An old adage says, If you really want to know a woman’s age, don’t look at her face—look at her hands.

It’s true. While many women treat their face with an array of surgical and nonsurgical procedures and products designed to keep things plump, smooth and glowing, the hands often are left to the elements. Sun damage and age leave the hands with telltale dark spots, visible veins and thinning skin.

However, there are things that can be done to improve the appearance of hands, as well as that of another area that reveals aging skin, the décolleté, which is the skin below the neck and above the breasts, often revealed by plunging necklines.

To minimize the appearance of veins in the hands, which become more pronounced due to a loss of fat, some plastic surgeons offer fat-transfer procedures, in which excess fat is removed from another area—often the thighs or buttocks—purified, and injected into the hands to provide volume. “Also, fillers are being used to do the same thing,” says Dr. Charles Nathan of Parkcrest Plastic Surgery. “The fillers are temporary, while the fat injections are more long-lasting.”

Surgery is not the first choice for creating more youthful-looking hands. “There are some skin-tightening procedures where people excise skin and then close it to tighten up the hand skin, but it’s at the expense of leaving some thin but permanent scars on the hand. More people we see want to have a more full, volumized look, and that’s where the fillers come in.” Nathan notes that surgeons who do remove skin from the back of the hand often combine the technique with fat or filler injections.

Dermal fillers, used for years to help camouflage deep facial lines, come in a variety of formulas. Plastic surgeons and dermatologists choose the more appropriate filler based on the patient’s needs, tending to use thicker fillers for deeper, more pronounced creases and more viscous formulas for finer lines. “Probably the one we’ve used most commonly in the hands is Radiesse, although I do have Artefill in my left hand and not my right hand, and I can hold them up five years later and see a fairly significant difference,” says Dr. Richard Moore, medical director of The Lifestyle Center.

Moore notes that the technique used to add filler to hands involves massaging the product that has been injected in order to distribute it evenly, which may result in some temporary swelling.

“For chest and neck areas, the old standby has been aggressive skin care, peels of various types and very light lasering,” Nathan says. “We don’t typically excise skin from that area because of the scarring that can occur.”

This area typically develops a leathery, deep wrinkly appearance. Nathan notes that there are skin-care products made specifically for the décolleté area, along with more aggressive peels.

Yet the most effective way to deal with wrinkles anywhere is to prevent them, and that comes down to good skin care and sun protection. Sunscreen year-round is a must on the hands, neck and décolleté, as well as on the face. Physician-directed skin care and prescription products, such as Retin A, help encourage new cell turnover and collagen production.

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