump and re-elevate them. Finally, the treated areas are massaged and molded into place to ensure smoothness and uniform coverage of the underlying structures. The entire procedure for both hands usually takes no more than 15 to 20 minutes.

Following treatment, there may be some redness, mild swelling and tenderness, which can last for about 24 to 48 hours. To minimize swelling, it’s best to avoid strenuous exercise during this time and keep the hands elevated as much as possible. Slight bruising is also possible, which can persist for several days, but in most cases the bruises are easily masked with an appropriate cover-up makeup. The esthetic benefits of the treatment are immediate, and more than 90 percent of patients are extremely satisfied with the results after just one or two sessions.

SCN: How long do results last, and what?s the cost?

Doctor: With hyaluronic acid fillers, improvement generally lasts several months before a touch-up is needed. Results with Radiesse may last between eight and 12 months. Fees for fillers and volumizers range from $1,000 to $2,000, depending upon the material chosen and the region of the country.

Overall, volume replacement by itself is frequently sufficient for masking boniness and patent tendons and blood vessels. Occasionally, however, particularly prominent bulging blood vessels will remain a problem even after sufficient volumizing.

SCN: What’s an effective procedure to help with bulging blood vessels?

Doctor: In these instances, sclerotherapy is useful. Sclerotherapy is just a fancy way of describing the injection of a liquid sclerosing or scar-promoting agent, directly into the unwanted blood vessels, in order to cause them to shrink and eventually disappear entirely.

It does so by irritating the inner lining walls of the blood vessels, which in turn causes them to narrow, then seal and finally to scar down. Hypertonic saline — a super-concentrated salt solution — is most often used for this purpose, although other sclerosants are now being tried successfully.

Neither topical nor local anesthesia is usually necessary. However, you may experience a slight burning sensation as the sclerosant enters the vessels. Sometimes a tourniquet is applied around the wrist area, or an assistant might grip your arm tightly in order to compress surrounding vessels and keep the sclerosant from spreading too far afield of the hands; this ensures maximum contact time with the salt solution. To achieve the desired results, several treatments spaced at monthly intervals might be necessary.

SCN: Many of us also have age spots or liver spots on our hands; what are some effective treatments?

Doctor: Liver spots, or solar lentigines, which are believed to result from the interplay of genetic predisposition and chronic sun exposure are unsightly, flat, dark, freckle-like patches that appear gradually on the backs of the hands.

They have nothing to do with the liver or diseases of that organ and probably got their nickname from their deep brown color and the occasional resemblance of their shapes to that of the liver. These spots respond to a variety of methods that include cryotherapy (the use of freezing solutions like liquid nitrogen), radiowaves or laser therapy.

I prefer to treat them with a series of six or more mild chemical peels spaced at two to four week intervals. Glycolic acid and beta hydroxy acids work well for fading mild cases. In my experience, stronger peels, such as the Golden Peel , are necessary for more stubborn cases and pose little risk of scarring or permanent discoloration, which are risks when alternative medium strength peels are used to treat the delicate skin of the backs of the hands.

Got a question for Dr. Novick? Send him an email at info@skincare-news.com. Your question might be featured in an upcoming article.

Skincare-News.com thanks Dr. Novick for his invaluable insight on non-surgical hand rejuvenation, in addition to the other great interviews he's given for our seven-part series on non-surgical procedures.

The Non-Surgical Rejuvenation Series:

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Facelifts (Part 1)

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Nose Jobs (Part 2)

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Eye and Brow Lifts (Part 3)

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Lip Enhancement (Part 4)

Talking Non-Surgical Neck Lifts (Part 5)

On Non-Surgical Chest Enhancement & Breastlifting (Part 6)

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In addition to Dr. Novick’s role as bestselling author, clinical professor of dermatology at The Mount Sinai School of Medicine in New York City and attending physician, he is also a fellow of the American Academy of Cosmetic Surgery (FAACS) and maintains a private practice in Cosmetic Dermatology and Cosmetic Dermasurgery on Manhattan’s Upper East Side. He has been featured on many popular television and radio shows and lends his expertise to scores of major publications.