Dec 1 2016
Not too long ago a woman named Ellen consulted with me for signs of ageing. When the consultation began, I was a bit confused. Ellen looked younger than her chronological age of 68. She had been a long-term user of sunscreen as well as using excellent medical grade skin care products. She was doing all the proper things. She confided in me that she had her eyes done, had a facelift and took advantage of Botox and fillers. She looked great, natural and not over-done. Most people that I see want to look like the best natural version of themselves and not like a distorted version. I could not figure out what could be bothering her until she took off her gloves and showed me her hands. She was embarrassed by the ageing appearance of her hands which were thin skinned with prominent veins and multiple brown spots that she referred to as liver spots. Her hands simply didn’t match her overall youthful appearance. She could not understand why she had liver spots when she could not recall ever having eaten liver and her primary physician told her after a recent physical that her liver was normal.
Ellen is not alone as I have treated many patients for the signs of ageing on their hands. Firstly, liver spots have absolutely nothing to do with your liver or ever having consumed liver. They are called solar lentigines and are caused by long term sun exposure. It is not unusual to lose volume and subcutaneous fat in the back of our hands as we age. This loss of volume can make veins and tendons appear more prominent. Fortunately, we have solutions to both problems.
The brown spots on the back of the hands can be treated in multiple different ways. Some people will freeze them with liquid nitrogen. We use the PicoWay Laser to treat these spots as it has fewer risks than liquid nitrogen. The PicoWay emits a beam of light that is selectively absorbed by the brown pigment. The laser light flashes on and off in picoseconds, so fast that heat is not spread to other normal skin structures. Picosecond lasers have dramtically improved how we treat pigment spots and tattoos. This allows us to remove the brown spots with minimal risk to surrounding structures. We can usually accomplish dramatic change in one or two sessions.
In addition to treating the brown spots we can also treat the loss of volume. Some patients will elect to undergo a procedure known as autologous fat transfer. This procedure is sort of like a mini-liposuction. It is performed in the office and does not require general anesthesia (being put to sleep). We typically extract some fat from the abdomen, thighs or hips and then inject it into the back of the hands. Some of the fat has the potential to create a long- lasting change by acting as a living graft whereas some of it will go away in several months. To perform this procedure, the individual must have enough fat to remove and inject. Many patients simply don’t have enough fat. For those slender individuals, we can inject a commercially available filler such as Radiesse into the hands. Radiesse can restore lost volume, minimize the visibility of veins and tendons and provide a smooth natural result.
Ellen underwent treatment where we injected Radiesse into her hands restoring lost volume and making the veins much less noticeable. In addition to this we treated her brown spots with the PicoWay laser. When I saw Ellen at her 2 month follow up visit I knew we accomplished our goal as Ellen was no longer wearing gloves to her visit. She held her hands up and was happy to point out that now her hands matched her face.