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Hands Up

By Janet McCormick
Posted: April 23, 2008, from the May 2008 issue of Skin Inc. magazine.

Estheticians receive extensive training in offering services and treatments for the face, but when it comes to treatments for the hands, that type of knowledge is more elusive. The wise esthetician seeks training for these kinds of treatments, especially now, and this old adage could sum up the ever-growing popularity of the trend: If you want to know a woman’s real age, look at her hands. Lately, more and more clients are asking for hand treatments to coincide with the services they are having done to match their younger-looking faces.
      Aging of the hands results from the same intrinsic and extrinsic processes as aging on the face. Intrinsic aging, from heredity and oxidation, results in loss of collagen and subcutaneous fat on the back of the hands, as well as a decreased barrier function of the stratum corneum. Extrinsic aging results from exposure to the sun and elements, and includes epidermal atrophy, or skin thinning; solar elastosis, or loss of elasticity on sun-exposed skin; pigmentary irregularities; and the development of actinic keratoses, which are scaly or crusty elevations on the skin.
      Many believe aging on the hands is ultimately more disfiguring than on the face, and it also can be more obvious and more difficult to address. Not wearing sunscreen on the hands is one of the key factors in their skin problems, and such problems may seem more obvious because the hands are seldom covered with makeup. Another trying factor in the treatment of hands is the possibility of constant hand-washing, as well as a lack of developed protocols.

Tracking hand-aging
      Hand aging is progressive, with spots usually beginning to appear after age 40. In fact, it’s estimated 90% of women 60 or older have one or more of these spots.
      When first starting to age, the hands will show dehydration through tiny fine lines, then wrinkles begin to develop, becoming more and more apparent. Next, the veins seemingly increase in size and stand out from the surface of the hands more and more as time passes, as do the tendons. The reality of the latter symptom is that the subcutaneous fat on the hands is resorbed with age, and the epidermis and dermis thin, allowing these veins to stand out. Then sun spots, often in the form of solar lentigines and hyperpigmentation, develop initially as small, light brown discolorations, later enlarging and darkening to brown—and sometimes even black—spots. Finally, the back surface of the hands and arms becomes drier and more dull, leading to an aged appearance that ultimately shouts, “I’m old!”
      Spa owners know well how much clients willingly pay to repair or enhance the appearance of aging on their faces, so why not move into treating the hands for such conditions, as well? The truth is, many people are becoming more and more self-conscious about the aging of their hands. Are you ignoring this opportunity with your clients, allowing their hands to shout their age and belie the benefits they’ve paid for on their faces? Do you treat your clients’ hands beyond hydration or relaxation?
      If not, you should begin offering these types of services now. Treatments options should involve not only hydrating the skin on the hands, but also improving their appearance through reducing fine lines, wrinkles and hyperpigmentation.

A hand evaluation
      Just as with the face, the hands, including the arms, should be analyzed to define their correct needs. “Our estheticians are trained to perform the same evaluation on the clients’ hands as on their faces, then to make recommendations,” says Pat Dobson, co-owner of the spa Changes of Cherry Creek in Denver, Colorado.
      Estheticians at her spa perform a high number of hand treatments, Dobson says, and they focus not only on the face, but on the entire body. “Every initial client analysis includes the hands,” she explains.

The hand plan
      After the evaluation, it is time to initiate the actual service, and most hand skin care treatments are performed during facial services. “They are simple, easy to perform for the esthetician and inexpensive for the client when performed during the facial as an add-on,” says Dobson.
       A variety of treatment plans can be created and recommended for these types of services, and the results can be as long-lasting for the hands as they are for the face. Protocols should include both home and professional care as well, because leaving out either one will discourage achievement of the goal.

      Home care. The home care regimen for the hands must be simple and focus on results-oriented products. The products also must enhance the recommended professional treatments, and maintain the results—youthful, beautiful hands—after they are finished.
Important ingredients are included in each of the home care program products, and the number of products can actually be limited to just three: a daytime moisturizer lotion, a nighttime treatment moisturizer and a scrub. These products shouldn’t just soften and smell gorgeous; they also are great products that provide important nourishment to the skin on the hands.

      Daytime moisturizing lotion—The options recommended for an anti-aging regimen here need to have superior hydration and softening ingredients, as they are much more results-oriented than the usual hand lotions. Other ingredients can be included in this lotion to addresses specific problems, as well: Lighteners are included to resolve hyperpigmentation, antioxidants are important to prevent further aging, peptides and other dermal stimulators are added to encourage the development of collagen and elastin in the dermis for minimizing fine lines and wrinkles, and of particular importance is an SPF, or sun protection factor, included in the formulation.
      Selling SPF products for the hands and arms only and achieving the important behavioral use can be tough, so prepare to offer some intense education concerning the causes of aging on the hands. The product should be luxurious enough to have clients using it after showers or baths as well as after every time they wash their hands. This reapplication after every daytime washing is important, as it works to protect the skin from the sun, so a purse size lotion is beneficial in encouraging use.
      Nighttime treatment moisturizer—The nighttime treatment should contain all of the above ingredients but also include 8–15% alpha hydroxy acids or possibly a retinol. Regular use can enhance epidermal thickness, stimulate development of the dermal matrix—which counters skin thinning through time—lighten the hyperpigmentation on the back of the hands, and bring a more youthful look to the skin. Optimal results do take time, though some improvements should visible within 10–14 days. Continued use is required to maintain these effects.
     Scrub—A gentle, manual exfoliator is also recommended for use two to four times per week and should usually be done in the evening before applying the nighttime treatment product. The regular use of the scrub enhances the products’ results and speeds up the anti-aging process.

      Some estheticians encourage clients that use anti-aging cleansers on their face to cleanse their hands with the same solution on the nights the scrub is not used, as well, before applying the nighttime moisuturizing treatment.

     Professional Treatments. Of course, home care options are great for maintenance, but nothing really compares to a professionally offered hand care service. These types of treatments can be offered as stand alones when appropriate, but most are performed as accompaniments to facial treatments. Also, they should be performed in a series in order to reach their maximum potential to change the skin.
      Hydrating treatment—Dehydration and dryness can cause aging and are often the first evidence hands show of growing older. If addressed properly, however, these conditions can be diminished.
      Millie Haynam, owner of Natural Beauty Salon & Spa in Twinsburg, Ohio, treats hand dryness by massaging a 15% glycolic cleanser into the hands and arms for two minutes, removing it and then applying a hyaluronic acid-based mask. Next, she places the hands in plastic mitts, then finishes the treatment by applying an SPF lotion over the absorbed mask. “The skin is noticeably softened and hydrated,” she says. Haynam suggests this service as a results-oriented anti-aging treatment series for the hands as well, explaining, “This treatment doesn’t have to be removed after 5 minutes like the 30% treatments do, so it is much more convenient to use during a facial routine.”
      Acid resurfacing—A 20–30% alpha or beta hydroxy acid treatment for the hands can produce the same enhanced cell turnover and lightening these types of services do for the face. This can also be performed as a stand alone or during a facial treatment as a tandem upgrade.
      Vivian Moreno, owner of BioKorium Salon & Day Spa in Riverside, California, recommends combining the facial and hand peel treatments, performing them both during the same appointment. Acid offerings for the hands should be treated the same as for the face, with a series of four to eight treatments performed at two-week intervals, and they must be supported by appropriate home care.
LED light therapy—This treatment can be performed following other treatments or as a stand-alone service if supported by good home care products. LED light therapy stimulates the development of the dermal matrix, lightens hyperpigmentation and has been seen as a successful method for diminishing aging if done in a series.
      Donovan’s Serenity and Wellness Spa in Alpena, Michigan, has both a hand-held LED light for the face and a hand spa, which is an LED unit that allows both hands in at once for full light coverage.
      “We use the hand spa unit whenever performing hand LED treatments,” says Kerensa Russel, one of the spa’s estheticians. “We cleanse the hands, apply product, then place the unit on the client’s lap for 10 minutes during the facial. Post-treatment, we apply an SPF lotion.” The spa’s staff is finding clients are most often pleased with the results of the hand treatment, as well as the fact that it can be performed in tandem with a facial.
      Chemical peels—Moderate and deep peels, such as TCAs and Jessner’s, are definitely not recommended for the hands, as permanent scarring is a distinct possibility. However, some estheticians will perform superficial peels on the hands, but be aware that the dangers are high due to the thinness of skin in this area. Also, no product company contacted endorsed the use of chemical peels on the back side of the hands.
      Microdermabrasion—Spas consulted about this particular service in regard to hand treatments felt microdermabrasion was too uncomfortable and didn’t produce significant enough results that couldn’t be offered by acid resurfacing and LED options. So, despite the fact that there are facilities that have tried this technique for the hands, they primarily have moved quickly past it to another method.
Medical-level treatments—Spas with medical directors can perform medical-level treatments, and some have found success with these types of hand options. “We have a medical director, so if the hyperpigmentation is serious, dark and deep, we recommend an IPL photofacial treatment,” says Dobson. IPL, or intense pulsed light, is a quick and comfortable light treatment that typically causes little downtime, but it can be costly and usually takes several treatments according to the severity of the hyperpigmentation, Dobson notes.