| HAND REJUVENATION | PEER-REVIEW The field of non-surgical
skin rejuvenation continues to gain popularity as the ability to attain cosmetic
enhancement with minimal risk and rapid recovery increases.
ABSTRACT Throughout a person’s lifetime, the face and hands receive the most sunlight exposure, and therefore show the most photodamage in the form of dyspigmentation, texture changes, wrinkles, and loss of volume. Although current aesthetic dermatologic treatments primarily target the face, rejuvenation of the hands to treat photoageing is also an important consideration. Inherent tissue properties of the hand make it challenging to safely and effectively improve pigmentation, wrinkles and texture with a single device. Technology has evolved from painful procedures that required significant downtime to non-painful, non-invasive procedures with no downtime and effective results.
Specifically,
appearance of lentigines, actinic keratoses and seborrhoeic keratoses emerge. There is an overall decrease in the quality and quantity of collagen and elastin in the dermis, as well as an increase in bruising, as a result of ultraviolet light damage to capillaries2
S . light and radiofrequency-based technologies
continue to be implemented and improved on to achieve the optimum degree of photorejuvenation for the aesthetic patient.
KIN IS COMPOSED OF A NETWORK OF collagen and elastic fibres, which determines its firmness and elasticity. As a person ages, this network loosens and begins to alter the appearance and function of the skin1
. The epidermis thins and the .
Approximately 1% of dermal collagen in adult skin is lost each year owing to an increase in collagen degradation and a decrease in collagen synthesis1
There are both extrinsic and intrinsic factors involved
in the ageing process of the skin. Intrinsic changes are genetically predetermined and occur as a natural result of ageing, while extrinsic factors are controllable and
Treatment considerations The anatomy of the skin on the dorsal hand differs from that of facial skin and must be addressed accordingly. The dermis is thinner on the dorsum of the hand than it is on the face, and there are fewer adnexal structures, such as pilosebaceous units and superficial dermal vessels4, 7, 8
. During the course of the healing process,
pigmentary changes occur more frequently because the hands have less capacity to replace the epidermis2 Clinically, the hands tend to show more significant
.
photoageing owing to inconsistent and inadequate sunscreen use, as compared to the face9
. Inherent
KEYWORDS laser, radiofrequency, hand rejuvenation, photoageing, photodamage
prime-journal.com | October 2013 ❚
include sun exposure, pollution and smoking, as well as movements over time and lifestyle components like nutrition, sleep position and a patient’s overall health3 The appearance of the hands can often reveal a
.
person’s true age, especially if it does not correspond with a younger-looking face4, 5
. The clinical manifestations
of the ageing hand are based on the pathophysiology of the epidermis, dermis and subcutaneous tissues. The epidermal components present as pigmentary changes, such as lentigines and ephelides, as well as generalised hyperpigmentation. Skin roughness can occur as a result of irregular epidermal contours and abnormalities in cell proliferation and turnover. Dermal components involving structural changes in collagen, elastin and glycosaminoglycans are expressed as wrinkles. Alterations to the deeper structures, including the subcutaneous tissue, muscle and bone, may result in skin laxity, volume loss and prominent veins6
.
MARK S. NESTOR, MD, PHD, is Voluntary Associate Professor, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, and Director of the Center for Clinical and Cosmetic Research and the Center for Cosmetic Enhancement, Aventura, Florida; and JESSICA NEWBURGER, DO, is Dermatology Fellow at The Center for Clinical and Cosmetic Research, Aventura, Florida
email:
nestormd@admcorp.com
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