Peels, Lasers and Photorejuvenation Can Get the Job Done

by Heather E. Endicott, NP

Today's aesthetic therapies can take years off the face. But the hands often tell the truth about a woman's real age. Hand rejuvenation can change that.

Topical Therapy

Topical therapy is noninvasive and appropriate for most skin types. This therapy speeds cellular turnover of the stratum corneum, a process that gradually thickens the epidermis and dermis through the stimulatory effects of keratinocytes and fibroblast production. Pigment lightening occurs when melanin granules disperse and epidermal turnover increases. This reduces the time necessary for keratinocytes to acquire pigment.¹

Skin improvements with topical therapy are subtle, and patients must use them consistently to maintain results.

Chemical Peels

Chemical peels can improve the appearance of photoaged skin by diminishing the cohesion of skin cells. A chemical peel produces a controlled injury to the skin. These peels can strip off the superficial layers of the stratum corneum or penetrate deeper into the skin. The epidermis regenerates from surrounding epithelium and adnexal structures. When the layer is sloughed off, wound healing results in the production of new epidermal cells and new dermal collagen. Wrinkles decrease and pigmentation improves.

When it comes to the hands, chemical peels are best confined to in-office superficial peels only to the papillary dermis.

Lasers

Using lasers to treat solar lentigines is safe, affordable and effective. In many cases, only one or two treatments are required. By choosing an appropriate wavelength, pulse duration and fluence, we can confine thermal injury (selective photothermolysis) to the pigment in the melanosomes of the epidermis layer.

Strong absorption of light at ideal wavelengths selectively destroys the melanocytes and avoids hemoglobin absorption. Q-switched lasers offer the shortest pulse duration (nanoseconds), but picoseconds are in development. The short-pulse duration combined with Q-switched wavelengths are optimal for treating lentigines on the hands.

Ablative Lasers

Ablative resurfacing of the hands requires caution. Laser resurfacing vaporizes layers of the epidermis, improving dyspigmentation when confined to the epidermal lesions.

Ablative lasers can permanently injure the adnexal structures when thermal injury extends to the dermal layer. As with chemical peels, the low density of adnexal structures and thinness of the skin on the hands limit the ability of the dermis to repopulate the surrounding tissue. Complications may include postinflammatory hyperpigmentation, hypopigmentation, infection and scarring.²

Photorejuvenation

Intense pulsed light (IPL) can provide noninvasive photorejuvenation. Using a broadband noncoherent light, IPL emits polychromatic light in a broad wavelength spectrum. Cutoff filters enable you to target specific absorption spectrums. With the broad wavelength spectrum, we can selectively treat targets of varying absorption spectra, such as deoxyhemoglobin and melanin or vessels with hemoglobin. The IPL pulse duration is in the millisecond range and is longer than the thermal relaxation time of the melanosomes. Although milliseconds are not the ideal pulse duration, improvements in photoaging, telangiectasia and lentigines of the hands are achievable.

The deeper penetrating wavelengths of IPL can also heat dermal collagen, inducing collagenases and improving skin appearance. These treatments are quick and not painful. Multiple treatments – three to five, spaced 1 month apart – improve the appearance of photodamaged skin.

Sclerotherapy

Sclerotherapy is often the treatment of choice for pronounced hand varicosities. In one study, researchers successfully treated the veins in 14 hands with sodium tetradecyl sulphate (90% to 100% clearance in one to two treatments).³ This sclerocent is preferred to saline because it is safe and produces little discomfort.

Fat Augmentation and Fillers

Fat augmentation and fillers are effective approaches to volume loss in the hands, a condition that makes hands appear "skeletal." Fat augmentation requires harvesting, processing and injecting the fat. Fat is ideally taken from the hips, outer thighs or medial knees (these sites offer dense, bloodless fat content), but no studies have determined optimal harvest sites. The fat is then centrifuged and injected into the hands.

A single treatment makes hands look fuller and more youthful. This procedure is time consuming, but the results can last for years.⁴ Fillers also can be used to treat volume loss in the hands, but results are more temporary. NP

References

1. Butterwick KJ. Treatment options for rejuvenating aging hands. Cosmetic Dermatology. 2006;19(3):199-204.

2. Butterwick KJ. Rejuvenation of the aging hand. Dermatol Clin. 2005;23(3):515-527.

3. Bowes LE, Golman MP. Sclerotherapy of reticular and telangiectatic veins of the face, hands, and chest. Dermatol Surg. 2002;28(1):46-51.

4. Butterwick KJ. Lipoaugmentation for aging hands: a comparison of the longevity and aesthetic results of centrifuged versus noncentrifuged fat. Dermatol Surg. 2002;28(11):987-991.

Heather Endicott is a family nurse practitioner who practices at La Jolla SpaMD in San Diego. Reach her at hendicott@spa-md.com.

New Approaches for Aging Hands