By William Byron Barber II, M.D.
Q. The back of my hands look very old to me. I have lots of big veins and my hands just look like skin, veins and bones. Is there any way to plump the back of my hands up and make them look younger?
A. As we get older, several things happen to the hands that do make the back of the hand look more skeletal. That means that the veins look big and are therefore more visible, and the bones and tendons look like they are just under the skin surface. This is primarily caused by thinning of the skin and also due to loss of fat under the skin. As the fat disappears, the skin begins to look almost transparent and the veins and boney structures seem to rise to the surface of the hand. One option that can be done is to inject some of your own fat into the back of the hand to fill in the lost fat and smooth the unwanted contours of the aging hand. The fat also makes the veins much less visible. The procedure is done first by harvesting a small amount of your own fat, usually from the abdomen or hip area. The fat is prepared by washing it, and then it is injected into the back of the hand just beneath the skin to plump the hand. At first there will be some swelling and can be some bruising that may last several weeks. Some of the fat will be reabsorbed by the body, so it is common that you might have to repeat the procedure several times over the course of a year or so. This procedure is performed usually under twilight anesthesia, so it is not necessary to be put to sleep. I recommend seeing a board certified plastic surgeon who has an interest in hand rejuvenation.
Q. I take really good care of my facial skin, but my hands seem to give my age away. I have so many brown spots on the back of my hands that I just have not been able to improve. I have tried every over the counter cream that I can find but nothing has worked. I read that there is a laser that can help. Do you know anything about this laser and whether it is a viable option?
A. Yes, there is a laser that is quite successful in lightening the brown spots and in some instances actually getting rid of them completely. The procedure does not require any anesthesia and can be performed in office if the plastic surgeon or dermatologist has the correct laser. The most common laser used for this treatment is the Nd-Yag QS-532 nanometer laser. The treatment will leave a temporary scab at each site where the brown spot was treated. The scab falls off after about 2 weeks and the brown spot will fall off with it. It is not uncommon to have to do a second treatment on some of the more resistant spots. The brown spots may eventually return, and retreatment is an option. However, the results do last for a long time, usually a year or more. Once you have had the laser, then there are some creams that can be applied to slow the return of the spots. The topicals that I recommend after laser treatment include Retin-A® to increase the collagen in the skin and hydroquinone (a skin bleacher) to reduce the capacity of the skin to reform the brown spots.