London - Hands, eh? They are such a giveaway, not just of your age, but of the life you lead.
You can smooth out your face with Botox and fillers, fill in the creases with foundation and pass for years younger, but the backs of your hands are not so easily disguised.
I was impressed by Nicole Kidman’s mitts when she raised them to her face to blow a kiss for the cameras earlier last month at the Sanremo Music Festival in Italy. They looked like the hands you would expect to find on a hard-working 48-year-old mother; bony, a bit wrinkly, perfectly normal - not a bit the pampered superstar.
Hands get a tough deal and we don’t prioritise them in the way that previous generations did.
They get more exposure to ultraviolet light than any other part of the body except the face, which means that every time they are out and about in daylight, they are notching up small amounts of sun damage, which eventually will show up in the form of age spots. (These marks are technically known as hyperpigmentation, and are caused by the overproduction of melanin, the brown pigment within the skin).
The hands are drier than most of the rest of the body, with fewer oil glands to moisturise them, and this, together with the way skin stretches over the knuckles, means hand skin loses its elasticity and becomes wrinkly more rapidly.
Unless you slather them with sunscreen every day, or wear gloves with the dedication of a Victorian matron, your hands will end up looking their age as hyperpigmentation creeps in from your late 40s. And then there’s the way ageing hands go bony . . .
I try not to spend much time looking at my hands. They are good strong practical hands, with short, square palms and nails, and sturdy fingers with big knuckles.
They can type like the wind, play the accordion for Christmas carols and hold me up in a handstand but things of beauty they are not.
They are clear of age spots, however, thanks to a lifelong sunscreen habit, but they are wrinkly, red in the knuckles (perhaps from washing up without gloves) and have huge veins that jump up once I start exercising or typing.
In short, they are showing their 52 years.
Which is why I found myself sitting across a treatment couch from Dr David Jack, a Harley Street cosmetic doctor who holds my hands gently as he sizes up my “interosseous” muscles, the pads between the bones which give hands their bulk.
“The volume does tend to fall out of the hand as you get older,” he tells me. “It’s not fat loss - there isn’t much fat in the hands - but you lose muscle bulk between the bones of the hand, so you get a deepening of the spaces between the tendons, which is why hands end up looking bony and veiny.
“Women often tell me their hands look at least ten years older than their face, so I developed a filler treatment designed specifically for this delicate area, to compensate for this muscle loss.
“I use a filler called Ellansé Hands which plumps up lost volume and decreases the visibility of tendons and veins.”
The procedure is called a “handacial” and Dr Jack has seen a four-fold increase in requests for it in recent months. Ellansé is a filler launched in the UK in 2010 so is less well known than such brands as Juvederm or Restylane. Unlike most facial fillers, which are made from hyaluronic acid, Ellanse is based on tiny spheres of a substance called polycaprolactone.
As well as providing bulk where it is injected, polycaprolactone stimulates the surrounding tissues to produce more of their own collagen, to provide more of a filling effect. The treatment should last for at least two years.
Before starting on the injections, Dr Jack gives the backs of my hands a few quick bursts of Intense Pulsed Light (IPL), to break up and disperse clusters of pigmentation (even if these are not visible, some will be lurking beneath the skin’s surface).
When performed on the face, IPL usually feels like you are being lightly flicked with an elastic band; on my hands, I feel only the lightest prickling. Next come the injections, four on each hand, into the spaces between the bones, the tendons and the veins.
Before injecting each blob of filler, Dr Jack injects a tiny amount of anaesthetic just beneath the surface of my skin. I then watch with appalled fascination as he follows with injections of filler, making a small but obvious lump, and carefully, with his thumb, mashes the mixture into the space he wants it to fill.
The injection of anaesthetic hurts a bit (okay, I’m a wimp) but then I don’t feel the rest of the procedure. Dr Jack works on, neatly and methodically. I am profoundly pleased to learn he was once a reconstructive hand surgeon meaning he has an extremely good anatomical knowledge of the area.
This is vital not just to get the filler in exactly the right place, but to avoid all the tendons, veins, bones and muscles that make up the hands.
It is all over in 20 minutes. Taking a cab home, I am glad I didn’t cycle to my appointment, partly because, as always after any encounter I have with needles, I am slightly in shock but mostly because the anaesthetic made my hands feel peculiar and semi-useless.
Studying my hands later, with the pock-marks from the needles and the slight swelling where the filler is, I wonder (as I often do after trying a new cosmetic procedure) whether I have done something stupid which I will come to regret.
Hands are such delicate mechanisms, it would be idiotic to provoke an upset when they were working just fine.
I ask Fazel Fatah, a consultant plastic surgeon and a former president of the British Association of Aesthetic Plastic Surgeons, if it is reckless to go and have needles stuck into your hands in the name of anti-ageing.
“You do have to be extremely cautious when injecting the hands,” he says. “If the injector is not familiar with the anatomy of the back of the hand, there are so many tendons, veins, nerves and blood vessels that it could cause enormous damage.
“Also, it depends on the type of filler that is being injected. No one should contemplate using permanent fillers as they can cause enormous damage in the long term. Of the temporary fillers, you need to be sure that the material being injected has Food and Drug Administration or EU approval.
“Even then you have to be careful as even with approved fillers, there is a small risk of there being a reaction to the material once it is in place.”
Over the next 36 hours, my poor hands swell and redden a good deal. It is normal for there to be a certain amount of swelling but there is enough to send me scampering back to see Dr Jack just to check that nothing untoward is going on.
It’s not, thank goodness, and as the days pass, it all calms down.
A week later, my hands are looking good; they are definitely softer and look younger. However, for such a relatively small change, this is an expensive procedure - £940 (about R18 000).
Dr Jack says that most women who have the Hollywood Handacial tend, not surprisingly, to have deep pockets. “It tends to be very wealthy patients who have had a lot of other treatments,” he says.
“They are usually aged between 50 and 60, an age where the volume is starting to fall out of their hands, so for them it is the last detail they want to address.”
As for my rejuvenated hands, while I’m on my way to have the “after” picture taken, I remember another trick for making your mitts look better.
As a debutante in the Fifties, my mother was amazed to find that one of her fellow “debs” insisted on holding her hands up in the air as she sat in a cab on the way out to dinner or a dance.
Then, when she arrived and her hostess took her hand in greeting, it would be pale and cool, with not a vein in sight.
Guess what? It still works.