Body Procedures

Hand Rejuvenation

Also known as hand enhancement

Hands are one of the first places where the telltale signs of aging become apparent. Even if you have taken steps to keep your face and neck looking youthful, sun-damaged, veiny, wrinkled hands can make you look older than you are. There are a number of effective techniques to rejuvenate your hands, improving the quality and texture of your skin, while decreasing the wrinkling and prominent veins.

When to Consider Hand Rejuvenation

• If your hands have prominent veins and tendons because of volume loss
• If your hands are wrinkled and thin
• If your hands have age spots
• If your hands would benefit from improved skin tone and color

Considerations

Pros

• A wide variety of options are available for rejuvenating your hands
• After rejuvenation your hands will be smoother and fuller and your veins will be far less prominent.
• Your hands will have a more youthful appearance

Cons

• Multiple procedures might be required to obtain the best results
• Hands may be swollen, bruised and stiff after treatment, which will limit activity
• If you have a history of impaired healing, such as diabetes, ongoing sun exposure and smoking (or exposure to secondhand smoke) you will see a less dramatic initial result and a shorter lasting result

These are the top three pros and cons to weigh when considering hand rejuvenation. If you want to focus on what is unique to you, please consult with your aesthetic plastic surgeon.

Are you a good candidate for hand rejuvenation?

The following are some common reasons why you may want to consider hand rejuvenation:

• Your hands have prominent veins and tendons because of volume loss
• Your hands are wrinkled and thin
• Your hands have age spots
• Your hands would benefit from improved skin tone and color

If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.

Detailed Procedural Info

Whether you require volume replacement, correction of sun damage or erasure of lines and wrinkles, your surgeon has numerous treatment options to choose from. Most procedures are minimally invasive, but in the case of very loose, wrinkled skin, your plastic surgeon may also recommend surgery to remove excess skin.
Volume replacement to treat protruding bones, tendons or veins:

Fillers (such as polyactic acid or hyaluronic acid)

• The filler is injected into the hand at multiple locations.
• It is placed in layers at multiple levels to reshape and augment the hands.

Fat injections (fat transfer or autologous fat grafting)

• Liposuction with suction tubes (cannulas) is used to remove fatty tissue from areas of your body with excess tissue, such as the abdomen, hips, back or thighs.
• The fat is then processed for fat transfer and re-injected into your hands.
• The fat is grafted in layers at multiple levels to ensure that a smooth, linear deposit of fatty tissue is left to reshape and augment the hands.
• The liposuction incisions are closed with sutures.
• Tape is placed on the skin of the infiltrated areas and left in place for 3 or 4 days as a protective barrier.

If you have poor circulation from vascular disease, diabetes, chemotherapy, HIV/AIDS or smoking you may not get as much of the graft volume to take as other patients.

Sclerotherapy

• Sclerotherapy is effective for medium-sized blood vessels (greater than 3 mm in diameter).
• A solution is injected into the vein with a micro-needle.
• The vein turns white (blanches) and gradually disappears.
• There is little if any discomfort when undergoing treatment and there is no downtime.

Laser vein treatment

• Laser treatment is typically used to treat small to medium-sized blood vessels (1-3 mm in diameter).
• A handpiece is passed over your skin and the laser light is absorbed by the blood, causing the vessels to coagulate and be absorbed by the body.
• There is little downtime.

Treatment for fine lines, wrinkles, discoloration, sun damage, or irregular pigmentation

Intense pulsed light (IPL) and photodynamic therapy (PDT)

• Your eyes will be covered for protection.
• The IPL hand piece is placed directly over the treatment area and light waves are emitted.
• After a series of treatments, the spots and discolorations on your hands will be begin to fade and disappear.
• PDT uses a solution on the skin before applying the IPL device which allows for more aggressive treatment.
• Recovery from IPL is similar to recovering from a mild sunburn.

Laser skin resurfacing

• Your eyes will be covered so that your corneas and retinas are protected from the laser.
• A wand is passed over your skin and the resurfacing laser emits a very brief pulse of high intensity light that damages the upper layers of your skin.
• As your skin heals, healthier, younger looking tissue emerges.

Treatment for very loose and wrinkled skin

Skin excision

• You will either have general anesthesia or local anesthesia with sedation.
• Your surgeon will generally make an incision on the top of the hand by the wrist and remove loose skin, then suture back together.
• Some swelling and pain is to be expected afterwards and can be managed by medication.

What are my options?

Some of the available options for hand rejuvenation are outlined below. These can be used alone or in combination to enhance the overall results. Your surgeon will recommend an approach based upon your treatment needs and aesthetic goals.

• Autologous fat grafting(also known as fat transfer) re-injects your own natural fatty tissue into your hands to add volume, cover underlying vessels and tendons, and improve the quality of your skin over time. It is important to note that if you have poor circulation from vascular disease, diabetes, chemotherapy, HIV/AIDS and smoking you may not get as much of the graft volume to take as other patients.
• Fillers, such as polyactic acid or hyaluronic acid, can be used to add volume to your hands and fill in around protruding bones and veins.
• Intense pulsed light (IPL), or laser skin resurfacing may be used to treat fine wrinkles, skin discoloration, sun damage or age spots.
• Photodynamic therapy (PDT)uses a solution with IPL for more aggressive treatment of irregular pigmentation or brown spots.
• Sclerotherapy or laser vein treatmentscan treat noticeable or protruding veins.
• Skin excisionto remove loose, excess skin on the hands.

Many of these procedures require multiple treatments to give you the best result. You should allow time between treatments to permit swelling and bruising to dissipate.

What will my hand rejuvenation incisions and scars be like?

If you have fat injections, the liposuction incisions to obtain the fat are very small and just large enough to allow the suction tube, or cannula, to go under the skin and remove the fat. The incisions used for injecting the fat into the hand regions are equally small. If there was loose skin that was removed surgically, the scars are on the top of the wrist and can be hidden by a watch or bracelet.

Selecting a Surgeon

It’s important to choose your surgeon based on:

• Education, training, and certification
• Experience with hand rejuventation
• Your comfort level with him or her

After finding a board-certified plastic surgeon in your area who is experienced in performing hand rejuventation, you will need to make an office appointment to set up your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit.

Your initial consultation appointment

During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Your surgeon will evaluate you as a candidate for hand rejuvenation and clarify what hand rejuvenation can do for you. Understanding your goals and medical condition, both alternative and additional treatments may be considered.

You should come to the consultation prepared to discuss your complete medical history. This will include information about:

• Previous surgeries
• Past and present medical conditions
• Allergies and current medications

Your treatment plan

Based on your goals, physical characteristics and the surgeon’s training and experience, your surgeon will share recommendations and information with you, including:

• An approach to your treatment, including the type of procedure or combination of procedures
• The outcomes that you can anticipate
• Your financial investment for the procedure
• Associated risks and complications
• Options for anesthesia and treatment location
• What you need to prepare for your procedure
• What you can expect to experience after treatment
• Show before and after photos of cases similar to yours and answer any questions, so you can make the most informed and intelligent decision

Questions to ask your aesthetic plastic surgeon

For a general list of questions to ask your surgeon about his or her background, find out about plastic surgery safety and to plan your procedure. We developed these questions to help you:

• Make the most informed and intelligent decisions about your procedure
• Confirm that you have the right surgeon for your procedure
• Make your initial consultation as rewarding as possible
• Understand your options, potential outcomes, and risks

It is important for you to take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation.

• Am I a good candidate for hand rejuvenation?
• Are the results I am seeking reasonable and realistic?
• Do you have before-and-after photos I can look at for the procedure I am undergoing?
• Will I have any scars from this treatment If so, will the scars be visible and where will they be located?
• What kind of anesthesia do you recommend for me?
• What will be the costs associated with my procedure?
• What will you expect of me to get the best results?
• What kind of recovery period can I expect, and when can I resume normal activities?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if the cosmetic outcome of my surgery does not meet the goals we agreed on?

Preparing for Your Procedure

Your surgeon will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history, and perform a physical exam to determine your fitness for surgery. If you are having laser skin resurfacing or a chemical peel, you may be placed on a pretreatment program during which you will apply special creams, lotions or gels to your skin for a few weeks or longer. You may also be given certain oral medications that you should begin taking prior to your treatment.

In advance of your procedure, your surgeon will ask you to:

• Stop smoking at least six weeks before undergoing surgery to promote better healing
• Avoid taking aspirin, certain anti-inflammatory drugs, and some herbal medications can cause increased bleeding
• Avoid unprotected sun exposure. Too much sun up to 2 months before the procedure can cause permanent irregular pigmentation in the treated areas. Discuss sun protection and acceptable sun exposure with your doctor.
• Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.

Hand rejuvenation is usually performed on an outpatient basis. Be sure to arrange for someone to drive you home after surgery and to stay with you if needed for at least the first night following surgery.

What can I expect on the day of hand rejuvenation surgery?

Your hand rejuvenation surgery may be performed in an accredited hospital, free-standing ambulatory facility, or office-based surgical suite. Most hand rejuvenation procedures take at least thirty minutes to two hours to complete but may take longer.

• Medications are administered for your comfort during the surgical procedure.
• Local anesthesia or intravenous sedation may be used depending on your situation.
• For your safety during the procedure, various monitors may be used to check your heart, blood pressure, pulse, and the amount of oxygen circulating in your blood.
• Your surgeon will follow the treatment plan discussed with you before treatment.
• After your procedure is completed, you will be taken into a recovery area where you will continue to be closely monitored. After fat transfer you may have tape placed on the skin of the infiltrated areas that is left in place for 3 or 4 days as a protective barrier.

You will probably be permitted to go home after a short observation period unless you and your plastic surgeon have made other plans for your immediate postoperative recovery.

Aftercare and Recovery

Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your postsurgical care, including information about:

• Normal symptoms you will experience
• Potential signs of complication

Immediately after hand rejuvenation

Immediately after surgery your hands will be bruised, swollen, and stiff. If you had fat grafting, the donor site for fat harvesting may be sore and bruised as well. Your surgeon may recommend that you apply ice to your hands, stay out of the sun, and keep your hands clean.

When the anesthesia wears off, you may have some pain. Contact your surgeon to find out if your pain, bruising and swelling are normal or a sign of a problem.

Recovery time frame after hand rejuvenation

It is vitally important that you follow all patient care instructions provided by your surgeon. This will include information about wearing compression garments, taking an antibiotic if prescribed and the level and type of activity that is safe. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals. Depending on the procedure, you can usually regain normal activities within hours or several days.

The first two weeks

• Bruising, stiffness, and swelling gradually disappear
• Hands appear more youthful, filled-out and smooth, with little or no brown spots or veins

Week two to eight

• Your skin may still be pink
• Your skin tones will begin to blend naturally without depigmentation
• If you had a more superficial treatment your surgeon may recommend a repeat procedure to enhance your results

How Long Will the Results Last?

Temporary fillers usually last from three months to one year. Fat grafts are usually long-lasting. Injections may be repeated when necessary. Results of skin tightening will depend on the type of treatment used. Patients with a history of impaired healing, such as diabetes, ongoing sun exposure, and smoking (or exposure to secondhand smoke) will see a less dramatic initial result and a shorter lasting result.

To help prolong your hand rejuvenation results it is important to avoid sun exposure and to take precautions such as wearing gloves and regularly applying moisturizer.

Maintain a relationship with your aesthetic plastic surgeon

For safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you notice any changes in your hands. Do not hesitate to contact your surgeon when you have any questions or concerns.

Associated Costs

The cost of hand rejuvenation varies from doctor to doctor and from one geographic area to another.

Because hand rejuvenation is an elective procedure, insurance does not cover these costs. Many surgeons offer patient financing plans to make the procedure more affordable.

Choose your surgeon based on quality, training, and experience—not cost.

Limitations and Risks

Fortunately, significant complications from hand rejuvenation are infrequent. Your specific risks for hand rejuvenation will be discussed during your consultation.

All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:

• Adverse reaction to anesthesia
• Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
• Infection and bleeding
• Changes in sensation
• Scarring
• Allergic reactions
• Damage to underlying structures
• Unsatisfactory results that may necessitate additional procedures

Other risks specific to hand rejuvenation are outlined below:

• Slow healing due to tension or excess stretching
• Abnormal healing and/or unanticipated color changes or skin blotchiness from chemical peels
• Fat reabsorption

You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your hand rejuvenation surgery.

Click to View Content Source >