- Best ResultsVariable
- Treatment RecoveryVariable
- Procedure TimeMinutes
- Skin SpecialistDermatologist
- Duration of ResultsYears
- Back to WorkImmediately
Hand wrinkles can be classified as volume loss dependent wrinkles & age-related decline in skin quality. Hence treatments are designed to replenish volume & stimulate dermal collagen. In Brisbane, Queensland, sun damage is commonly encountered on the hands, adding to the complexity of hand rejuvenation.
FactsFacts on Hand Wrinkles
- Hands start to show their age in the fourth to fifth decade of life
- Wrinkles are due to both collagen loss & fat loss
- Collagen loss is best treated with fractional laser resurfacing
- Fat loss is treated with dermal fillers
- Fat transfer can be effective in some cases
- Combination treatments give the best results
- Anti-wrinkle creams include retinoic acid, retinol & alpha hydroxy acids
How to treat hand wrinkles?
The three best methods to rejuvenate hands include lasers, dermal fillers & creams. Fractional lasers improve pigmentation, sunspots & superficial wrinkles. Dermal fillers replace loss volume, improving wrinkles caused by fat & collagen depletion. Hand creams maintain skin quality post procedures.
What can dermal fillers do?
Dermal fillers are the key to all aspects of skin rejuvenation as they provide volume. One of the contribution factors for hand wrinkles is age & sun induced depletion of both collagen & fat. Fillers replace fat, & stimulate dermal collagen, elastin & hyaluronic acid. For hand wrinkles I employ the following fillers;
- Calcium hydroxyapatite; the best filler for this location.
- Poly-L-Lactic acid: in hyper dilute solutions can be used for the hands.
- Hyaluronic acid: not cost effective in this location.
How long do fillers last?
It depends on the filler. For HA fillers, between 10 to 16 months. Collagen stimulating fillers including PLLA & Ca hydroxyapatite last at least twice as long. This group of fillers give the best results 3-6 months after injections.
Fillers take 5- 10 minutes to perform. There is no downtime associated with filling.
What types of lasers do we use to treat hand wrinkles?
A simple way to understand lasers & energy devices is to conceptualise the depth of wrinkles & photoaging.
Superficial wrinkles are treated with a combination of Intense Pulse Light & thulium 1927 or 1940 lasers.
Deeper wrinkles are treated with a combination of CO2 fractional laser, thulium or 1940/1550 Frax/Fraxel lasers.
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How many laser sessions are typically required for hand wrinkles?
3-4 over a course or 4-6 months. Unlike facial skin, treatments must be conservative on the hands as they take much longer to heal; typically, 5-12 days. Some patients elect to have this done over the cooler months of winter.
What is the role of fat transfer?
I think fat transfer is a good option if one has volume loss, but little in the way of sun damage (it doesn’t happen frequently in Brisbane). Can adipose stems & nano fat improve skin quality? Yes, however the results are subtle, variable & can be bettered with 20 seconds of sensible thulium or CO2 lasers.
Where I employ fat transfer is correction of large volume deficits, any improvement in wrinkles is a bonus, hence why I combine fat transfer & lasers.
Why do hand wrinkles appear?
As with all types of wrinkles, two forces come into play- intrinsic aging (happens to all of us), extrinsic aging, due to sun, heat, radiation, as well as environmental factors such as smoking & pollution.
Aging & wrinkly hands are due to loss of both collagen & fat, hence the solution of lasers, dermal fillers, or fat transfer.
What can be done about sunspots, rough skin & sun damage?
Lots. It really depends on the extent of sun damage & pre-cancerous areas. Dermatologists prescribe creams such as Efudix, Aldara or Photodynamic therapy.
I also use laser assisted & activated PDT. This combines lasers with traditional sunspot treatments. This gives much better results as it treats pigmentation, wrinkles & solar keratoses.
What anti-wrinkle creams can be used on the hands?
Acral skin differs from facial skin as it can take a lot more. Skin on the hands is thicker. Dermatologists prescribe a variety of customised anti-wrinkle topicals that include the following ingredients-
- Salicylic acid; anti-inflammatory & keratolytic
- Glycolic, lactic acid; exfoliant, hydrates the epidermis reducing wrinkles
- Urea; provides skin hydration
- Olive oil; antioxidant, Lopez special (yes, derms do prescribe olive oil)
- Retinoic acid; 0.05 to 2% in compounded creams
- Squalene: brilliant wash, provides hydration
- Glycerine; as above
Disclaimer: I do not prescribe creams; my work is entirely procedural. I may elect to prescribe compounded bespoke formulations post procedure as maintenance for my patients.
What can chemical peels do for hand wrinkles?
I do think that lasers provide a greater safety profile compared to chemical peels in this area. I tend not to perform medium depth Jessner -TCA on the hands, purely because of the handholding (excuse the pun) post procedure. It can take up to 2 weeks to heal.
Peels can be advantageous as they address wrinkles, pigmentation, sunspots & provide a nice blend. Lasers require more treatments but are safer & more cost effective for patients.
What is the role of PDT for hand rejuvenation?
PDT stands for photodynamic therapy. It is a light induced chemical reaction using a cream known as a photosensitiser. This treatment is good for sun damage, including solar or actinic keratosis, & wrinkles.
In my practice, I use lasers in combination with creams. This gives much better results.
What does a hand wrinkle treatment program look like?
The program depends on the amount of volume loss, pigmentation, age, & presence of solar keratosis. Examples are-
- Mild To Moderate Hand Wrinkles
Treat with: Thulium or Co2 laser +/- IPL, BBL
Maintain with: Retinoic acid & lactic acid creams
- Moderate to severe Hand Wrinkles
Treat with: Laser resurfacing & collagen stimulating dermal fillers
Maintain with: Retinoic acid, lactic acid creams.
Davin’s Viewpoint on Hand Wrinkles
This is a popular treatment as hands reveal their age. They are frequently neglected in the treatment algorithm; however, treatment is easy to execute. The mainstay of all treatments is to prevent further damage with high factor SPF sunscreens. If you garden a lot, go to the extreme of wearing cotton gloves to protect your skin.
The most predictable way to reduce wrinkles is with the use of combined lasers & dermal fillers. Treatment time is 20 minutes. Dermal fillers provide an instant correction that gets better with time. I use PLLA, Ca Oh as well as traditional hyaluronic acid filler. My preference is hyper dilute Ca Oh- it just works. This filler gives good one to one correction that moves over 3-5 months with more collagen stimulation. It typically last 2-3 years.
I also combine various lasers to help improve superficial hand wrinkles & to improve skin quality. They include BBL-IPL with thulium laser or erbium – CO2 fractional. I occasionally combine ALA PDT or retinoic acid, depending on the degree of sun damage.
Fat transfer in this area is also a sensible option – especially in large volume defects. It can be more cost effective than dermal fillers in the long run. The big unknown is the predictability of duration (regardless of what other people tell you). Fat can improve hand wrinkles- mainly via displacement of volume (sultana vs grape analogy). Any superficial improvement in skin quality, namely dyschromia & fine wrinkles, is a fluke.
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