Turning back the ‘creepy old hands’ of time

For Susan Waitley, it was her “banana hands” that did it.

“You know how a banana starts to get spots as it gets older?” says the 62-year-old entrepreneur from San Diego. “I started to look at my hands the same way. I thought, ‘I look like an aging banana here.’”

So Waitley had her hands “done.” More specifically, her dermatologist used an IPL (or intense pulsed light) treatment known as PhotoFacial to zap away the age spots.

Jo Anne Wagner, 66, a hand model and commercial actress from Palm Beach, Fla., had a different problem. Instead of spots, her hands had a sunken-in hollow look. Her solution was to have her dermatologist plump them up with Restylane, an injectable cosmetic filler.

“We all worry about our faces, but your hands can give it away in two seconds,” says Wagner. “You put your hand up to your face and your face looks fine. But there’s a creepy old hand up there.”

Up until a few years ago, those hoping to hide their true age were forced to feint and dodge their way to a youthful facade with high-end manicures, fingerless gloves, and a collection of chunky distracting bracelets. But today, a raft of new hand rejuvenation procedures offer the cosmetically conscious a chance to turn back the hands of time.

“The newfound acceptance of non-invasive light devices and filler materials has remarkably changed the ‘face’ of hand rejuvenation,” says Dr. Ranella J. Hirsch, a cosmetic dermatologist in Cambridge, Mass., and president of the American Society of Cosmetic Dermatology and Aesthetic Surgery. “By using some of the newest technologies to restore lost volume and remove sun damage, we can reset the clock.”

In other words, these days the hands do lie.

In a 2006 study in England, nearly 100 participants were asked to examine unaltered photos of female hands and then guess their age. The results showed that hands with wrinkles, veins, prominent joints, thin skin and spots were routinely and accurately characterized as older. But when altered images of older hands were shown with veins, wrinkles, and age spots digitally removed, participants classified those hands as younger. (Nail polish and jewelry also helped lower the age, but not to the same extent.)

Plumping up bony hands
While dermatologists and cosmetic surgeons can’t stamp out the signs of age with the ease of a Photoshop guru, they have begun to offer their patients rejuvenation techniques that can temporarily shave 10 to 15 years off of a hand within the course of an afternoon.

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Injectable fillers and volumizers are used to plump up thin, skeletal hands, either with injections of fat harvested from the patient’s own stomach, thighs, or butt or with a cosmetic dermal filler such as Restylane or Perlane. Both fillers are made from non-animal sourced hyaluronic acid and have been approved by the FDA for the correction of facial folds and wrinkles (dermal fillers for the hands remain an off-label use). Another volumizing option is poly-L-lactic acid (marketed in the U.S. as Sculptra), a synthetic polymer that has been widely used in dissolvable stitches, bone screws and facial implants. A collagen stimulator as opposed to a filler, Sculptra has been approved by the FDA to restore and correct facial fat loss in people with HIV (again, use on the hands is off-label).

Cost for soft tissue fillers and volumizers can run from $500 to $3,000 and fat injections can cost $1,200 to $5,000, depending on where a patient lives and the number of treatments that are required.

Hand-rejuvenation options Hand-rejuvenation treatments have been around for years. Old and new options include: Prescription topical treatments: Lotions and creams, some with glycolic acid or other exfoliating agents, can be effective for treating dryness and light sun damage. Costs vary. Microdermabrasion: A soft “sandblasting” of the skin involving tiny crystals that are sprayed onto the skin. Works best on superficial skin problems like fine lines, dull skin, brown spots, mild acne scars, and age spots. Average cost: $162. Chemical peel: A chemical solution is applied to the skin, which causes it to "blister" and eventually peel off, leaving smoother, less wrinkled skin. Used to treat wrinkles and reduce age spots and freckles. With hands, there is a risk of scarring, particularly for people with very thin or sensitive skin. Average cost: $870. Sclerotherapy: A procedure used to eliminate varicose veins and “spider veins” from the face, legs or hands. Sclerotherapy involves the injection of a salt solution directly into the vein which then irritates the lining of the blood vessel, causing it to stick together. Over time, the body absorbs the vein. Average cost: $329. Laser therapy: The use of various lasers and/or intense pulsed light (IPL) to remove age spots, even out skin tone, tighten loose skin, and stimulate collagen growth. Average cost: $845. Injectable fillers and fat: Plumping up the skin of the hands with soft tissue fillers, collagen-enhancing volumizers or injections or fat (also known as fat grafting and fat transfers). Average cost: $532 (for fillers such as Perlane/Restylane); $1,040 (for Sculptra); $1,450 (for fat injection). Some procedures require multiple treatments. Information courtesy of The American Society of Cosmetic Dermatology and Aesthetic Surgery and The American Society for Aesthetic Plastic Surgery.

Jo Anne Wagner, who does “real hand” modeling (she holds medical instruments as opposed to showing off nail polish), found her procedure to be both a “pick-me-up” and a good investment. “If they’re showing my hands with a product, it’s important that they look good,” she says.  “They want a real-looking hand, but they want a nice real-looking hand, not a scrawny real-looking hand.”

Dr. Kenneth Beer, the Palm Beach dermatologist who plumped up Wagner’s hands says the problem with aging hands is that they lose both connective tissue and fat, which is what makes them look “stringy.”

“You end up seeing the tendons and veins you don’t see when you’re young,” he says. “By injecting filler – either Restylane or Perlane or Radiesse – you can give a buffer layer between the skin and the tendons and bones so the hand appears more youthful.”

For a time, anyway.

Beer says Restylane and Perlane last about six to eight months, Radiesse lasts about a year, Sculptra sticks around for 16 to 24 months and fat injections can last anywhere from two to five years. Unfortunately, while fat injections may last longer, they also require additional sessions, cost more, are more invasive (remember, the fat has to be harvested first) and are less predictable.

“The problem with fat injections is that it can look lumpy and can make the hand look like a mitten,” says Dr. Z. Paul Lorenc, a New York aesthetic plastic surgeon and author of “A Little Work: The Truth Behind Plastic Surgery’s Park Avenue Façade.” “Fat isn’t very discreet. It’s not predictable and it skips areas, so you can have lumpiness.”

When freckles are no longer cute
Skin texture, skin color changes and age spots are another unmistakable “tell” and for that, many people turn to laser therapy. As with fillers, there are a number of different laser options, ranging in price from a few hundred to a few thousand dollars, depending on the type of treatment, the region where a patient lives (rural or urban) and the number of treatments necessary.

Intense pulsed light (IPL), marketed under names like Limelight or PhotoFacial, throws a broad spectrum of light at the skin (think of it as a big flashlight turning on and off) and is good for removing brown spots and evening the tone. Intense focused light lasers will hit a particular wave length (think of them as a pen light rather than a flashlight) and, just as with physicians, each tends to have its own specialty. One laser, DioLite, addresses the color red and is used to eliminate spider veins, freckles and age spots; another, Titan, emits an infrared energy, a different wavelength that goes deeper into the skin and causes skin contraction.

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