Case study

The hands are often the first place to show signs of ageing. Dr Aamer Khan shares a hand–rejuvenation treatment using a collagen–stimulating injectable

Dr Aamer Khan

Dr Aamer Khan is co-founder of Harley Street Skin and has dedicated the past 16 years to performing cosmetic and non-surgical procedures for thousands of patients. He has knowledge in diverse areas including human psychology, psychiatry, surgery and dermatology. Follow him on Instagram: @dr.aamerkhan

Before the Harley Street Hand Lift

The skin on the hands ages much quicker than skin on other areas of the body because it is constantly exposed to the environment (including sunlight), has fewer oil glands, and is continuously stressed by the movements of the hands and regular washing.

Post-menopausal women find that there is an accelerated deterioration in the collagen in their skin (from 1% per year to 1.5% per year) due to lack of oestrogen. As the years go by, crêpey skin, prominent veins and volume loss on the hands reveal our true age faster than any other part of the body. Using injectables can visibly minimise the effects of ageing in the hands. Traditional dermal fillers only address lines, wrinkles and folds, but Ellansé –a collagen-stimulating injectable made from carboxymethyl cellulose (a gel carrier and short-term volumiser), and microspheres of biostimulator polycaprolactone – works beneath the surface of the skin to activate cellular regeneration and stimulate type I collagen production. Ellansé can be injected into the sub-dermal tissues, down to the periosteum.

At my clinic Harley Street Skin, we have created a treatment using Ellansé called the Harley Street Hand Lift. The treatment involves up to 20 micro-injections into the subcutaneous layer of the skin on the backs of the hands. The results are immediate – volume is restored, dilated and bulging veins diminish, and ageing hands look years younger. In the weeks that follow, as fibroblasts and newer collagen are formed, skin quality improves with tighter looking, more youthful skin. Fibroblasts are also found in the subcutaneous fat, and their stimulation also serves to increase the thickness of this layer. The results can last up to three years. 1

Consultation

When treating the hands, it is incumbent upon us as practitioners to consider any differential diagnoses and exclude any other significant pathology, which the patient’s concern may be a presenting complaint for, such as multiple system atrophy, carpal tunnel syndrome, muscular atrophies or dystrophy, other motor nerve problems, inflammatory conditions, such as arthritis, collagen disorder; and fat strophic disorders. Though these conditions are rare, and would have other signs and symptoms, we should be aware of them and be able to refer the patient back to their GP for further assessment if necessary, before treating them. As ever, a lot of clues will be in the patient’s medical history, so it is important to take the time to establish a comprehensive history from them.

After the Harley Street Hand Lift

I initiate a conversation about the ageing process and explain to the patient what impact that has on their hands, and what they can do to slow the process down, improve and preserve things for themselves. This serves to empower the patient. With better knowledge and understanding, it engages them with the whole process of rejuvenation, and allows them to take personal responsibility for part of the treatment and the outcomes. We then discuss the options available, including doing nothing, explaining that any action or treatment carries a risk and outcomes cannot be guaranteed. It is important to discuss not only the benefits but also the limitations of each of the options, including the contraindications.

June, 58, presented with thin, veiny and blotchy hands which looked much older than her face. She hoped to not only improve them but to avoid the psychological discomfort when holding hands with her younger boyfriend. She wanted to rejuvenate her hands as much as possible to reverse the signs of ageing. After the initial consultation and assessment, it was felt that June had been unhappy about her hands ageing since the menopause. This had affected her confidence; she would avoid showing her hands, especially in pictures. Her sense of psychological discomfort was heightened when she met her younger partner, and this was her trigger to seeking help and advice.

Treatment plan

Examination revealed loss of skin elasticity, with dyschromia due to photodamage with early keratoses. There was loss of subcutaneous fat, with increased prominence of the appearance of the veins. There was no other significant medical or psychiatric history, and there were no other conditions that we would be concerned about.

We discussed the options along with their risks, limitations, and benefits, and decided upon a comprehensive regenerative approach treatment including skincare and sun protection for the hands and Ellansé injected sub-dermally to rejuvenate the skin and sub-cutaneous fat layer.

Consideration of peels or IPL for rejuvenation of photo-ageing was considered for a later date if necessary.

A numbing cream was applied to the backs of June’s hands and 15 to 20 injections were administered which covered an area from just above her wrists to the bottom of her fingers.

Results

We saw instant results in June. Her hands looked plumper, more rejuvenated and less wrinkled and her veins were less noticeable. In following up after the treatment, we offered advice on how to maintain the results for longer. Washing our hands all the time and the constant exposure to oil-stripping soap and hot water, along with application of alcohol-based hand sanitisers can make even the sturdiest of hands dry, red and irritated. June was advised to watch her water temperature as hot water can strip the skin of its natural oils, leading to dry, chapped, and cracked skin. I reminded her to opt for washing her hands with soap wherever possible instead of using a handsanitiser gel as it is much kinder to the skin and more effective at actually cleaning the hands, too.

A gentle, unscented soap with hydrating ingredients like glycerine which pulls moisture into the skin is best, as well as ceramides, shea butter and coconut oil. Soothing ingredients such as aloe vera, chamomile and green tea can also decrease any inflammation and irritation. June was also advised to always use a hand cream after washing as it will act as a barrier and help seal in hydration. The skin can absorb the most moisture during the first few minutes after washing your hands. I told her to choose a thick, creamy formula with ingredients like oatmeal (good for soothing itchy skin and eczema) emollients and hydrators. Again, these include glycerin, ceramides, vitamin E and shea butter or hyaluronic acid and help the skin barrier retain its natural moisture. She can also use an intensive hand mask once a week to intensely hydrate the skin.