Hand rejuvenation: treating age spots, volume loss, and skin quality on the hands

The hands are often called the clearest tell of a person's age — they receive constant UV exposure, they're thin-skinned and low in fat, and they're rarely treated in aesthetic planning despite being highly visible. Here's a breakdown of what ages the hands and what you can do about it.

What makes hands look older

Volume loss: The fat pads that pad the back of the hand diminish with age, making the tendons and veins more prominent and visible. This is often the most dramatic aging change on the hands.

Sun damage and age spots: Cumulative UV exposure creates solar lentigines (age spots) on the back of the hands. These are similar to face sun spots but often more pronounced because hands lack the SPF protection the face receives from daily skincare.

Skin thinning and crepiness: The skin on the dorsum (back) of the hand becomes thinner and less elastic with age, creating a crepe-paper texture.

Prominent veins: As volume decreases and the skin thins, veins that were previously cushioned become more visible.

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Treatments by concern

Volume loss (prominent tendons and veins)

Radiesse: The gold standard for hand volumizing and the only filler FDA-cleared specifically for hand augmentation. Radiesse (calcium hydroxylapatite) is injected across the dorsum of the hand to restore the cushioning fat layer, softening the appearance of tendons and veins.

How it works: Radiesse provides immediate volume from its carrier gel, then stimulates collagen production as the CaHA microspheres dissolve over 12–18 months. The biostimulatory effect extends results beyond the filler itself.

Technique: Radiesse for hands is typically injected via cannula (blunt tip) for safety and even distribution across a large area. The hand's dorsal venous network is dense, making cannula technique preferred over sharp needles to reduce vascular risk.

Results: Visible immediately; full result at 2–4 weeks as the product integrates. Tendons and veins become less prominent; the hand has a fuller, younger appearance.

Duration: 12–18 months. Some patients get 2 years with the collagen stimulation effect.

Cost: $700–$1,200 per hand; $1,400–$2,400 for both hands (typically treated together).

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Hyaluronic acid filler (off-label): HA fillers can be used for hand volumizing as an off-label alternative. Advantages: reversible if needed. Disadvantages: generally shorter duration than Radiesse (6–12 months); Radiesse is FDA-cleared for this use specifically.

Sculptra: Diluted Sculptra injected across the dorsum for collagen stimulation is used by some providers. Gradual result over 3–6 months; long-lasting (2–3 years). Requires 2–3 sessions.

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Age spots and sun damage on hands

IPL (Intense Pulsed Light): Effective for discrete sun spots on the hands. The same principles as facial IPL apply — spots darken, pepper-fleck, and lift off over 7–14 days. 2–3 sessions typically.

Q-switched or picosecond laser: More targeted than IPL for individual spots. 1–3 sessions per spot or cluster.

Chemical peels: Glycolic acid peels applied to the hands can fade pigmentation and improve overall texture. Multiple sessions.

Topicals: Daily retinoid application and sun protection prevent further damage and gradually fade existing pigmentation.

Important: Get any suspicious pigmented lesion on the hands evaluated by a dermatologist before treatment — the hands are a common site for acral lentiginous melanoma.

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Skin quality (crepiness, texture)

RF microneedling: For significant skin quality improvement, RF microneedling on the hands stimulates collagen production and improves skin texture. 2–3 sessions.

Chemical peels: Superficial to medium peels improve texture and luminosity.

Laser resurfacing (fractional): Fractional non-ablative laser improves texture and skin quality with moderate downtime. Appropriate for more significant skin quality concerns.

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Combination approach: the most common hand rejuvenation plan

Most patients benefit from addressing both volume loss and pigmentation together:

Radiesse for volume (1 syringe per hand) — primary treatment
IPL for sun spots — 2–3 sessions, 3–4 weeks apart
Daily SPF 50 — without this, spots return and the investment is wasted

The combination is often done in separate sessions (Radiesse first; IPL a few weeks later) to allow the filler to settle before applying energy.

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Aftercare and maintenance

Sun protection: Hands lose SPF protection throughout the day through washing. Reapplying sunscreen to the hands is critical for maintaining results and preventing new spots. Many patients find that SPF-containing hand creams or keeping a small sunscreen at their desk helps with compliance.

Volume maintenance: Radiesse typically needs touch-up at 12–18 months. Some patients have enough collagen stimulation effect to extend to 2 years.

Spot recurrence: Sun spots can recur if UV protection is not maintained. Annual IPL or laser maintenance is appropriate for patients with significant photodamage.

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Cost summary

| Treatment | Per session | Typical course |
|---|---|---|
| Radiesse (both hands) | $1,400–$2,400 | Single treatment |
| IPL (hands) | $150–$300 | 2–3 sessions |
| Q-switched laser (spots) | $100–$300 | 1–3 sessions |
| Chemical peel (hands) | $100–$250 | 3–6 sessions |
| Sculptra (both hands) | $800–$2,000 | 2–3 sessions |

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Questions to ask your provider

Based on my hands, is my primary concern volume loss, pigmentation, or skin quality — and which treatment should we prioritize?
Do you use Radiesse or HA filler for hand volumizing, and why?
Do you use a cannula for hand filler, and what's your technique for even distribution?
Can I do IPL and filler in the same appointment, or should I stage them?
What sun protection do you recommend to maintain my results?

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