Even in Hollywood, where faces have been plumped, nipped, filled and pulled in a quest to look decades younger, hand care can be neglected, revealing the age people spend thousands of dollars to hide.

Crepey dry skin, dark spots and prominent veins are the giveaways.

“If you did a cross-section of the skin when we're younger versus older, we see that the skin becomes a lot thinner,” says Dr. Michael Zarrabi, a cosmetic and reconstructive surgeon in Southern California. “We lose a lot of collagen and elastin — that's what gives the skin elasticity so when it's pulled it springs back. We also lose a lot of the subcutaneous fat as we age. ... So the anatomy of the back of the hand — the veins and the tendons — becomes more visible.”

Another issue: Hands are vulnerable to UV damage. “That can cause brown spots on the backs of the hands,” says Zarrabi, who sees more sun damage and skin cancers on the left side (the driving side) of the face and left hand than the right.

At a minimum, he recommends using a daily moisturizer and sunscreen with a 45 SPF or higher on your hands.

Dr. Anne Taylor, vice president of the American Society of Plastic Surgeons' health policy and advocacy committee, says that increasingly she's seeing doctors using injectable fillers in the hands to add back a youthful plump. This year, Radiesse became the only dermal filler that has been approved by the U.S. Food and Drug Administration for hand augmentation, but Juvaderm and Sculptra are also being used, off-label, Taylor says.

Dr. Scot Bradley Glasberg, past president of the plastic surgeons' society, says that in addition to those fillers, “fat injections must be included in hand-rejuvenation discussions, as this is being used more and more.”

Zarrabi uses Radiesse, which is usually used for facial contouring, as part of his “hand-lift” treatment (about $1,600-$2,800). “It's basically a combination of nonsurgical procedures to help improve the aesthetics of the hand,” he said.

He anesthetizes the hand with a few small injections, “and then we very carefully inject a volumizer, mainly Radiesse, in the subcutaneous tissue, filling in areas, particularly between the tendons, to help alleviate hollowing,” he says. Immediately after this process, he does a laser treatment on the back of the hand to remove brown spots. He says one laser treatment can eliminate from 80 percent to 95 percent of brown spots.

He generally sees patients again about three weeks later to remove any lingering spots.

“Laser technology is getting better and becoming more specialized. … Just like anything else, the hand-lift is an evolution. We've used different fillers [including fat] and different lasers. … We're always looking to the next step in the evolution,” he says. “The results of a hand-lift are quite amazing, but it's important to understand the procedure is going to be an improvement; we're not going to take anyone's 50-year-old hands and make them look like they're 20.”