Successfully adding head and neck rejuvenation treatments to one's practice requires starting with fillers, toxins, chemical peels and whatever devices one already owns, an expert says.
Wherever possible, "I recommend optimizing the use of a device that you have, increasing the revenue it produces by expanding its indication to include the hands," Dr. Lupo says.
One can then use the increased cash flow to purchase a more sophisticated device, she adds.
Similarly, she says, "Peels are still important, particularly for a budding aesthetic practice."
The first step in hand rejuvenation involves assessing the patient's problem or problems, Dr. Lupo tells Dermatology Times.
In this regard, she says, "The most common problems we see with hands are dyschromia, fine lines and 'crepiness,' loss of elasticity and firmness and loss of dermal and subcutaneous volume."
The primary cause of these problems is lifetime UV exposure, Dr. Lupo says.
Even women who begin taking good care of the skin in their 30s frequently neglect their hands, says Dr. Lupo, "and therefore, our hands show our age more than our faces."
Dyschromia includes mottled hyperpigmentation with discrete lentigines, guttate hypomelanosis and solar purpura.
Treatment options for these problems include topical agents, lasers and noncoherent light sources such as intense pulsed light (IPL), Dr. Lupo says.
Among topical agents, Dr. Lupo says retinoids are her workhorse.
"Sunscreens are uniquely important for the hands because of the chronic, daily, insidious sun damage that the hands endure," she says.
Moreover, Dr. Lupo says cosmeceuticals should complement prescription retinoids and good sunscreens. For example, she says, Solage (Barrier Therapeutics) combines mequinol with tretinoin.
However, she says, discrete lentigines almost always need specific treatment, even if it's just with spot liquid nitrogen.
Other options for discrete lentigines include spot 25 percent trichloroacetic acid peels, Nd:YAG lasers, IPL lasers or fractional lasers.