The First FDA-Approved Filler for Hands Gives Mind-Blowing Results
I could have been a concert pianist. Even when I was young and my hands still had dimples, I was told that my long fingers were made to fly over piano keys, the way a gull’s outstretched wings are made to ride a current of air. But my fingers are vexingly slow. They lack the speed and dexterity to finely chop an onion, much less master Chopin (or even "Chopsticks"). Still, the idea that my hands had an air of virtuosity and untold potential made me a little vain about them — confident to the point of being unconcerned. I've never lavished attention on my hands. I can count on just one of them the number of salon manicures I've had. I don't even wear my wedding ring because the plain, polished band feels too heavy and obtrusive. While I've subjected all other aspects of my appearance to intense scrutiny, my hands have escaped it. I simply let them… be. And that allowed me to inch toward an understanding of what it meant to feel beautiful. We're told that beauty is about subtraction; to pour effort into it is to take away from it. My hands brought this hazy concept into high relief. Looking at them, I saw nothing to criticize, nothing to worry about, nothing to improve.
Now that I’ve reached the age of, say, a rather young president, I still think my hands are doing just fine. But my editor has sent me on a mission to investigate all the ways that our hands (and our impressions of them) shape-shift over time. So today, I’m sitting in dermatologist Ranella Hirsch’s Cambridge, Massachusetts, office. My hands are balanced over her palms in straight, parallel lines, like a pair of skis. She passes her thumbs over the backs of them, following the taut path of a tendon here, the blue branch of a blood vessel there. I feel anxious, as though I’m about to have my past divined and my fortune told. In a way, I am.
"Hands suggest so much," says Hirsch, while studying mine. "As a dermatologist, I can look at a patient's fingernails and know if they have a nervous tic. I can often tell if they're pregnant. Even just socially, think of how you react when you shake a person's hand for the first time and it's very rough and calloused."
I think. It's true. Our hands telegraph messages about our health, professions or pastimes, and relationship status (they’re sort of the original Facebook). But perhaps the most obvious signal is age — and that hardly requires the trained eye of a dermatologist to pick up on. "There are certain things we immediately identify as 'old,'" Hirsch says. "Bony, ropy hands are one of them."
Hands suggest so much [about a person].
Unfortunately, hands often display signs of aging more prematurely than any other body part, because they’ve been served a double disadvantage. The skin on the backs of our hands is as fragile as the skin under our eyes, says Hirsch, plus it’s exposed to regular abuse (name another appendage that you use to handle dirty dishes, furniture stain, and dumbbells). And our mania for technology is only heightening that wear and tear.
"We're exposing our hands to the elements more than ever because we're on our phones wherever we go," says Hirsch. "I see people dressed for winter in Boston, but they aren't wearing gloves, because they're busy texting."
These biological and environmental factors combine to speed up collagen loss. The result is bulgy, more prominent blood vessels and tendons — the twin flags of faded youth. Given the vulnerable nature of our hands, we've become almost fatalistic in accepting their early, inevitable decline. While we aggressively tackle fine lines, sun damage, and droop elsewhere on our bodies, we seem to believe that the state of our hands is, well, out of our hands.
"A lot of patients really want to rejuvenate their hands but don't even know to ask," says Doris Day, a clinical associate professor of dermatology at NYU Langone Medical Center in New York City. "They aren't aware they have options."
We're exposing our hands to the elements more than ever because we’re on our phones wherever we go.
That lack of awareness is poised to change now that a hyaluronic acid filler has been FDA-approved to treat hands. Sure, dermatologists and plastic surgeons have been using fillers to return youthful plumpness to hands for years, but there was only one option that wasn't off-label — Radiesse, which consists of calcium hydroxylapatite suspended in an aqueous gel. Restylane Lyft (formerly known as Perlane) is the first hyaluronic acid filler to be evaluated and approved by the FDA for use on the hands (or, for that matter, any area other than the face).
"We're talking about a dramatic improvement in a relatively short period of time, and results that make people very, very happy," says Hirsch. If they can afford them. A single syringe can cost upward of $750 (one is often sufficient to treat both hands, depending on the level of tissue loss), and results typically last from six months to a year.
But fillers in this area aren't without risks — the anatomy of the hands is complex, says Hirsch, and poor placement of the needle could cause serious complications, including scarring and necrosis. That's why you should only go to board-certified dermatologists and plastic surgeons for this or any kind of injectable (you can confirm the board certification of any doctor with the American Board of Medical Specialties at abms.org).
To improve the tone and texture of the hands, there are less-invasive — and surprisingly effective — fixes. Creams, serums, and masks containing gold-standard active ingredients, such as retinoids, hydroquinone, alpha hydroxy acids, and fruit enzymes, can significantly brighten skin, balance pigment production, and boost cell turnover.
For more extensive sun damage, in-office treatments, like lasers, intense pulsed light therapy, and professional-strength chemical peels, make the biggest difference. While there’s no one-size-fits-all remedy, new tools are making it easier than ever to tailor an approach. Newer picosecond lasers allow doctors to precisely control the wavelength and density of the energy being delivered, making it possible to target speckling on darker skin tones — a practice that was considered risky just a few years ago.
With my own hands still outstretched, I ask Hirsch if there’s anything else patients should be aware of. “When you find a doctor you trust who’s good at what they do, watch out,” she says. “Why?” I ask warily, anticipating another health-risk warning. “Because our hands are tied to so much emotional stuff,” she says. “Everyone has a hand story — you don’t always want to erase it. Mine is about my mom, who has the most beautiful, delicate hands. We have a lot more associations with our hands than we give them credit for.”
Wow, I think. She’s right. I look at my hands, and for the first time, I begin to see more. Memories start circling. An image of my grandmother flashes into my mind, the time when she made us turn the car around because she had left her wedding ring in a porcelain dish on top of the dresser. With a pang, I recall the way my infant sons used to wrap their tiny hands around my finger; I marveled at how so small and helpless a gesture could also be the most unbreakable. And I realize, a little late to the game, that beauty is based not on subtraction, but reflection. At its deepest and most powerful, it represents a memory, an attitude, a history, a relationship, a sacred, vanished moment. I’m still no concert pianist, but I’ve composed a symphony of life experiences. We all have. And it’s written between the hollows and prominences of our hands.
Hirsch completes her assessment. My tendons protrude a little, but not in a pronounced way. She wouldn’t recommend filler for me. In her medical opinion, I should consider a “flutter of a sleeve” to offset the bony knobs on each of my wrists, and a more rounded shape to my nails to soften the look of my long, slender fingers. And of course, sunscreen, sunscreen, sunscreen. I go home and dutifully apply SPF in addition to my everyday hand lotion. And then I slip on my wedding ring. It’s a nice change of pace. But I wouldn’t change another thing.
Back-Handed: Masks and serums made for your hands.
BeautyBio Upper Hand Brightening Hand Crepe Correctors: The sheet-mask model (these are small and round) traps brightening licorice root and vitamin C on skin for a 20-minute treatment.
Susanne Kaufmann Hand Peel and Hand Serum: This azure-colored, gently gritty hand treatment sloughs off dull skin cells with plant-derived cellulose beads. The serum combines a protective antioxidant with hydrating hyaluronic acid.
Tenoverten The Rose Oil Nourishing Cuticle Oil: A pampering blend of jojoba oil (so it sinks in quickly) and emollient vitamin E, rose flower oil, and pomegranate oil. Super soothing on frayed cuticles and on chapped knuckles.
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