Image: Hand lift, before and after
Dr. Kenneth Beer, Palm Beach Aesthetic, Dermatology and Laser Center
Jo Anne Wagner, 66, had her dermatologist Dr. Kenneth Beer inject her hands with the wrinkle filler Restylane.
By
msnbc.com contributor
updated 2/25/2008 12:47:05 PM ET 2008-02-25T17:47:05

For Susan Waitley, it was her “banana hands” that did it.

“You know how a banana starts to get spots as it gets older?” says the 62-year-old entrepreneur from San Diego. “I started to look at my hands the same way. I thought, ‘I look like an aging banana here.’”

So Waitley had her hands “done.” More specifically, her dermatologist used an IPL (or intense pulsed light) treatment known as PhotoFacial to zap away the age spots.

Jo Anne Wagner, 66, a hand model and commercial actress from Palm Beach, Fla., had a different problem. Instead of spots, her hands had a sunken-in hollow look. Her solution was to have her dermatologist plump them up with Restylane, an injectable cosmetic filler.

“We all worry about our faces, but your hands can give it away in two seconds,” says Wagner. “You put your hand up to your face and your face looks fine. But there’s a creepy old hand up there.”

Up until a few years ago, those hoping to hide their true age were forced to feint and dodge their way to a youthful facade with high-end manicures, fingerless gloves, and a collection of chunky distracting bracelets. But today, a raft of new hand rejuvenation procedures offer the cosmetically conscious a chance to turn back the hands of time.

“The newfound acceptance of non-invasive light devices and filler materials has remarkably changed the ‘face’ of hand rejuvenation,” says Dr. Ranella J. Hirsch, a cosmetic dermatologist in Cambridge, Mass., and president of the American Society of Cosmetic Dermatology and Aesthetic Surgery. “By using some of the newest technologies to restore lost volume and remove sun damage, we can reset the clock.”

In other words, these days the hands do lie.

In a 2006 study in England, nearly 100 participants were asked to examine unaltered photos of female hands and then guess their age. The results showed that hands with wrinkles, veins, prominent joints, thin skin and spots were routinely and accurately characterized as older. But when altered images of older hands were shown with veins, wrinkles, and age spots digitally removed, participants classified those hands as younger. (Nail polish and jewelry also helped lower the age, but not to the same extent.)

Plumping up bony hands
While dermatologists and cosmetic surgeons can’t stamp out the signs of age with the ease of a Photoshop guru, they have begun to offer their patients rejuvenation techniques that can temporarily shave 10 to 15 years off of a hand within the course of an afternoon.

Injectable fillers and volumizers are used to plump up thin, skeletal hands, either with injections of fat harvested from the patient’s own stomach, thighs, or butt or with a cosmetic dermal filler such as Restylane or Perlane. Both fillers are made from non-animal sourced hyaluronic acid and have been approved by the FDA for the correction of facial folds and wrinkles (dermal fillers for the hands remain an off-label use). Another volumizing option is poly-L-lactic acid (marketed in the U.S. as Sculptra), a synthetic polymer that has been widely used in dissolvable stitches, bone screws and facial implants. A collagen stimulator as opposed to a filler, Sculptra has been approved by the FDA to restore and correct facial fat loss in people with HIV (again, use on the hands is off-label).

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Cost for soft tissue fillers and volumizers can run from $500 to $3,000 and fat injections can cost $1,200 to $5,000, depending on where a patient lives and the number of treatments that are required.

Jo Anne Wagner, who does “real hand” modeling (she holds medical instruments as opposed to showing off nail polish), found her procedure to be both a “pick-me-up” and a good investment. “If they’re showing my hands with a product, it’s important that they look good,” she says.  “They want a real-looking hand, but they want a nice real-looking hand, not a scrawny real-looking hand.”

Dr. Kenneth Beer, the Palm Beach dermatologist who plumped up Wagner’s hands says the problem with aging hands is that they lose both connective tissue and fat, which is what makes them look “stringy.”

“You end up seeing the tendons and veins you don’t see when you’re young,” he says. “By injecting filler – either Restylane or Perlane or Radiesse – you can give a buffer layer between the skin and the tendons and bones so the hand appears more youthful.”

For a time, anyway.

Beer says Restylane and Perlane last about six to eight months, Radiesse lasts about a year, Sculptra sticks around for 16 to 24 months and fat injections can last anywhere from two to five years. Unfortunately, while fat injections may last longer, they also require additional sessions, cost more, are more invasive (remember, the fat has to be harvested first) and are less predictable.

“The problem with fat injections is that it can look lumpy and can make the hand look like a mitten,” says Dr. Z. Paul Lorenc, a New York aesthetic plastic surgeon and author of “A Little Work: The Truth Behind Plastic Surgery’s Park Avenue Façade.” “Fat isn’t very discreet. It’s not predictable and it skips areas, so you can have lumpiness.”

When freckles are no longer cute
Skin texture, skin color changes and age spots are another unmistakable “tell” and for that, many people turn to laser therapy. As with fillers, there are a number of different laser options, ranging in price from a few hundred to a few thousand dollars, depending on the type of treatment, the region where a patient lives (rural or urban) and the number of treatments necessary.

Intense pulsed light (IPL), marketed under names like Limelight or PhotoFacial, throws a broad spectrum of light at the skin (think of it as a big flashlight turning on and off) and is good for removing brown spots and evening the tone. Intense focused light lasers will hit a particular wave length (think of them as a pen light rather than a flashlight) and, just as with physicians, each tends to have its own specialty. One laser, DioLite, addresses the color red and is used to eliminate spider veins, freckles and age spots; another, Titan, emits an infrared energy, a different wavelength that goes deeper into the skin and causes skin contraction.

Not surprisingly, these new non-invasive lasers have taken the place of older hand rejuvenation techniques such as chemical peels, which Lorenc calls “passé” and “unforgiving,” since it can be difficult to control how deep the chemical might go.

“Laser is by far my most popular hand procedure,” he says. “It has a very pronounced effect and it offers the most drastic improvement. In my practice, the overwhelming concern is age spots versus volume.”

Such was certainly the case for Wendy Merrill of Sausalito, Calif., who, at 50, thinks of her thin hands as “Audrey Hepburn chic” but finds her age spots much less charming.

“When I was 30, it was a cute freckle, but when I turned 50, it suddenly became an age spot,” says Merrill, who owns her own marketing/communications company and spent $250 for 20 minutes worth of DioLite laser therapy. “I have a certainly amount of vanity and want to maintain my looks and take care of myself, but I’m not going to go over the top. This didn’t really hurt and it wasn’t a lot of money — I spend that much on a pair of shoes if I really want them. And it made me feel better, more confident and happier.”

While numbers on the cosmetic hand procedures performed in the U.S. aren’t available, Dr. Kimberly J. Butterwick, a dermatologist in La Jolla, Calif., says the number of “hand lift” patients has been increasing over the last few years, especially as new procedures become available.

“I see maybe one hand patient a day of some sort,” she says. “But there has been more interest in the hands and more publicity about what can be donenow. The interest seems to follow the technology.”

Butterwick says most of the patients she sees for hand work are women “Our skin is thinner, we’re out in the sun more and our hands are part of our beauty,” she reasons. And while these women may not be “old hands” at cosmetic procedures, the majority of them have had previous work done.

Face first
“It’s usually not the first entry, that’s always the face,” she says. “But after a while, the more seasoned patient will say, let’s treat the hands, too.”

Of course, there are still many who for reasons fiscal or philosophical, prefer to keep things “old school.”

“I’ve certainly noticed that my hands look much older than they used to, much more bony and wrinkled,” says Theresa Shadrix, a 36-year-old, fashion/beauty columnist from Anniston, Ala. “But I’m a wimp when it comes to cosmetic procedures.”

Instead of turning to flashing lights or dermal fillers, Shadrix says she’s become a “moisturizing freak.” She slathers on sunscreen whenever she goes outside, wears gloves (when it’s cold out and when she’s doing dishes), opts for soap and water instead of alcohol-based hand sanitizers (which dry out her skin) and, all in all, tries to keep both her beauty and our culture’s fixation with it in perspective.

“It seems over the top to plump your skin up,” she says. “And it makes me wonder, ‘Are you just bored and you’ve done stuff everywhere else, so let’s try the hands?’”

An observation that does seem to beg the question — what’s next?

“Nothing surprises me anymore,” says Beer of Palm Beach. “If somebody in Hollywood starts to talk about getting their elbows done, I guarantee doctors will line up to take the course.”

Diane Mapes is a Seattle freelance writer and author of "How to Date in a Post-Dating World."

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