Published in The Toronto Star, December, 2009.
Joy Noseworthy used to hide her hands.
In conversation, she would fold them away and tuck them in her lap, not making any hand gestures.
At a restaurant, the simple act of holding up a menu caused her distress.
"You could grab the entire skin off my hand and stretch it out," says Noseworthy, who now lives in Newfoundland after 30 years as a Mississauga resident. "I had the hands of an 80-year-old."
So, after a jaw-dropping transformation that included an eye lift, tummy tuck, arm and neck lifts, hand rejuvenation surgery was to be the crowning glory in her extreme makeover. Restoring youth to her sunken, brown-spotted hands became the finishing touch in her quest to belie her years – a number she declines to reveal except to say that her surgeries knocked "10 to 15 years off" her age.
Cosmetic hand rejuvenation is little known in Canada, but it's slowly gaining ground as the final frontier among the anti-aging obsessed. In this Botox-padded generation, quick scans of a woman's neck and hands are dead giveaways for her age, the ultimate "hands of time."
"You can't possibly do facelifts without looking at the hands," says plastic surgeon Dr. Stephen Mulholland of SpaMedica, in mid-town Toronto.
"When I do a facelift, I look at the neck, the chest and décolleté area and the back of the hands. We try to make them all look as if they're at least within the same decade.
"You can't turn back the face 10 years and leave the hands looking the way they are. It's like leaving a bad scar."
Of the 120 facelifts he does a year, Mulholland says he does 100 hand-rejuvenation procedures that include brown spot removal, micro-fat grafting to plump up the area, injectable filler to thicken the skin and vein diminishing.
At the McLean Clinic in Mississauga, Gail Denniston, 69, looks the other way as nurse Ann Sheidow injects a filler, Radiesse, into the back of her hand. Denniston's hands have borne the brunt of wintering six months of the year in Florida, and unprotected exposure to the sun. She's seeking treatment for her protruding blue veins, sun spots and bony hands.
"My hands are old-looking and age me," she says.
Sheidow pulls the skin on the back of Denniston's hand taut, plotting out her injection sites. She pumps the filler – calcium-based microspheres suspended in gel – into the sunken areas of Denniston's hand, which forms a small lump underneath the skin. After applying a topical lubricant, Sheidow then massages the hand to evenly distribute the product throughout the area.
"The filler works as a film over the tendons and blood vessels," Sheidow explains, as her thumbs apply gentle pressure. "The result is softer-looking hands."
Denniston also inherited bony, sunken hands from her mother, whose hands aged prematurely, she remembers.
"There's no sense having a nice manicure if you don't take care of the whole hand," she said, looking down at her unadorned, unpainted fingers. "I'm doing this for myself."
Sculptra, another injectable filler, is made from fruit acids. It has been shown to stimulate collagen production and thicken the skin by up to three millimetres, Mulholland says.
While fillers last about a year, micro-fat grafting is permanent, says Toronto plastic surgeon Dr. Trevor Born. Fat is harvested from the abdomen or flank area and injected under the skin of the back of the hand in a fine layer.
The presence of stem cells in the fat is also believed to improve skin over time, Born says.
Intense pulsed light (IPL) treatments are popular procedures for the hands that don't involve surgery. The IPL device focuses onto the skin a broad spectrum light that targets and removes brown pigmentation, in addition to stimulating new collagen production.
"Sun damage is cumulative and will result in irregular pigmentation," Born says. "And hands are probably more exposed than the rest of the body, particularly for people who drive a lot."
Other hand rejuvenation procedures include fractional laser resurfacing, which punches microscopic holes into the skin to treat wrinkles and sun damage, and Thermage, which uses sound waves to tighten the skin and encourage new collagen production.
Procedures cost, on average, between $650 per hand to $3,000 for the pair.
Meanwhile, it has been a year since Noseworthy had her hands rejuvenated with fillers and light treatments, and she's been back to the McLean Clinic for a touch-up. The procedure gave her the confidence to don flashy, chunky rings and speak freely with her hands. She has monthly French manicures, and is no longer concerned about gnarled, wrinkly, time-worn hands outing her true age.
"The hands say a lot," she says. "They speak to manual labour and a person's age. I can tell a woman's age from her neck and hands because I've had it all done myself. I should know."
Madonna's bad hands
While he hasn't had requests for "celebrity hands," Dr. Stephen Mulholland says clients cite one particular star for her atrocious paws: Madonna.
"She gets mentioned more than any other individual."
While Madonna's taut, crease-free face says one thing, gnarled, protruding veins and wrinkles on her hands say another.
"What people detect is when things are out of context," adds Dr. Trevor Born.
"It's an issue whenever you have discontinuity between one feature of the body to another."
Smooth, soft hands may not immediately register on an observer's radar, but the TV series Seinfeld devoted a whole episode to "man hands," proving that brutish, beefy mitts on an otherwise beautiful woman can be a deal breaker.
"It's like a creature out of Greek mythology," Seinfeld said in the episode.
"I mean, she was like part woman, part horrible beast."