Dr Sach Mohan
07/10/2010 15:10 | By Dr Sach Mohan, columnist, MSN Life & Style

Ask the expert: ageing hands

I have hands like Madonna. Help! J Gill, via email


A close-up of Madonn's hand (© Getty)

Funny you should be asking that! The first thing I asked my friends that were out partying with Madonna at Aura in Mayfair a fortnight ago, was whether she was wearing gloves or not and how her hands looked. Well, the news was that she wasn't covering her hands, but it was too dark in the club to really be able to get a good view! However, paparazzi shots of her leaving the club revealed her hands were on show and they certainly look a lot better than they did a few years ago.

There has been much hype about what treatment Madge's New York Physician adopted for helping her hands, ranging from microdermabrasion, which helps improve the skin, to sclerotherapy, which shrinks the veins.

The backs of the hand actually take quite a battering over the years, and like the face, can show the ravages of time prematurely. A combination of sun exposure and intrinsic ageing causes a loss of cutaneous collagen, which leads to the formation of dry crêpey skin with a decrease in elasticity. There also may be sun spots in lighter skin types.

As we lose muscle mass and subcutaneous tissue volume, this causes the deeper tendons and veins to become more prominent and give quite an unsightly look. When the individual is quite lean - such as the Material Girl, there is very little fat deposited within the hand to buffer and hide these structural changes.

Therefore, any treatment plan requires the practitioner to really assess the skin to see which changes are present in the hands. Let's work our way up from deep to the surface:

Prominent tendons and veins

This has to be one treatment that never fails to impress and is one of the favourites within my practice. Using a dermal filler, called Radiesse, the practitioner pinches the skin on the back of the hand to lift the skin up and, in one injection, the contents of the syringe are deposited into the back of the hand. The product is then distributed around by massage. Over a six week period, the filler biodegrades and microscopic calcium crystals then act as a source of new collagen production that can last up to 18 months. The Radiesse softens the appearance of the veins and tendons and gives the hand a healthier appearance. Anticipate the hands to look slightly swollen for a fortnight as it all settles (treatment usually costs around £800-£1,000).

The reported use of sclerotherapy injections into visible veins to help them shrink and disappear is something that I would advise with caution in healthy functioning veins. Those familiar with this very effective procedure for thread veins on the legs are advised that the veins often look a lot worse for a few weeks, and it can carry risks such as staining of the skin which can persist for months (treatments from £150).

Where the hand doesn't require any volumisation, but there is evidence of dehydration and crêpiness within the skin itself, then the industry favours a range of moisturising Hyaluronic Acid injections. The brands that are marketed for such indications are Restylane Vital and the recently launched Juvederm Hydrate. This requires a series of around four sessions done a few weeks apart, and results are mild to moderate improvement (from £200 per session, transforminglives.co.uk).

Sun-damaged skin

Now, in order to lift out the pigmentation caused by sun exposure, there are a couple of options available. The first is Intense Pulse Light (IPL) which uses a broadband light to heat up and disrupt the pigment, which is then naturally degraded and exfoliated over a fortnight. It's a very effective treatment that can require two to three sessions. The setback to this treatment is that it is unsuitable for darker skin types. The alternative is the Genuine Dermaroller, a treatment which has gained immense popularity (genuinedermaroller.co.uk), which uses micro needles to stimulate and harness the natural regenerative abilities of the skin. With the right skin product regime, it can give results on par with IPL. However, the Dermaroller's key strength is that it is far superior at regenerating collagen within the skin (to the point where it can address certain scars) with relatively little downtime (both treatments, from £200-£250 per session).

Whatever route your practitioner advises, don't be surprised when they recommend a combination of the options mentioned, as IPL or Dermaroller can be used with Radiesse, Vital or Hydrate for a comprehensive treatment package. You will see the best results after 12 weeks - invest in a really good SPF to protect your investment!

Until next time,

Dr Sach x

Dr Sach Mohan is one of the UK's most sought-after cosmetic physicians. For more information email info@revereclinics.com  or visit the website revereclinics.com

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