Aged Hands, Necks
& Decolletage

what causes them?

The lines in your palm won’t reveal any secrets about your life, but the back of your hands might.

Patients often take great pains to pamper their faces but neglect to take care of other exposed areas like hands, necks and decolletage. As a result, these areas appear incongruent with the face, especially if it has been rejuvenated through aesthetic medicine procedures. This can give rise in socially awkward situations where this disconnect leads others to realize that the patient actually has had a lot of work done on their face.

As fat wastes away over the years and collagen production slows down, the hands, necks and decolletage get that “sunken” look: the skin becomes thinner, tendons and veins become more prominent, and wrinkles multiply — in other words, they look old.

Evidence-Based Treatments

to treat aged hands, necks & decolletage
safely and effectively

Dermal Fillers

Injectable dermal fillers are intended to fill in lost volume, giving a smoother appearance. Most fillers are temporary and are eventually absorbed into the body. Temporary fillers can be classified into 2 broad groups:

  • mainly volume replacement - these are most commonly composed of hyaluronic acid, which draws and binds water to itself and the surrounding skin
  • collagen stimulating - contain materials such as polynucleotides, calcium hydroxyapatite, polycaprolactone or poly-L-lactic acid that cause the body to produce collagen in response

Fillers can be injected deeper to volumize sunken grooves. They can also be injected more superficially using an injector gun to hydrate the skin and ameliorate fine lines (Hydrashine / Skinboosters).

Fractional Infrared Lasers

Fractional laser resurfacing involves the deposition of a pixelated pattern of microscopic laser wounds surrounded by healthy tissue resulting in both greater efficacy and shorter downtime compared to non-fractionated treatments. It can be further subdivided into ablative and non-ablative. Ablative fractional lasers have longer wavelengths (e.g. CO2 10600nm) and lead to full-thickness destruction of skin, whereas non-ablative fractional lasers have shorter wavelengths (e.g. Erbium Glass 1550nm) and leave an intact skin surface. CO2 has greater efficacy compared with Erbium Glass but longer recovery time and a higher risk of complications.

Fractional Infrared Lasers have a good body of research evidence demonstrating safety and efficacy.

Fractional Picosecond Laser - Discovery Pico Plus

Quanta Discovery Pico Plus is a second-generation triple wavelength picosecond laser that generates the highest peak power in the world. A special microlens array further focusses the energy into numerous micro-beams 2mm under the skin. The highly concentrated energy produces laser-induced optical breakdown (LIOB) stimulating collagen production with almost no downtime.

Fractional Bipolar Radiofrequency

Fractional Radiofrequency creates a pyramidal thermal injury zone (a relatively large coagulation zone deep in the skin with minimal surface damage) as opposed to the columnar shape of ablative lasers. Hence Fractional Radiofrequency has a favourable side-effect profile (such as downtime, post-inflammatory hyperpigmentation) in comparison to fractional lasers.

Fractional Microneedle Radiofrequency

Skin remodelling requires heat delivery to the deep part of the skin. However, in most machine-based treatments for scarring such as lasers, much of the energy is dissipated at the skin surface and little reaches the deep layers. Fractional microneedle radiofrequency overcomes this using insulated microneedles to spare the upper part of the skin and deliver radiofrequency energy precisely up to 4mm deep in the skin, resulting in faster recovery, higher efficacy and increased safety.

Fractional Thulium Laser

Thulium laser has a wavelength of 1927nm and is able to selectively remove only the superficial layer of the skin where most of the pigmentation is concentrated, leading to a whitening effect, collagen stimulation and improvement in pigmentation. Due to the very controlled damage when applied in a fractional manner, there is very minimal downtime.

1Aesthetics's View

dr wan's perspective

Revitalization of the neck, hands and decolletage is an often overlooked part of aesthetic medicine practice. An effective skincare regimen and facial aesthetics intervention might help you look years younger than your true age but the prominent tendons and veins on the back of your hands, dark spots and wrinkly skin on your neck and decolletage might be telling a different story.

Dr Wan makes it a point to assess the patient holistically, not just the face but the hands, neck and decolletage. There are many available techniques but Dr Wan usually uses a mix of rejuvenation techniques targeting each affected layer from the skin surface to deep structural volume loss.

UV protection and avoidance, as well as topical medications or products, are critical to improve and maintain the results.



  • Fractional energy devices tighten the skin in the area - which to use would depend on the thickness of the skin and severity of the wrinkling
  • Deep, bound down lines (typically horizontal neck lines) may need subcision followed by filler

Volume loss

  • Fillers replace the lost volume, making the underlying veins, tendons and grooves less visible
  • Hyaluronic acid fillers draw water and hydrate the overlying skin, reducing the appearance of wrinkles
  • Fillers can also stimulate collagen production to tighten the skin.
Dr Wan Chee Kwang

Dr Wan Chee Kwang


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