The majority of minimally invasive cosmetic procedures focus on the face, but increasingly physicians and patients are exploring options for rejuvenation of other areas of the body, including the chest and the hands. For some patients, interest in rejuvenation of the hands develops once they have received facial treatments; With a rejuvenated facial appearance, these patients feel that their aged hands give away their true age. However, some patients present with concerns about aged hands as a primary complaint. There is a range of options to treat aging hands, according to Dee Anna Glaser, MD, Professor and Vice Chairman and Director of Cosmetic and Laser Surgery in the Department of Dermatology at Saint Louis University, who presented on the topic at the Summer Meeting of the AAD in Boston in August.

Patient Perceptions

With aging, changes occur in the skin of the hands at all levels—Epidermal, Dermal, and Subcutaneous. These include formation of lentigines, roughness, laxity, and in some cases the appearance of actinic keratoses. Volume loss develops, with subsequent paper thin skin, prominent veins, prominent tendons, and deep interosseous sulci, Dr. Glaser noted. Interestingly, patients may not articulate concerns about the bony appearance, volume loss, and skeletinization, Dr. Glaser observed. Instead, they typically complain of lentigines, veins, crepiness, or laxity.

Possible Interventions

The range of treatment options for aging hands is shown in Table 1. Of course, Dr. Glaser stressed, photoprotection is essential for the hands, though often overlooked. Dr. Glaser stressed the need to use a multi-modality approach to address aging at all levels of the skin of the hands. Keep in mind that the clinician may need to initiate a conversation about hand rejuvenation; sometimes patients wish for an intervention but don't know that treatment options exist. Good patient selection and adequate counseling are also important to long-term success.

Clinicians and patients must recognize that multiple filler options are available for the hands, and optimal results depend to a large extent on physician technique. Any injector should receive training specifically in treatment of the hands, as familiarity with the anatomy of the hands is essential for a safe and effective treatment.

While collagen and hyaluronic acid fillers are options for hand rejuvenation, other fillers, like Calcium Hydroxylapatite (Radiesse, Merz Aesthetics) and Poly-L-lactic acid (Sculptra, Valeant) can be used safely and effectively to treat the hands with studies showing durability of effect from nine to 12 months to three to fours months, respectively. In the clinic, longer durations may be possible.