Why do hands look older, and why do veins and tendons become prominent?
Veins and tendons on the back of the hand become prominent most often because of loss of the fat and volume beneath the skin and thinning of the skin. Veins and tendons are present in youth too; they become more visible as the soft tissue covering them decreases. Sun damage, collagen loss and frequent hand washing contribute to this look.
The skin on the back of the hand is thinner than facial skin, and the layer of subcutaneous fat beneath it is limited. With age, this fat decreases, the skin thins and the collagen and elastic fibre structure weakens. As a result, its ability to cover the structures it lies over falls: veins look raised, tendons appear as sharp lines and bony prominences look more marked. This change often progresses independently of changes in the face; someone with a youthful face may have hands that have changed noticeably more for their age.
Factors that age the hands include years of sun exposure, dryness from frequent hand washing and use of sanitiser, smoking and inherited characteristics. Sun damage causes brown spots and uneven texture on the skin; these spots are a separate problem from volume loss and do not change with filler. In the assessment, therefore, the first question is what determines the look of the hand: volume loss, thin skin, spots, or a combination of these. In some people, medical causes such as swelling, joint problems or vascular disease may also play a part; marked or sudden changes call for assessment by a doctor.
What is hand filler, and what can it change?
Hand filler aims to support the lost volume and soften the look of veins and tendons by placing a measured amount of filler in the subcutaneous layer on the back of the hand. The skin can look fuller and smoother. However, filler does not remove spots, skin laxity or the wrinkling itself; these problems need different approaches.
The basic idea of the treatment is to create a cushioning effect under thin skin. The added volume covers the veins and tendons, increases the overall fullness of the hand and can help the skin look less crinkled. The result is planned as a subtle, natural change; the aim is not to make the hand look puffy but to balance an overly hollow look. The degree of change varies from person to person: in hands with little volume loss the effect is harder to notice, and in hands with marked hollowing it can be seen more clearly.
It is also necessary to know from the start what filler cannot do. Sun spots, uneven colour, the surface texture of the skin and very prominent clusters of veins are not corrected by filler; adding product over a very raised vein may not even give the expected effect. Age-related bone and joint changes, or deformities of the finger joints, are not the subject of this treatment either. At the consultation, therefore, your expectations and the real condition of the hand are assessed together; when filler is not suitable, other options such as skin care and device treatments for spots are explained.
Is hyaluronic acid or CaHA used on the back of the hand?
Both hyaluronic acid fillers and calcium hydroxylapatite (CaHA) products can be used on the back of the hand. Hyaluronic acid provides volume straight away and can be dissolved with hyaluronidase when necessary. CaHA gives volume while also supporting a collagen response, and it cannot be dissolved. Which product suits which hand is decided by the doctor according to the product’s licensing status and the condition of the skin.
With hyaluronic acid fillers, softer and more spreadable products suited to the hand are preferred, because the back of the hand is very mobile and a firm gel can be palpable in the hand. Soft gels adapt to the tissue more easily; the tendency of some products to draw in water may cause swelling to last longer in some people. Being able to reverse the result when necessary gives hyaluronic acid an important safety feature, especially for people having treatment for the first time. The structure of products and the differences in cross-linking are explained on the page about what hyaluronic acid filler is.
CaHA products are also used on the back of the hand, in diluted form or in ready-made forms. With these products, part of the effect comes from the product itself and part from the collagen response it stimulates, so a more gradual look is aimed for. Because CaHA is not dissolved by hyaluronidase, technique and amount are kept especially measured. Although it has been reported that certain products are approved for the back of the hand in some countries, the approved uses of products differ from country to country; you should ask your doctor whether a specific product is licensed for this area in our country. The comparison of the two classes is covered on the related biostimulator and filler pages.
How is hand filler done, and what can I expect afterwards?
The hand is cleaned with antiseptic, a numbing cream may be applied, and the product is placed with a fine needle or a blunt-tipped cannula in the subcutaneous layer of the back of the hand, usually over the tendons. The area is then gently massaged so the product spreads evenly. Swelling and bruising may last a few days; hand movement usually eases the same day.
At the consultation the look of the hand is assessed at rest and while making a fist, and you are asked about the medicines you take, blood thinners, hand surgery you have had and joint conditions. The aim of treatment is to spread the product in the right layer, away from the veins and tendons. It is generally a measured procedure that progresses in small amounts, with balance kept between the two sides of the back of the hand. The lidocaine in many products, or a numbing cream, reduces discomfort; even so, the back of the hand is a thin-skinned area and can be sensitive in some people. The length of the procedure varies with the area and the product.
In the first days, swelling, tenderness, a feeling of tightness and bruising may be seen on the back of the hand; because the hands are used often, swelling can last longer than it does in the face. Keeping the hand above heart level and cold compresses can be soothing. For the period your doctor advises, avoiding heavy lifting, intense exercise and hot environments, and not rubbing the area firmly yourself, is usually recommended. The final look is often assessed a few weeks later, once swelling has settled. If an important event is approaching, it is easier to plan treatment ahead for possible swelling and bruising.
What are the risks of hand filler, and who may not be suitable?
Common effects are swelling, bruising and tenderness. Less common but important ones include prolonged swelling, lumps, asymmetry, infection, restricted tendon movement and, rarely, vascular occlusion. In pregnancy, breastfeeding, infection or skin disease in the treatment area, allergy to the product’s contents and some connective tissue diseases, treatment is generally not given or is postponed.
Swelling on the back of the hand can last longer than in the face; constant use of the hands and the area’s tendency to swell play a part. If the product settles unevenly, palpable lumps can form; lumps from hyaluronic acid filler can be dissolved with hyaluronidase, while with products such as CaHA management is harder. Infection is rare, but treatment is not given with an open wound, eczema or an active skin infection. In people taking blood thinners the likelihood of bruising can increase; you should not stop your medicines without consulting your doctor. In people with rheumatic joint disease or vascular or connective tissue disease, treatment is assessed separately.
Increasing pain after treatment, blanching of the skin, a net-like purplish discolouration, coldness or colour change in the fingers, fever, or an area that is becoming more red and warm is not part of normal healing and should be reported to a doctor without delay. In serious symptoms such as a change in vision, difficulty breathing or widespread swelling, go to an emergency department. Results vary from person to person, and every treatment carries risks. It is useful to receive written information after treatment about how to use the hand and which symptoms are urgent.
Frequently asked questions
How long does hand filler last?
Duration varies with the product, the amount and the person; hyaluronic acid hand filler often gives a look that lasts for months, and with some products the effect is reported to last longer. Because the hands are very mobile, duration can differ from that in the less mobile areas of the face. An estimate specific to you is made at the examination once the product and amount are decided.
Does hand filler hurt?
There may be a stinging or pricking sensation during treatment; the back of the hand is a thin-skinned, sensitive area. A numbing cream and products containing lidocaine can reduce discomfort but do not remove the sensation completely. Tenderness and swelling in the first days are usual; if pain is steadily increasing, tell your doctor.
Can I return to daily activities after hand filler?
Most people return to daily activities the same day or the next; however, for jobs and sport in which the hands are used a lot, it may be necessary to take care for a few days because of swelling. Heavy lifting, intense exercise and hot environments are avoided for the period your doctor advises. Making a fist may feel difficult in the first days.
Will filler get rid of the brown spots on my hands?
No; filler adds volume but does not change the colour of sun spots. For spots, methods such as skin care, chemical peels, lasers and similar device treatments can be considered after a doctor’s assessment. In some people volume and spot problems occur together, so the two approaches can be addressed in sequence within the same plan.
Will my hands look natural after hand filler?
With a measured amount placed in the right layer, the change is usually perceived as a subtle, natural fullness. Too much product can make the hand look puffy, soft and unnatural. For this reason it is important to progress gradually, to assess movement with the hand in a fist and to come for a review after the swelling has settled.
Is there any treatment for prominent veins other than filler?
For prominent bulging veins, vein treatments such as sclerotherapy or a vascular surgery assessment may come up depending on the type of vein; this decision is made by a vascular specialist. Filler does not remove the vein; it softens its look by covering it. A vein swelling that appears suddenly, is painful or affects one side only should be shown to a doctor.
What is the difference between hand filler and Profhilo or a skin booster?
Hand filler aims to soften the look of veins and tendons by adding volume under the skin. Treatments such as Profhilo and skin boosters target the skin’s hydration, elasticity and texture rather than volume. In some people the two can be considered together; which is suitable is decided at the examination according to the condition of the hand.
What should I ask before having filler in my hands?
You can ask the name of the product to be used, its licensing status, whether it is used on the back of the hand, whether it can be dissolved, the possible risks and whom to contact in an emergency. You are also entitled to see the product’s box and label and to ask for a record containing the lot number and date.
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This content is for general information and does not replace a personal medical assessment.