Patients are expressing an interest in hand rejuvenation.B It is a visible part of the body that can give a patientb�s age away.B After treatingB the face andB neck, the hands are the nextB most visible part of the body.
As one ages, the hand will develop deep surface and skin changes.
The surface changes from aging are due to exposure to sun, chemicals and smoking.B B B The surface changes that occur in the epidermis and dermisB include solarB lentigines or sun spots, seborrheicB or actinic keratosis which are raised age spots which are pre-cancerous, poor skinB laxity, roughness and telangiectasiab�s or superficial fine vessels.
The subcutaneous or deeper tissue compartment also undergoes changes with age.B Volume loss with prominent tendons and bones along with prominent veins are usually seen.
There are a number of treatment options available to treat the changes that occur with time.B TheB surface changes can be treated with topical acids like tretinoin and Vitamin C, topical 5-FU and bleaching agents .B These treatments will correct the pigmentation and treat the premalignant changes such as seborrheic and actinic keratosis.B Microdermabrasions, chemical peels and different lasers have been used to improve the appearance of the epidermis.B These can be associated with hypertrophic scarringB and pigment loss.B B I have treated the prominent veins with sclerotherapy to help close some of the larger veins.
My preferred approach to treat the surface changes is byB using the Dermapen on the skinB after I do volume replacement in the deep tissues.B I sometimes use PRP with the Dermapen for maximal effect.B Studies have soon a 200% increase in collagen formation with microneedleing; the same as with laser resurfacing.B The beauty of using the Dermapen is that the skin heels with an increase in transforming growth factor beta-3 which presentsB dermal scaring durning the healing process.
Volume replace is crucial for rejuvenation of the hands.B I like autologous fat graftingB for volume replacement.B I using place about 5-10 of spun fat in each hand.B It is important to inject very small volumes to prevent nodule or lumps in the hands.B I will mix the fat with PRP if the patient is having PRP rejuvenation of the skin as well.B The main side effect that I have seen with fat grafting is edema or swelling which can persist for weeks.B I usually have the patients compress their hands with colban or a hand brace for 1-2 weeks.B B The results should last for years since the life span of a fat cell is about 7 years.
Fillers can also be used to replace volume.B Hyaluronic Acid (HA) can be used in theB deep dermis or subcutaneous tissue.B B Superficial injections can cause lumps and a bluish discoloration of the skin.B Hyaluronidase can be used to dissolve the filler if needed where too much as been injected superficially.B B HAb�s (Restylane, Perlane, Belotero) can last 6-12 months.
CalciumB Hydroxlyapatite or Radiesse can also be used to rejuvenate and volume fill the hand. It is thick and fills nicely hiding the tendons and veins.B 1-2 syringes are usually needed for full correction.B I like to inject with a blunt cannulas to prevent bruising and discomfort. This will stimulate collagen formation and the correction should last 6-18 months.
Poly-L-lactic acid (PLLA) or Sculptra can also be used.B This requires repeat treatments and correction occurs with neocollagen formation which does takes time.B B The results last 18-24 months.B Side effects include swelling, lumps and persistent granulomas.B A more dilute solution will usuallyB prevent the complications.B Message is needed after treatments.
This is what one patient said about her treatment.B b�After losing weight my hands looked old and veiny.B Dr. Lopez injected fat into my hands and also used the Dermapen on my hands and arms.B The results are amazing.B They are smooth and younger looking.B I am very happy with the results.b�