Just as there is great demand for surface surgery to eliminate lines and wrinkles associated with aging facial skin, we also receive many requests for treatment of signs of aging hands. As time advances, the hands age in two very characteristic ways. First of all, there is atrophy of the subcutaneous tissue, which allows the veins to stand out in a rather unattractive way. Second, there is a tendency for freckles and other brown spots to develop and continuously increase in number and size.

Recently, fat injections, using the patient’s own fat, have shown promise for filling out the backs of the hands. The fat is removed through liposuction techniques, although little fat is actually required for the procedure. The extraction can be done with a small tube and a syringe under local anesthesia. However, the fat transplantation technique is not entirely permanent, and after several months, some of the fat begins to disappear. There is some evidence that repeated injections may lead to a more permanent result, although this has not yet been proven.

As far as the brown spots, more frequently a concern of patients, standard commercial bleaching creams may be of some temporary help, but rarely are completely satisfactory. Mild chemical peels have been found to be quite effective for this problem. Treatment with Glycolic acid can also be useful in some cases, especially when combined with bleaching agents.

A peel using a salicylic acid paste has been quite useful for rejuvenation of the hands. It is applied and left in place under a protective dressing for 48 hours. Usually, the peel produces moderate discomfort for the first day or so. Pain medicine by mouth is always adequate. On some occasions, the peel is repeated since some skin is resistant to the effect of the chemicals.

Patients can expect a marked decrease in the brown spots, although some of them may remain. It is important to avoid heavy sun exposure to the backs of the hands, as this may lead to a recurrence of the condition. Hand surgery, while not as common as some procedures, answers a demand that has existed for many years. •