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Dr. Barry Eppley

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Surgeon Dr. Barry Eppley

Posts Tagged ‘hand lift’

Total Hand Rejuvenation

Wednesday, July 11th, 2012

While the aging of the face seems the most visible and subsequently the most treated by plastic surgery, it is not the only visible and unclothed body part that ages. I have seen many older women whose face is quite smooth because of numerous facial rejuvenation procedures but whose hands give their age away. The hands simply don’t go with their face, age or lifestyle. The hands are as much exposed to the elements as the face but are far less pampered and protected.

Like the face, the hands age in a similar way. They lose volume through fat atrophy, the skin loses elasticity and becomes wrinkled and age spots appear. As the fat layer in the hands disappears, which is already thin to begin with, the skin becomes partially translucent and thinner. This creates the classic skeletonized hand appearance where the veins and tendons are clearly visible. The rows between the hand bones become sunken in. The skin when you pinch it on the back of the hands doesn’t bounce back due to loss of elasticity.

The aging of the hands can clearly be seen in many tabloids and magazines. Famous aging women with youthful faces and great bodies have old-looking hands. Their veins can clearly be seen bulging out on their emaciated hands. This may be why some performers wear fingerless gloves in an effort to hide the back of their hands.

Treatment of the aging hands can be done through various rejuvenation methods. The most common treatment by far is for the brown age spots or sunspots. Intense pulsed light (IPL) or broad band light (BBL) can quickly remove brown spots, many of which can be eliminated in a single treatment session of about 15 minutes. It turns them dark and speckled and they then fleck off over the next week or so. A touch-up treatment may be needed a month later to clear what remains. It is important to wear sunscreen on the back of the hands afterward to prevent reflaring of some of the brown spots. A minimum of SPF50 sunscreen should be used.

These light therapies can be supplemented with laser resurfacing to help tighten the loose skin and reduce the wrinkling. Fractional is the best laser method because it has enhanced collagen stimulation effects. Laser resurfacing can be combined with light therapies to get a better overall effect than either one alone. Laser treatments take the same amount of time to do, about 15 minutes per hand.

Most so-called ‘hand lifts’ employ the use of injectable fillers to plump out the atrophic subcutaneous tissues and ‘deskeletonize’ the back of the hand. Fillers like Juvederm, Restylane and Radiesse can be quickly injected in the office for an instant filling effect. Placed right under the skin near the wrist level, they can be pushed into the indented rows once injected right under the skin. While they are not permanent the filling effect will last anywhere from six months to a year.  Fat injections are another option and generally create a better result because the volume injected is greater. It is a minor surgical procedure where fat is harvested from inside the belly button, concentrated, and then injected just like synthetic fillers. Unlike off-the-shelf fillers, fat has the potential to be longer lasting.

Other hand treatment options included the use of skin tightening devices like Exilis and the sclerosing of hand veins by injection or their actual extraction like varicose veins of the legs. One treatment option that is not used is a formal hand lift where skin is excised and the skin tightened. While it can be done by making an incision at the wrist level, the scarring is not acceptable.

A complete hand rejuvenation approach is the combination of injectable filling, light therapy for brown spots and fractional laser for wrinkling and skin tightening. Both hands can be treated in one hour in the office with complete healing in just one week.

Dr. Barry Eppley

Indianapolis, Indiana

Hand Rejuvenation with Injectable Fillers

Wednesday, August 27th, 2008

Do your hands give away your age? In many people, the hands are just as revealing as our faces about our age. But our faces understandably get much more attention and the hands are often forgotten. (but not unseen by others) As we age, our hands (particularly women) loose that once plump fullness and youthful look. Aging hands become thinner with vein and joint exposure, loose creapy skin, and brown spots over the back of them. These changes occur from chronic sun exposure and extensive use. While hand creams are a good first line of defense, they are not enough to produce a dramatic rejuvenating effect.
Adding volume back into the hands through injectable fillers is a good way to lessen the prominence of the veins and give a more plump appearance. The question is….which injectable filler? In my experience, you have 4 options…three off-the-shelf and one operative (which is only done if you are in the oprating room anyway for other procedures)
While all of the hyaluron-based injectable fillers (e.g., Restylane, Juvaderm) are extremely well tolerated, their effects are too short-term and do nothing to stimulate actual collagen tissue ingrowth so I prefer not to use them in the hands. The particulated fillers, such as Radiesse and Artefill, are better options as they last longer and may actually help stimulate favorable tissue ingrowth for longer-term results. Radiesse uses resorbable ceramic beads in its mixture so the effects are immediate but the beads are eventually resorbed over a year or so. It is also white in color although much of this is masked by the color of the skin. Artefill uses non-resorbable plastic beads in a collagen base which is much more likely to last longer and produce a better tissue-thickening result. Because both particulated fillers have a tendency for ‘clumpiness’ and irregularities, injection technique is critical and it is best to not inject too much at once. A
few staged treatments (spaced 6 to 8 weeks apart) slowly adding volume, and doing daily massage over the injected areas is the best way to ensure a smooth-looking result. Sculptra is another off-the-shelf filler option that is really like injecting ‘liquid plastic’ rather than a bead or particulated approach. Its material is resorbable over time and you have to be really careful about adding too much volume at once as it can cause local tissue reactions. Which one of these off-the-shelf injection materials is better for the hands is not yet known….and none of them are FDA-approved as of yet for use in the hands.
Another injectable option, which has been around for a long time with a track history of use in the hands…is your own fat. This is certainly the injectable filler option with the least potential for any downside with the exception that it has not historically lasted. In the past, I have done some beautiful results with it as it fills the depressed areas between the rays (fingers) quite well creating a nice plump hand. Five to seven ccs of fat per hand (which is much more volume than one could afford with an off-the-shelf- filler) is about what each hand needs. But the long-term outcome was disappointing. Now with improved purification and concentration methods, and with the addition of PRP concentrate (extracted platelets from the patient), fat is more likely to have a better long-term result. For this reason, this is my preferred method when the patient is in the operating room anyway…particularly if they are already having a liposuction procedure.
Hand rejuvenation, sometimes referred to as a ‘hand lift’ (erroneous term but catchy nonetheless), is based on the concept of restoring volume. Whether it is from a synthetic injectable filler or your own fat, short-term results appear to be quite good. Whether they will stand the test of time and what complications may yet emerge is not yet known. But at this point in time, I will give it at least a temporary thumbs up with the other four fingers still in neutral position.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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