“I wanted to take a few minute to talk about an area and topic that is really commonly asked, and is a common issue. There’s an old saying “If you want to know the age of a woman” and this applies to men too “then look at their hands”.

Well there is a lot of validity to that, we have a lot of treatments for and do lots of care for our faces and often times you’ll see hands that are completely untreated or unattended to, and there are a number of very good options available for improving some of the aging changes that happen to our hands so that it matches our face and the rest of our self so that we’re taking good care of ourselves.

Amongst the things that make hands look aged are the loss of soft tissue in between the tendons, the prominence of the veins that then become quite significant in the hands, the age or brown spots that commonly occur on the hands as well as dilated blood vessels just like we see on the face or even bruising and port wine type of staining on the hands and you know, also of course, wrinkles.

So if we look at all those features there’s really simply blurred color which is in the form of brown spots, there are vascular colors, the blue veins or the red of small vessels, capillaries and telangiectasia’s or spider veins. There’s a loss of volumes which makes the tendons stand out, makes the hands look quite thin and there are a series of treatments that we can do to address those both collectively or individually and overall we call that management of the aging hand.

So the simplest of those and just to give you a brief overview, we’ll get into some details later on the techniques but there are very good fillers now that we can use to both disguise the loss of the volume that creates the prominent tendons and loss of the normal youthful volume of the hands and there’s a number of fillers that we can use for that. We’ll talk about those in some details that’s an office base treatment that’s done probably in about a half an hour with typically very little downtime.

There are treatments for the brown spots and those are based on the condition of the hand. If it is really just color and brown spots, the simplest treatments are what are called IPL or Intense Pulsed Light treatments which we’ve discussed elsewhere but a summary of IPL is a broadband light so unlike a laser it’s light that is in our environment or in a room, but it’s very intense and it’s applied to the skin surface through a crystal, a very bright flash of light is absorb by the brown pigments in our skin, typically the so-called age or liver spots and when we damage the pigment, not the skin itself, that pigment will naturally work its way to the surface within a couple of weeks and we have nice clearing of the brown spots on the skin.

IPL can also help with vessels and it’s not really a treatment for wrinkles, we can get into that, but another option that gets both brown spots and wrinkles as a special type of skin resurfacing. Skin resurfacing as we’ve spoken about before, can come in different varieties with chemical peels, light peels, medium and deeper peels, laser resurfacing but historically laser resurfacing to any substantial depth was really undoable in the hands because of the amount of injury that would be created by the laser and the lack of good wound healing properties that the hand skin has. Not as good as blood vessels of the face and what’s change that is the advent of fractional laser. So with fractional laser, we can actually improve by treating the hands with the fractional laser resurfacing both the color and the texture or surface of the skin, improving wrinkles and brown spots together.

So this is a typical hand of an aging man and I’ll use my hand as an example of course , and you can see what happens with age is that we start to see the intratendinous areas, this regions here that begin to loss volume, you’ll very commonly see prominence of the veins, as you can see here in the hand and then this little brown spots that collect from sun damage on the hand. Of course when we’re young we call them freckles but as we age they actually coalesce to become true age spot or what we use to be referred to as liver spots and so when we add those collectively, we have an aging hand. So there’s the vessel prominence, the areas of volume loss in between the tendons and the discoloration of the skin and while there are not a lot of wrinkles on this middle aged hand, they will certainly be there at some point and so the treatments that we outlined earlier are fillers to reduce the prominence of the veins and reduce the volume loss in between the tendons of the hand which are quite prominent, the tendons here, and you can see the hollowness in between that also again disguises the veins, IPL or even re-fractional laser resurfacing to treat the discoloration or spots.

So we talked about color, texture is important again fractional resurfacing medium or light peels can also be somewhat helpful but fractional lasers probably the best to improve wrinkles overall and then lastly there’s the volume issue. This is very common, most of us lose volume in our face, in our hands as we age. This is loss of the fatty tissues that are in between the small tendons that we prominently see on our hands and what we’ll do with that is use one of the fillers and typically start with one of the HA fillers perlane, restylane, juvederm, in that category. and we’ll do a series of injections to restore the volume in the inner tendinous area. It works very effectively, there is minimal discomfort when we do that and we actually disguise some of the veins at the same time so that the tendons aren’t so prominent and that the veins are not so prominent on the hands which create that aging appearance.

So really in summary, we address the hands in the categories that make them look old. The surface of the skin, the texture to primarily with fractional resurfacing but also other types of resurfacing techniques. The treatment of the colors which primarily are brown, the age spots on the hand, best treatment that’s non-invasive is IPL although fractional laser also works on that as well, and then the restoration of volume with the series of fillers that we talked about earlier.

So pretty simple summary of management of the aging hand, a very important area. A thing that can make an enormous difference with what we see in public situations where we’re address for the opera or the symphony or just going out casually, the two areas that are always exposed or typically exposed, are our hands and our face and we have good answers for them.

So if you have any questions about hand or aging hand management, please don’t hesitate to write to give me or give us a call is the website where you can post photographs and or questions. Our main website is and of course you can reach us anytime at our office at 415-567-7000. Corey S. Maas MDTM on Looking Your Best.”

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