Friday, 15 March 2013

HAND REJUVENATION- IMCAS review




HAND REJUVENATION

Long regarded as the area that gives a woman's true age away, hands are now in the spotlight as the area to pay particular attention to, now that safe and effective treatment options have become available.

Hands show the ageing process in numerous ways, from thinning of the skin, loss of subcutaneous fat volume, to loss of elasticity, precancerous changes and surface pigmentation.  The nails are another area of much neglect, and complete hand rejuvenation must also address this area.
In Paris there was much discussion on the best way to rejuvenate the hands, with some famous examples of celebrities who have forgotten this area:

Sarah Jessica Parker

Madonna


Home based hand care remains the cornerstone of patient satisfaction, and is essential to address before longterm success can be achieved with clinic treatments.  All consultations at Skin Temple address the use of home care on the skin, and we also offer preventative care for avoiding skin cancers on high risk areas such as the backs of the hands and face.
As far as clinic based procedures are concerned, the options include:

  • Laser or Light based treatments for surface pigmentation  and collagen stimulation
  • Topical cryotherapy or immune modulator creams for precancerous actinic keratoses
  • Fillers and Collagen stimulators for volume loss

At Skin Temple we commonly use our alexandrite based Gentlelase to remove isolated areas of pigmentation on the backs of the hands, or our IPL for more widespread pigmentation problems.  These treatments work incredibly well, but take about two weeks to recover from, and the patient must be very careful to wear sunscreen (and preferably also gloves when driving!) in order to prevent a reaccumulation of pigmentation.

I'm not a big fan of cryotherapy though, having seen many cases of permanent hypopigmentation from this procedure used in general practices and dermatologist offices over the years.  In my opinion, it is much safer and more cosmetically appealing to use an immune modulator such as Aldara or a topical chemotherapy product such as Efudix to treat sunspots (actinic keratoses) or early squamous cell or basal cell carcinomas.  Sometimes these will need to be excised and surgically repaired, which we also do in the clinic.
 
The two most popular options are gel based dermal fillers or collagen stimulators.
Gel based fillers must be soft enough to disperse evenly under the skin, so those with strong lifting capacity (known as G' prime rating *see below for further explanation) are inappropriate in this area.  Even dispersion prevents lumpiness and allows for fewer insertion points and smaller cannulas.  Low G' prime gel based fillers will last up to 12 months, but may only last 6 months in some patients.

Collagen stimulators are currently my favourite method of hand rejuvenation, as some work quickly but with reliable medium term longevity.  Again, some products, when diluted 50:50, have a lower G prime allowing for easy distribution in the upper dermis.  

So please, if you're looking after your facial appearance, don't forget your hands too!




*To quote Dr Leslie Baumann, cosmetic dermatologist in the USA:

"The stiffness or G′ (pronounced G prime) of a product is one of the most important considerations. G′ is a measurement of gel hardness. It is obtained when a gel is placed on a plate. A second plate is placed over the gel and a lateral force is applied. The measurement of resistance to deformation is known as the elastic modulus or the G′. Together with the cohesivity of the product, G′ values could be used to determine the appropriate placement of an XX dermal filler. For example more robust products (higher G′ values and higher cohesivities) such as XXXXXXXX XXXXX XXXX and XXXXXXX®, should be used in deeper lines, such as nasolabial folds and marionette lines, as well as to lift the lateral brow, to correct the nasal bridge, to give the ear lobe youthful volume, to evert the nipples, and to raise the nasal tip. More fluid products such as XXXXXXX XXXXX and XXXXXXXXX® are more suited to be used over large areas such as the cheekbones and cheeks. Low G′ products such as XXXXXXXX® and XXXXXXXX XXXX® are necessary in areas that require a softer agent, such as the body of the lip or the tear trough. As new products reach the market, knowing the G′ will help practitioners match fillers with indications."

Please note that several of the products mentioned by Dr Baumann are not available in Australia (XXXXXXXX XXXX, XXXXXXXX)  whilst other products with much higher G' available in Australia (XXXX**) are not yet available in the USA, nor are some of the lighter G' products commonly used in Australia (XXXXXXXX XXXX**, XXXXXXXX XXXXX**, XXXXXXXX**, XXXXXXXX XXXXXX**, XXXXXXXX XXX XXXXXXX**).

**Apologies to those confused by the products referred to above.  For legal reasons, under Australian law, the TGA has directed all medical practitioners to refrain from using the names of S4 products "unless authorised or required to be made under the Act." Therefore all S4 product names have been censored in this post and replaced with generic Xs.  If a member of the public were to write this blog, it would not be a problem though! Government censorship of educational material on the internet and harassment of cosmetic practitioners is a very real occurrence in Australia today.