Everything you need to know about hand rejuvenation
There are a surprising number of options to improve signs of aging skin on our hands

It's surprising to many, but one of the first places on our body that begins to show signs of aging is our hands. And if you stop and think about it, perhaps that's not unexpected given the daily beatings our hands take – from constant washing, to sun exposure, to simply being in motion nearly 24/7 – it's no wonder why the skin on our hands would break down first.

"Hands are a frequently neglected and often underestimated area of the body when it comes to aging and beauty," explains Dr. Lara Devgan, a New York City-based plastic surgeon and member of the American Society of Plastic Surgeons (ASPS). "A classic anecdote among plastic surgeons is that if you want to guess someone's age at a cocktail party, all you have to do is look at their hands."

As we age, patients become increasingly concerned about "wrinkles, loss of volume, loss of elasticity, increased visibility of veins and pigmentation – all associated with aging hands," says board-certified plastic surgeon and ASPS member Dr. Umbareen Mahmood, who has a practice in Midtown Manhattan. "A hand rejuvenation procedure can address all of these concerns."

So what, exactly, is a hand rejuvenation procedure? Drs. Mahmood and Devgan explain it for us.

What is hand rejuvenation?

It's not just one thing, says Dr. Devgan. Instead, it refers to a collection of procedures "designed to improve the appearance of the hands," she says, adding that it can include a variety or combination of treatments ranging from laser resurfacing to fat grafting and injectable fillers to soften the appearance of the tops of hands.

"Because of their unique exposures to the environment and also their high functionality, the hands bear a significant load and, therefore, show significant signs of time and aging as we move through our lives."

What are the benefits of hand rejuvenation?

As with any surgical intervention, the benefits depend upon the patient's primary concern, says Dr. Mahmood, as well as their comfort level with differing treatments. For instance, some patients may be comfortable with fillers, but not quite there yet with fat transfer.

"Filler and fat grafting are best to restore lost volume and stimulate collagen to decrease wrinkled skin," Dr. Mahmood says of the various treatments and their benefits. "Lasers, like Fraxel or IPL, or chemical peels, are best for pigmentation; sclerotherapy can be used for select veins."

Am I a candidate?

According to Dr. Devgan, if your hands are beginning to show signs of aging, like crepiness, boniness, hyperpigmentation or an overall "sinewy appearance that makes them appear older" – and these factors are bothering you – then you're a prospective candidate for a hand rejuvenation procedure, and a board-certified plastic surgeon will outline your options during your initial consultation.

What are my treatment options?

Procedures that smooth and enhance the hands range from noninvasive to surgical, so there is a treatment designed for every concern and patient comfort threshold.

Filler injections

Beginning with the most accessible course of treatment, temporary dermal fillers can be injected into many areas aside from the face that have also experienced a loss of volume, including the hands. "There are several fillers that work well for hand rejuvenation," says Dr. Mahmood. "Some popular ones being Restylane Lyft or Volume. Radiesse has an added benefit of contributing to increased collagen stimulation, compared to some of the other fillers." And just like facial fillers, both the appointment and the recovery are quick and will need to be maintained with additional injections over time.

Chemical peels

Moving up a notch on the scale of noninvasive options are chemical peels, which can work wonders to lighten dark spots on the hands by using a chemical solution (potencies can vary depending on the severity of hyperpigmentation), to slough off the top superficial layers of skin to allow new, fresher and more evenly-toned skin to surface. One downside to peels is that they don't address every problem, specifically, prominent veins or thinning hands.

Laser skin resurfacing

"Erbium laser resurfacing is an amazing treatment for hyperpigmentation, UVA and UVB-associated sun damage and irregularity of texture," says Dr. Devgan. Specifically designed to reduce or remove superficial to moderately deep wrinkles on the face, hands, neck and chest, the Erbium laser is a narrower and more targeted procedure, resulting in fewer side effects and a faster recovery than the more traditional CO2 laser resurfacing, although Fraxel or IPL are also very effective for pigmentation, says Dr. Mahmood.

Fat transfer

"Autologous fat grafting is an extremely effective modality for replacing lost volume," explains Dr. Devgan of the two-step surgical procedure. "Fat transfer has the added benefit of moving healthy, surviving stem cells from the donor area to the recipient tissue bed, which also allows them to appear healthier at the cellular level," effectively working to heal your hands from the inside out.

Because this is a surgical procedure, it starts with liposuction of an area on your body with a bit of fat to spare, then the fat is refined to remove impurities and, subsequently, reinjected into the tops of hands.

"There is more associated downtime, but results are more durable," says Dr. Devgan. In addition to the potential complications of liposuction, "the main issue with fat transfers is that some of the transferred fat is reabsorbed by the body," says Dr. Mahmood, "so more than one session may be needed for the optimal result." Once achieved, however, the benefits last several years before a touch-up is needed.

Sclerotherapy

Another surgical treatment is sclerotherapy, which is the complete removal of large, protruding veins "But patients must have good upper arm vein accessibility in order for IVs and blood draws to be done in the future," says Dr. Mahmood of the permanent procedure.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.