Emilie Palef, 69, has always been diligent about skin care, and she’s pleased with the way her face is aging. “But I never used SPF on my hands, so now they don’t match my face,” she says. We enlisted Adam R. Kolker, MD, a Manhattan plastic surgeon, who brought the latest treatments to bear.
Help for slack skin and prominent veins
Both conditions can be targeted with one treatment: an autologous fat transfer. In simpler terms, this means excess fat is removed from another area—typically the stomach—via a tiny incision. The fat is then injected into the hands’ dorsal (nonpalm) side; this plumps the hands and pulls slack skin taut, making veins and bones less obvious. The procedure requires a small dose of local anesthesia (comparable to what you’d get for a colonoscopy) and costs $6,500 to $8,000. Most patients require just one transfer,but in rare instances a second injection may be necessary. Ideal candidates are healthy nonsmokers who are not significantly overweight.
Synthetic or hyaluronic acid fillers can also be used as plumpers, but Kolker prefers fat transfer because he believes the results look more natural, are almost immediate and can last for many years (though, obviously, you won’t stop aging). Fillers, by contrast, yield less dramatic immediate results, require two or three treatments and last up to two years. Prices start at about $1,060 per treatment. If concerns about money, health or downtime prompt you to choose fillers over fat transfer, Kolker says Sculptra is his filler of choice for hands.
Help for spots or mottled tone
Kolker opted to treat Palef’s discoloration with one session using an ablative fractional CO2 laser (as opposed to a nonablative laser, such as Fraxel, which also works well but requires multiple treatments). The CO2 burns off the skin’s upper-most, damaged layers, revealing the fresh skin beneath; it also smooths skin by stimulating new collagen growth. Kolker treated Palef fingertip to elbow, using the strongest laser pulse on her hands and gradually decreasing the intensity as he moved up her fore-arm. This is essential, he says, to avoid a glove-like result. The only downside? Downtime. Palef had major flaking that lasted two weeks. During that time, she had to wear gloves and long sleeves outdoors (her skin was so raw, just using SPF cream would have been insufficient). She was also advised to keep the skin clean and soothed by rinsing it often with diluted acetic acid and slathering on Aquaphor.The average cost of the CO2 laser treatment is $2,222, and the results are permanent (though to maintain results, you must apply SPF 50 daily). Fair to medium skin responds well to the CO2 laser. For darker-skinned patients, who are at higher risk for hyperpigmentation (irregular darkening) or hypopigmentation (irregular whitening), Kolker prefers the Fraxel 1927 laser, which takes two or three treatments av-eraging $1,113 each. If cost or downtime is an issue, a series of chemical peels (three to six) at $150 and up per treatment is also effective, albeit slower. Prefer to tackle spots at home? Kolker likes combining a prescription retinoid, such as -Retin‑A, witha doctor-dispensed skin-lightening product like Vivité or Elure (visit viviteskincare.com or elureskin.com to find a local doctor for a prescription).
Next: Fast Hand Fixes at Home
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