The hands age in a specific, predictable way — and unlike the face, the changes are particularly difficult to disguise. The skin on the dorsum (back) of the hand is thin, has minimal subcutaneous fat, and is exposed to UV radiation virtually every day of the year. The result, by the late 40s and 50s for most people, is a combination of volume loss (visible tendons and veins), pigmentation changes (sun spots), and skin texture deterioration (crepey, thinning skin).
This guide covers what actually changes in ageing hands, the treatment options that genuinely work, who suits each option, and what to expect from the recovery process. The right approach depends entirely on which of the three problem areas — volume, pigmentation, or texture — dominates your particular situation.
What changes in ageing hands
Three distinct processes contribute to the aged appearance of the hands, and most patients are seeing some combination of all three:
Volume loss. The subcutaneous fat layer between the skin and the underlying tendons, muscles, and bones gradually thins with age. As this padding decreases, the underlying anatomy becomes increasingly visible — tendons appear as ropes running down the back of the hand, veins become more prominent, and the spaces between the bones (the metacarpal interspaces) deepen. This is often the first and most visible sign of hand ageing.
Pigmentation changes. Cumulative UV exposure produces solar lentigines (sun spots, age spots, or liver spots) — flat brown patches of increased pigmentation on the back of the hand. These appear from the 40s onward and progressively accumulate. They’re entirely cosmetic, not medically concerning, but for most patients they’re a significant marker of perceived age. For more on the broader topic of hyperpigmentation, see our service page.
Texture changes. The dermis thins, collagen and elastin production decline, and the skin loses its springy, smooth quality. The result is “crepey” skin — thin, slightly wrinkled, with reduced elasticity. Repeated sun exposure accelerates this process significantly.
A useful self-assessment: pinch the back of your hand gently and let go. Younger skin springs back immediately. Older skin tents momentarily before settling. The longer the tenting, the more advanced the texture changes.
The treatment options
Several treatments address hand ageing, each targeting different aspects of the problem.
Dermal filler for volume restoration
The most directly impactful treatment for volume loss. Hyaluronic acid filler is placed in the subcutaneous layer between the skin and underlying tendons/veins, restoring the padding that ageing has thinned. Visible tendons and veins become substantially less prominent, and the overall hand contour looks softer and more youthful.
What to expect:
- Topical anaesthetic applied for 15-20 minutes before treatment
- Filler injected through 1-2 entry points per hand using a blunt cannula
- Typical volume: 1-2ml per hand
- Gentle massage to distribute the product evenly
- Total treatment time around 30 minutes
Recovery: mild swelling and possible small bruising for 3-5 days. Most patients return to normal activities the same day. Avoid vigorous hand use, heat exposure, and gym/manual work for 48 hours.
How long it lasts: 12 to 18 months. Hand filler typically lasts longer than facial filler because the area has less constant movement than the face.
Fat transfer for volume restoration
For patients wanting longer-lasting volume restoration, autologous fat transfer uses the patient’s own fat — harvested by liposuction from areas like the abdomen, flanks, or thighs — and placed into the hands after careful processing.
The process:
- Small-volume liposuction from a donor site (typically 50-100ml of fat needed for both hands)
- Processing of the fat to isolate viable fat cells and remove fluid, oil, and damaged cells
- Injection of purified fat into the hands using micro-cannulas
- Distribution across multiple planes within the subcutaneous layer
What to expect: performed under local anaesthesia with optional sedation. Takes 90 minutes to 2 hours total. More substantial swelling than filler for 7-10 days. Final result visible at 3 months once the surviving fat (typically 50-70% of what was placed) has integrated.
How long it lasts: potentially permanent for the fat that survives. Most patients maintain a meaningful proportion of the volume long-term, though occasional top-up sessions are sometimes needed.
Considerations: fat transfer is more involved than filler — both surgically and in recovery — but for patients wanting durable restoration with their own tissue rather than gel-based products, it’s the more comprehensive option.
Laser treatment for pigmentation
Solar lentigines respond well to targeted laser treatment. At Centre for Surgery, we use Fotona Er:YAG laser technology to address pigmentation through two complementary modes:
SMOOTH mode (non-ablative). Delivers heat to the dermis without breaking the surface of the skin. Stimulates collagen production, improves overall skin quality, and gradually reduces pigmentation through gentle thermal effect.
TwinLight fractional mode (ablative). Creates micro-channels in the skin to trigger collagen remodelling and target pigmented spots more directly. More effective for established dark spots, with slightly more recovery (mild redness and crusting for 3-5 days).
What to expect:
- Topical anaesthetic if the ablative mode is used
- Treatment takes 20-30 minutes per session
- Course typically of 2-4 sessions spaced 4 weeks apart
- SPF protection essential throughout the treatment course and afterwards
Recovery: SMOOTH mode — mild pinkness for a few hours, no downtime. Ablative — 3-5 days of mild redness, sometimes scabbing on treated spots, before the pigmentation flakes away revealing fresh underlying skin.
For more on the laser technology generally, see our guide on Fotona laser treatment costs.
Skin boosters and biostimulators for texture
For crepey skin and overall texture improvement, injectable treatments that bioremodel the dermis from within can produce meaningful change:
Profhilo uses a unique high-concentration HA formulation injected at specific points to stimulate fibroblast activity and improve overall skin quality. Particularly useful for the back of the hand. Two sessions 4 weeks apart, with maintenance every 6 to 9 months. See our comprehensive Profhilo guide.
Polynucleotide treatment uses purified DNA fractions to stimulate skin regeneration. Works on similar principles to Profhilo but through different biological mechanisms. Often combined with Profhilo or used in patients who want more aggressive texture improvement.
Skin boosters (Redensity 1 and others) combine hyaluronic acid with amino acids, antioxidants, and minerals. Less aggressive than Profhilo or polynucleotides but suitable for patients with early texture changes.
Combined treatment
Most patients benefit from combining approaches rather than relying on any single treatment. A typical combined plan might include:
- HA filler or fat transfer for volume restoration
- Laser treatment for pigmentation
- Profhilo or polynucleotides for skin quality
- Daily SPF as preventive maintenance
Treatments are typically sequenced over several weeks rather than performed simultaneously, with a 2-week minimum gap between energy-based and injectable treatments.
Who suits which approach
Predominantly volume loss (visible tendons, deepened metacarpal spaces, prominent veins) → filler is the first-line approach. Fat transfer if the patient wants longer-lasting restoration with their own tissue.
Predominantly pigmentation (multiple sun spots, otherwise reasonable skin texture and volume) → laser treatment as the priority.
Predominantly texture changes (crepey skin, fine lines, generally thin-looking skin) → Profhilo or polynucleotides as the priority.
Combined ageing (volume, pigmentation, and texture all visible) → combined treatment plan addressing each component in sequence.
Very advanced ageing with significant skin laxity → none of these treatments produce dramatic results; the underlying problem requires surgical skin reduction, which is not typically performed on the hands due to scarring considerations.
Preventive maintenance
For all hand rejuvenation patients, lifestyle factors significantly affect both the longevity of treatment results and the rate of continued ageing:
Daily broad-spectrum SPF on the hands. The single highest-impact preventive measure. UV exposure drives both pigmentation and texture changes. Apply SPF 30+ to the hands every morning regardless of season, and reapply after handwashing.
Hand cream with active ingredients. Vitamin C, retinol (at night), niacinamide, and hyaluronic acid all benefit hand skin. Apply morning and evening.
Protective gloves for harsh chemicals. Cleaning products, detergents, and gardening chemicals damage skin barrier function. Use gloves to limit exposure.
Limit hot water immersion. Repeated hot dishwashing or hand washing damages the skin barrier. Use lukewarm water where possible.
Don’t smoke. Smoking accelerates skin ageing throughout the body, including the hands.
These habits don’t reverse existing damage but they substantially slow further deterioration and extend the duration of treatment results.
Cost
- HA filler for hands: from £450 per syringe (typically 1-2ml per session, both hands)
- Fat transfer to hands: from £4,500 (includes liposuction, processing, and injection)
- Fotona laser for hands: from £350 per session (course of 2-4)
- Profhilo for hands: from £400 per session (course of 2)
- Polynucleotide for hands: from £450 per session
A typical combined treatment plan for moderate hand ageing might involve £1,500-£3,000 in total spend across a treatment course over 2-3 months, with maintenance roughly annually.
Finance options through Chrysalis Finance, including 0% APR, are available across all treatments.
Risks and considerations
For filler: minor bruising and swelling, lump formation (rare), vascular occlusion (very rare in this area but recognised). Reversible with hyalase if needed.
For fat transfer: donor site discomfort, asymmetry between hands, partial absorption of placed fat (this is expected — fat transfer is sometimes performed in two stages for this reason).
For laser treatment: temporary darkening of treated spots before they fade, very rarely persistent hyperpigmentation or hypopigmentation. Risk is higher in patients with darker skin tones — careful patient selection and conservative laser parameters mitigate this.
For Profhilo and polynucleotides: very low risk profile. Minor bruising at injection points; mild tenderness for 24-48 hours.
A thorough consultation discusses your individual risk profile based on skin type, medical history, and the specific treatment plan.
Common questions
Will my hands look obviously “done” after filler?
Not when conservatively dosed. The aim is restoration of natural contour, not adding visible bulk. Done well, the hands look refreshed and younger without obvious filler appearance.
How quickly will I see results?
Filler — immediately, with continued improvement over 2 weeks as swelling resolves. Fat transfer — final result at 3 months. Laser — initial pigmentation darkening then fading over 2-4 weeks. Profhilo — gradual improvement over 4-8 weeks after the second session.
Can I have all treatments in a single session?
Some can be combined (filler + Profhilo, sometimes). Others need sequencing with gaps (laser + injectables). Your treatment plan will sequence the components appropriately.
Will the results match exactly between my two hands?
Each hand is individually treated, but both hands are addressed in the same session. Small differences in absorption or healing can produce subtle asymmetry — this is typically corrected at follow-up if needed.
How does hand rejuvenation pair with facial rejuvenation?
Many patients address the hands at the same time as facial work. This is sensible — the hands often “age out” of the rejuvenated face if neglected, becoming a more obvious marker of age than the face itself. Combining facial and hand work produces more coherent overall results.
What about veins specifically — can these be treated?
Prominent hand veins respond to filler placement that increases the surrounding subcutaneous volume — this effectively reduces vein visibility without affecting the veins themselves. Direct treatment of hand veins (sclerotherapy or surgical excision) is occasionally performed but generally not recommended for cosmetic reasons.
Can men have hand rejuvenation?
Yes — and increasingly do. The treatment approach is similar for men and women, though men typically opt for more conservative volume restoration to preserve a more anatomically masculine appearance.
If I dislike the result, can it be reversed?
HA filler can be dissolved with hyalase if needed. See our guide on dissolving filler in the face and lips — the same principles apply for hand filler. Fat transfer is not reversible — fat that has integrated is permanent. Laser treatment effects are gradual and don’t require reversal in normal circumstances.
Centre for Surgery · CQC-regulated · GMC specialist-registered surgeons · 95–97 Baker Street, Marylebone, London W1U 6RN · 0207 993 4849 · Book a consultation · Finance from 0% APR
