The problem of aging hands can be broken down into two parts: aging hand skin and a loss of volume or fullness involving the backside of the hand. The skin is frequently sun damaged, causing the presence of scaling, dry patches, brown spots call solar lentigines, and even precancerous lesions called actinic keratoses. Volume loss is primarily due to thinning of the skin and loss of the fat previously under the skin. The loss of volume can make tendons and veins much more visible.
Treating the skin involves a wide variety of options including chemical peels, retinoids, photodynamic therapy, and lasers. Of course, prevention of sun damage is always a key issue. Paitents should really make of habit of applying sunscreen to the backs of their hands whenever they plan to be outside.
Volume loss can be treated with dermal fillers containing hyaluronic acid (Juvederm and Restylane). Another type of dermal filler that can be used effectively is calcium hydroxylapatite (Radiesse). These treatments are typically done in the office with local anesthesia.
Some plastic surgeons prefer fat transfer when it comes to replacing volume in the hands. Fat is removed from the abdomen, flanks, or thighs by liposuction. The fat is then injected into the backside of the hands using a small blunt cannula. This option can give a more permanent result, but it usually done in the operating room and is thus more expensive.
The best results are typically achieved with a combination of procedures.