The hands often age quicker and out of proportion to the remainder of your skin due to their greater exposure to the environment especially sun.
The ageing hand manifests itself on 3 levels and most patients have a combination of concerns requiring several treatment modalities.
This is where there is epidermal damage resulting in pigmentation abnormalities or roughness on the skins surface. For discrete pigmented areas the treatment of choice is laser with usually a single treatment session being successful.
For diffuse or generalised hyperpigmentation treatment is by fractional laser resurfacing with the FRAXEL laser.
All pigmentation treatment programs should include using daily sunscreen to prevent recurrence of pigmentation. For resistant cases laser treatment is often used in combination with a prescription depigmentation cream such as hydroquinone 4% which is applied nightly.
Skin textural abnormalities such as roughness may be due to combination of age related reduction in water content of the skin combined with sun related skin damage. Superficial peels can help in this situation either as a regular home based program (e.g. 6-12% lactic acid) or in the clinic on an occasional basis (e.g. 20-50% glycolyic acid).
This is where there is dermal damage resulting in wrinkling. Wrinkle formation is one of the main features of hand ageing that concerns patients. Superficial peels with a nightly program of retinoids or glycolyic acid lotions in conjunction with clinic peels (e.g. 50 to 70% glycolyic acid at 1 to 3 months intervals) may stimulate dermal collagen.
Fractional laser technology can stimulate collagen production to help dermal damage. Usually a series of 4-6 treatments at monthly intervals are necessary.
This is where there is subcutaneous volume loss and skin laxity. Veins on the back of the hand often become much more prominent. Skin laxity is sometimes treated with deep tissue heating using monopolar radiofrequency and volume loss can be treated by dermal fillers. Whilst use of fillers such as hyaluronic acid to replace lost hand volume is a simple technique it often requires one or two syringes per hand and may need repeating every 6 months.
Prominent hand veins can be treated by using a very fine injection technique called sclerotherapy to treat these veins in the same way leg veins are treated. Each hand is treated during a separate treatment session and an elastic bandage needs to be worn for 48 hours after treatment usually one or two treatments are needed to get a satisfactory improvement.