Hands are often tell-tale signs of chronological age when other parts of the body, including the face, are more youthful in appearance. The dermal layer of the skin on the back of hands is thinner than that of the face and contains less collagen that the face for example. The hands age more in women than men because their hands lose volume by fat loss and also some muscle bulk between their fingers creating hollows. As a result the hands looks bony and irregular in contour. Loss of collagen and elastin from menopause onwards contributes to hand skin ageing.
In the past, wrinkly, liver spotted hands have been hidden and airbrushed away by older celebrities who prefer for us to think they are still 20-something not 50-something.
However, in recent years, there have been some remarkable developments in turning back the clock on hand ageing. One of the most recent, which I have been using for the last year in my own dermatological practice in London, is a completely new type of injection that we call “Neocollagen injections”. These are injections that contain microscopic uniform microbeads of polycaprolactone, which is a biodegradable substance that has been widely used in orthopaedic and other types of surgery.
The tiny beads of polycaprolactone are suspended in a cellulose gel that can be injected into the back of the hands very safely using cannulas. Our technique is to mix the polycaprolactone bead cellulose mixture with local anaesthetic.
We use microcannulas instead of potentially traumatising needles to avoid damaging the delicate blood vessels in the back of the hands. These fine microcannulas have rounded ends that push aside the blood vessels and avoid piercing them and therefore minimise risks of bruising. I also use a laser light to highlight blood vessels in the skin so I can be very accurate when placing my cannulas.
Because they are less traumatic, than needles they reduce bruising and also swelling after the injections. The injection is placed where there is the most hollowing of the back of the hands.There is an immediate improvement with the injection of the polycaprolactone beads. In addition as the microbeads gradually dissolve this they stimulate the skin cells called fibroblasts to manufacture new collagen and elastic tissue.
I have found this new type of injection to be more effective than hyaluronic acid fillers which were quite effective but simply created volume without stimulating the body’s own fibroblasts to start creating their own collagen.
The best results in patients are those achieved with a combination of therapies, including the injections of polycapralactone and use of lasers. If the hand skin has wrinkles and skin thinning, then the use of the gentle Fraxel laser with low density settings used every four to six weeks gives rapid healing usually only one day of mild redness. This will stimulate tissue below the skin surface to produce more collagen and elastin going tightening of the fine wrinkle skin leaving a much smoother youthful hands.
Long-pulsed Alexandrite laser can target localised brown spots very efficiently and can be used in the same session as the Fraxel laser or st a separate treatment.
This way, we have a deep smoothing out of deep wrinkles and contours and the skin surface quality is better too.
Of course, the most important thing is to try and avoid the problem happening in the first place. I always advise my patients to cover their hands with UV-protective sunscreen – often forgotten while the head and neck is given full coverage. Driving in a car with your hands on the steering wheel is also a quick route to liver spots and wrinkles unless you protect your hands since studies show that UV light easily penetrates car windscreens.
Skin quality can be improved by the regular use of a prescription retinoid (vitamin A) cream or gel. These must be applied in the evening before bed, (daylight can destroy the active retinoid molecules in the cream and gel).
All these treatments can help to ensure that hands can return to a youthful appearance, even if your patient is closer to retirement age than the school prom.
and Clinical Professor of Dermatology, UCLA School of Medicine, Los Angeles.