“As we age, the subcutaneous fat layer in our hands becomes thinner, revealing tendons, arteries and bones,” explained New York’s go-to hand doctor, David Cangello M.D, when I rang him to discuss the options. “Meanwhile, the collagen within the skin gets less bouncy as the fat thins. Sunscreens can protect surface skin but there is no way of preventing this thinning.”
It’s easy to see this process in action if you pinch up a little flesh from the back of your hand and then let it go. The skin will take much longer to sink back to a smooth state than it did at the age of 20.
Add in all the tiny wrinkles, scars and accumulated sun damage and boom – hands can look at least 20 years older than the face. Also, is it just me or are New York ladies’ hands of a certain age looking younger these days? I put it to the doc.
“We are seeing lots of interest in cosmetic treatments for hands among women in their 40s and upwards,” said Dr Cangello. “It is natural to think about restoring balance and unity if hands are looking scraggly compared to a radiant face.”
Fat transfer is this doctor’s favourite method for filling in the gaps between tendons and arteries because of its longevity. Once injected, the fat lives on in the hand potentially forever, lessening the need for follow-up treatments.
“We harvest a small amount of fat through a cannula, typically from the lower belly where people might have a little pouchy fat,” he says. “We then process the fat and graft it into the hand. It requires tiny incisions and some anesthetic so it is a surgical procedure compared to say, Radiesse filler, which I also like to use but which is just injected below the skin.”
There are two classes of fillers in use for face and hands today. One set is hyaluronic acid based, and comprises pretty much every filler you’ve ever heard of – Restylane, Juvederm and all the other well-known brands. However, these will only last about three months in the hand before they begin to dissipate.
The other class of fillers such as Radiesse is more expensive because it works naturally with the body over time and stimulates new collagen production. Even though the Radiesse eventually fades, fewer top-ups are needed because new tissue has grown beneath the skin. Most patients wait a year or even longer for a second treatment.