Thursday, April 26, 2018

Old-looking hands and what you can do about them

If you really want to hide your age, hide your hands. • Hands are often forgotten when it comes to anti-aging prevention measures and cosmetic treatments. You dye your hair, spend big bucks on Fountain of Youth skin creams for your face, and dip into savings to have Botox injections and lifts for the eyelids and jowls. • But most of us — okay, it's primarily women — forget about our hands, which, experts agree, will say more about your age than your hair, face and neck. • Here are some things to know about hands:

Age giveaway No. 1

Prominent bones and veins on the backs of your hands.

As you age, your hands lose fat and volume. The skin also thins and seems to cling tightly to bones and blood vessels, making the vessels look even more blue. Heavy makeup can cover the blue. But, other than gloves, what can you do for that bony appearance?

Treatment: More women are opting for fillers. Paula Knaus, associate dean of faculty affairs at the USF College of Public Health, is one of them. The 66-year-old former sun worshiper had been getting rejuvenating facial treatments for years, and decided she wanted her hands to match the youthful appearance of her face.

"I had one treatment. I just wanted a little improvement to make me feel better about myself," said Knaus, who had the injections about a year and a half ago. "I noticed an improvement immediately. It's a subtle difference. I don't look 16, but I don't want to look fake either. Now my hands look smoother."

The synthetic filler is injected under the skin to plump up the areas around the bones and blood vessels. It takes five to 10 minutes in the doctor's office and costs about $1,200.

Another option gaining popularity is fat transfers. Fat cells, usually from the patient's own thighs or buttocks, are removed by liposuction, cleansed, processed and then injected into the hands. Fat removal takes 10 to 15 minutes; injecting the fat takes between five and 20 minutes. It's all done in the doctor's office, and the cost varies from several hundred dollars to several thousand dollars, depending on where you live and the extent of treatment.

Age giveaway No. 2

Liver spots or age spots are a hallmark of aging hands.

These dark brown marks, some as big as a quarter, show up because the backs of our hands tend to get lots of sun. Age spots can show up as early as your 30s if you've been a longtime sun worshiper, but they are more common starting in the 50s. In addition to the hands, these spots also may appear on the face, chest, back and the tops of feet. They are most common in people who sunburn easily. They become more numerous with age and may run in families.

Treatment: Some over-the-counter topical creams will fade age spots over several months, making them less obvious. Look for products that contain hydroquinone and/or retinoids or tretinoin. Your doctor can prescribe stronger creams that will be more effective and cost between $50 and $200.

For more dramatic results, look into Intense Pulsed Light or IPL therapy. This treatment destroys the color or melanin-producing cells without damaging the skin's surface. You may need just two treatments or as many as six, depending on your skin and the number and size of the age spots. The cost is about $125 per treatment.

Cryotherapy, or freezing with liquid nitrogen, also is sometimes used to destroy the pigment in age spots. But there is a risk of permanent scarring or discoloration. The cost varies from $500 to $900 per session.

Dermabrasion, which is like sanding the skin, is another option. It removes the discolored surface so a new layer of skin can grow in its place. The cost can range from $50 to several hundred dollars depending on the extent of treatment.

Chemical peels have a similar effect. Acid is used to burn off the outer layer of skin which, after a few days, peels off so new skin can form in its place. It usually takes several treatments to notice results and there is a risk of permanent changes in skin color. The cost varies according to the type of peel and strength used, but runs about $100 per session.

Least expensive is prevention. Use a 30 SPF sunscreen every day. Keep a sample size bottle in your purse and car, and reapply when you're headed out in daylight. Because sun damage is cumulative, start protecting your hands early in life to prevent problems in your 30s, 40s and 50s.

"Women take great care protecting their face from sun exposure. They will use sunscreen on the face," said Dr. Neil Fenske, professor and chairman of the Department of Dermatology and Cutaneous Surgery and director of the Cosmetic and Laser Center at USF Health. "But they forget their hands. And, if you're not caring for the skin on your hands, you're not hiding anything."

Age giveaway No. 3

Seborrheic keratosis, the brown, black or tan growths that look like a mole.

As you age, they can pop up on the backs of your hands, but they are also common on the face, chest, shoulders and back. Sebs, as doctors call them, are slightly elevated and may look scaly and wartlike or smooth like a drop of brown wax. They aren't cancerous or contagious and they don't have to be removed unless they bother you.

These growths seem to run in families, so if your mom, dad, sister or brother has them, you may get them, too. According to the American Academy of Dermatology, doctors are still trying to figure out what causes sebs but think they may be linked to sun exposure. However, they also appear on skin that is usually covered, so more research is needed.

Treatment: If they bother you, sebs can be removed using cryotherapy. They will fall off in a few days. The cost for hands usually runs $25 to $100 per session.

They also can be treated with electrosurgery, which involves anesthetizing the area and applying an electric current that destroys the growths. Sometimes doctors will need to scrape off the growths after they've been treated with electrosurgery. The cost can range from several hundred dollars to several thousand dollars.

Other features of aging hands

Excessive bruising: As you age, it seems every little bump, even on your hands, makes a big bruise. Unfortunately, there's not much that can be done about that, short of covering up with heavy makeup or channeling Madonna and wearing half gloves in public.

A crinkled, parchment paper-like appearance: Again, sun exposure is largely to blame. Cosmetics can help, as can topical creams containing antioxidant vitamins including A, C and E.

Vertical ridges on your fingernails: Talk to your doctor about taking a biotin supplement.

The cost of treatment

If you are a candidate for multiple sessions of any of these therapies, treatment can be expensive. Insurance companies don't usually cover the cost of cosmetic procedures, so experts warn you should choose your practitioner carefully.

There are times in life when it's good to cut corners, but not when it comes to your hands, said Dr. James Spencer, medical director of Spencer Dermatology in St. Petersburg and professor of clinical dermatology at Mount Sinai School of Medicine in New York City.

"Working on the hands can be tricky, especially when you're using fillers," he said. "You want someone with a lot of experience and special training to provide your treatment."

He recommends going with a board-certified dermatologist, dermatologic surgeon or board-certified plastic surgeon.

Contact Irene Maher at [email protected]

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