THE HANDS OF TIME

Plastic surgeons are offering services that can help erase years from your hands

4/23/03

By CHARLOTTE BOECHLER

NEWS-PRESS STAFF WRITER

Turning back the hands of time used to be something that happened in October.

But plastic surgeons are now doing it year-round.

"It's an old adage that people's hands give them away even if they have had good plastic surgery," said Dr. Brent Moelleken, a plastic and reconstructive surgeon. "So people are coming in for their hands as well."

He has seen an increase in the number of people willing to, well, hand them over to physicians.

"I have a lady whose husband died and she is now dating a man who is 20 years younger than she is. She came in and had some facial work done. The guy has no clue. But she was very afraid her hands would give her away," said the doctor, who practices in Santa Barbara and Beverly Hills.

Patients can take 10 to 15 years off their hands -- and the only finger they have to lift is the one that pulls out their wallet.

"We can't make a cut and lift things," said Dr. Moelleken. "Where would you hide the scar? When you do an incision on the face, you have a natural seam that you can hide it in. The hand has no seam -- unless you never take your watch off."

You can, however, tick away the years by thickening the skin. Retin-A, a prescribed cream or gel that's applied about once a week, encourages collagen production and can therefore reduce the visibility of the bones and tendons. Dryness and sun sensitivity are the most common side effects, added the doctor, but pregnant women should avoid the substance because it can cause birth defects.

Microdermabrasion, which essentially is a form of sandblasting, is another approach that thickens the skin. His patients often do the procedure, which starts at $150 per session, once a month and can see results after the first visit.

Those who would rather eat a slab of liver than see liver spots on the back of their hands might want to consider V-Beam laser therapy. The five-minute procedure, which involves directing pulsed light onto the skin, can reduce the appearance of age spots.

"People usually notice a big difference in one treatment," said Dr. Moelleken. "That's as close as you can get to one-stop shopping."

The price tag in his office will set you back at least $500.

But, in the wrong hands, the cost could be even higher.

"By the same token that it can cause nice changes, it can cause bad changes -- like too much or too little pigment," explained the doctor, who advises those with darker skin to find a different approach. He also recommends making sure the person who offers the procedure is board certified in dermatology or plastic surgery. "If someone is stupid and they turn up the light too high, you're going to get a lot of problems."

Dr. Moelleken often does his handy work on people in the entertainment industry.

"It's survival," said the doctor. "They don't earn their living based on their superior intellect or ability to run a business. They make it on looking good."

When it comes to aging hands, that requires constant maintenance.

"It's kind of like if you have a home. You have got to paint it, clean it, keep it landscaped. There's not one thing to keep your house up or beautiful," said the doctor, who recommends clients use a variety of tools to refurbish their hands. "They can decide not to mow the lawn or paint the house, but their home is not going to look the best."

He encourages ordering the right supplies before there's even a problem.

"People should come in while they're in their 20s because that's when much of the damage is done," he said. "If we can get people on a good sunblock and skin-care system when they're young, they would save thousands of dollars later."

Isabel Thompson usually hears complaints about age spots from women between the ages of 40 and 70.

"They have nice jewelry, they have nice nails. They want their hands to go along with the whole thing," said Ms. Thompson, a certified physician assistant at Spa Medicus. "There is a tremendous pressure to look good. It's not just Hollywood. It's writers, it's salespeople. Everybody wants to be the best they can be."

Maybe that's why PhotoFacials, which also consist of pulsed light that targets discoloration, are so popular at the Santa Barbara spa.

"The melanin in the skin absorbs the light and the brown spots become little superficial scabs," said Ms. Thompson, who is licensed to perform the procedure, which is $150 per visit. "Then they just flake off in about a week or two."

Unlike V-Beam laser therapy, PhotoFacials usually require about three sessions. They are not recommended for those who are photosensitive or have darker skin.

"There's no downtime," said Ms. Thompson, adding that the procedure only takes about 15 minutes for both hands. "More and more people want to do little things to make themselves look better without losing time from their life."

Don't want to be accused of being vein? Consider sclerotherapy.

"As you get older, the fat in the back of your hand decreases and the skin thins, so the veins become more prominent," said Ms. Thompson. "It kind of gives you away. Imagine an older woman who's 60, 65, has had a face lift and has done as many things as possible to look good. Then she has these gnarly, veiny hands."

That isn't an issue after this 30-minute procedure, which costs $350 per session and involves relatively painless injections into bulging veins.

"The agent causes local irritation and inflammation. The inner vessel wall responds by forming scar tissue, which blocks the vein and causes it to close," said Ms. Thompson, adding that it takes up to two months to see results. "The body, over time, reabsorbs the vessel and the back of the hand becomes smooth and flat."

Side effects may include bruising, infection and small blood clots.

"When you close a superficial vein down, wherever it is, you push the blood flow deeper, but nothing is compromised as far as circulation," said Ms. Thompson, adding that those with a history of such problems still aren't good candidates.

Dr. Robert Sheffield gladly lends a hand when patients complain about the wrinkles and other signs of aging on theirs. He usually suggests, in conjunction with other alternatives, a light chemical peel.

"It's a liquid you apply on the skin that acts as any acid. It basically destroys the most superficial layer of the skin and the skin regenerates itself underneath," said the Montecito plastic surgeon. He uses a cotton swab to dab a higher concentration on any pronounced age spots. They turn a darker brown over the next three or four days and eventually peel off. "It's kind of like the ultimate sunburn in those areas."

The chemical peel, which usually starts at $300 in his office, takes about 20 minutes to perform and usually needs to be repeated a few times before results are seen. Side effects may include redness in the general area for a few hours, or up to eight weeks on the concentrated spots. Those with darker skin or a history of abnormal healing should avoid chemical peels.

Dr. Sheffield said his patients are often in the office for a facial peel when they consider the procedure.

"It lends itself to, 'You're already there, the acid is out, why not do my hands?'" he said. "You sort of do this when people are on their way out the door."

So, what's their verdict?

For many, two youthful-looking thumbs up, naturally.