In this episode of Carpools & Cannulas, Dr. Gallus of Restore SD Plastic Surgery in San Diego, CA, and Dr. Greer of Greer Plastic Surgery in Cleveland, OH, discuss the ways to turn back the clock on the hands. Want to keep your hands from revealing your age? Listen in as the experts dish!
Transcript
Dr. Greer: Hey guys, it’s Dr. Greer. And Dr. Gallus will be joining me in a minute and we’re gonna talk about hand rejuvenation. And you’re probably going to have a cat. There he is. You’re gonna have a cat butt in a sec. And there it goes. He’s fun that way. He’ll probably knock over a plant at some point too. All right. And then, we’ll look for Dr. Gallus. See if she is on. The cat is literally right next to my phone.
Dr. Gallus: Hello.
Dr. Greer: Good. How are you?
Dr. Gallus: How is it going? Oh, I guess I’m under Gallus, whatever.
Dr. Greer: Oh, yeah, I just invited both because I didn’t know what you would be under.
Dr. Gallus: That’s okay. My middle daughter broke her phone again while we were in Hawaii, so she was using mine. And now, when I log on, since she used mine, there’s, like, 18,000 accounts on Instagram logged in because, you know, all the teenagers have, like, four Instagram accounts.
Dr. Greer: Really?
Dr. Gallus: It’s ridiculous.
Dr. Greer: Oh, okay. I guess I have, like, two.
Dr. Gallus: I know. It’s accounts where you can follow people, secret accounts, private accounts. Yeah.
Dr. Greer: Wow. Yeah. I’m not that cool.
Dr. Gallus: Yeah. For sure.
Dr. Greer: How was Hawaii?
Dr. Gallus: Yeah, I’m not that cool either. So it was good. It was really nice. It was relaxing. The weather was beautiful, because it’s always beautiful there, and I don’t know.
Dr. Greer: Nice.
Dr. Gallus: It was just chill. So, now I’m back. I had a killer week in the OR last week, because that’s what happens when you get back from vacation. And yeah, still going strong.
Dr. Greer: Ooh, somebody from Denver is watching. Hi. I went to Denver once.
Dr. Gallus: Oh, cool.
Dr. Greer: Nice.
Dr. Gallus: I’ve been to Denver. I’ve been skiing out there, not Denver, obviously.
Dr. Greer: Cool.
Dr. Greer: So, hand rejuvenation. Yours are definitely younger than mine and look class.
Dr. Greer: Only because I laser them all the time.
Dr. Gallus: All right, well, let’s start with laser. What do you use the laser for?
Dr. Greer: I do BBL on my hands, but then I’ll get like…have you ever seen a really flat seborrheic keratosis? And they’re hard to tell, like, from a solar lentigo, but I’ve had a couple of those off that I’ve done ablative spot laser on too, and it worked really well. The only thing I warn patients is the scar stays pink for, like, six months. It stays pink forever.
Dr. Gallus: Oh, for the seborrheic?
Dr. Greer: Yeah. It is IPL but it’s just a different brand.
Dr. Gallus: So the BBL Hero is Sciton’s. So, it’s an intense pulse light. So for our audience, that generally targets pigment. Yeah. So, I have an IPL. I’ve stacked it with fractionated CO2 on the hands. It’s nice because it’ll hit the pigment.
Dr. Greer: Hi, hi Amanda, how are you?
Dr. Gallus: Oh, so you use the BBL. So use that pretty frequently. When you say frequently, like everyday, every week, every month?
Dr. Greer: A couple of times every year.
Dr. Gallus: Okay, I feel like our personal goals would be to do something to your hands every month, but what ends up happening is it’s twice a year, which is great.
Dr. Greer: I feel like quarterly would be a really great goal for me to have strived to, but I…
Dr. Gallus: Because it takes, like, a hot second to do it.
Dr. Greer: Yeah, it doesn’t take long.
Dr. Gallus: Great. Do you numb for that?
Dr. Greer: Although, you know, I’m doing a Vivace radiofrequency microneedling on my chest tomorrow. Maybe I’ll just hit my hands too.
Dr. Gallus: Yeah, sure. Why not? Yeah. And also I live in Southern California where, you know, sun exposure is a thing. And so, even if people take good care of their face, etc, etc., it comes up all these areas that you maybe didn’t pay such close attention to. Chest is probably number one. Number two would be hands, and now I have people bugging me about the area right above their elbow…
Dr. Greer: Well, I always feel like hands are tough because chest, you can put sunscreen on. Hands you put sunscreen on and you wash them an hour later, and it’s hard to keep the light out. Like, I’ve noticed just being outside I have more freckles on my hands now that are popping up. Annoying.
Dr. Gallus: Yeah, I feel like unless you’re a proponent of the riding glove or driving glove, you’re not, which I do. I do have a couple of those patients which, props. So, they have little driving gloves in their car and they put them on so that there’s…I mean, that’s most exposure. For a while I tried to keep Supergoop, they make a handscreen. So, it’s hand lotion with sunscreen in it in the car so I would remember to do it, but I am just not that attentive. But yeah, so we do IPL, but we have the Rohrer fractionated CO2 laser, and it actually has a box attached to the side of it. And you disconnect the laser that you would normally do, you know, face whatever with, and you attach it to this box and you put your hand in the box and it’s fractionated CO2 laser on the hand.
Dr. Greer: Wow, that’s amazing.
Dr. Gallus: It’s amazing. Yeah. And so that also only takes a few minutes. I don’t numb for it. Most people don’t need to numb for it. And then it does, it thickens the skin on the back of your hand. And it’s not as great at pigment obviously because IPL. That’s why I’ve stacked it for people before. But it definitely works, so much so that I did my right hand three times, like when we first got it, and didn’t do anything to my left hand just so you could see, like, the effect, and it’s definitely… You can see the veins in my hand were much clearer, you know, everything was…the quality of the skin was totally different. Skin tone, darker skin tones?
Dr. Greer: Because IPL is tricky on darker skin tones. You can do fractionated laser though and that will help build collagen. If there’s a lot of pigmentation changes, you can do a very cautious BBL.
Dr. Gallus: I would say fractionated CO2, because the hand skin can take it pretty well and you can do a lower setting, because we’ve played with that as well. But yeah, so I’ve done that. And I’m actually prone to hyperpigmentation and I didn’t have any, like, post-inflammatory hyperpigmentation. And I do pretreat my face if I’m gonna CO2, but with the hand, no, and it just had no issues. I do not get any new wrinkles.
Dr. Greer: Yeah. We have fractionated erbium. That’s what the Sciton has. But then, if we’re doing a Halo peel on the face too, we can also do the hands. And the Halo’s got dual-wavelengths, so it does the fractionated and then it does a fractionated deeper layer, which… So, that’s really good for uneven pigmentation and that would be great for darker skin tones too.
Dr. Gallus: Yeah. So yeah, I love the laser for the hands. You just have…the CO2 leaves it scratchy for about a week to 10 days. It just seems, like, kind of like a cat’s tongue. It feels like sandpaper. And you would keep it extra moisturized and, you know, stay out of the sun if you can stand it.
Dr. Greer: I try not to use hand sanitizer a bunch.
Dr. Gallus: Yeah. But I’ve scrubbed with it and it’s fine. It’s not like CO2 on the face or anything. And then, I am looking at doing it to, like, upper arms, that area over your elbow. I did CO2 to someone’s anterior thighs today.
Dr. Greer: Fun, for that crepiness?
Dr. Gallus: We’ll see how she does. Yeah, for that crepey skin. So you can do the… You have a Vivace and I have the Virtue, but basically, you can do frequency microneedling. You can do both of those to improve laxity too. So yeah, there’s really no reason you couldn’t do that to the hands.
Dr. Greer: Yeah, for sure. It just starts to get prohibitively time-consuming if you’re, like, trying to do your entire anterior thigh or like the entire inside of your upper arm. It’s a lot.
Dr. Gallus: Oh yeah, for sure. Yeah, you kind of want to break that up, but the hands are easy to throw in there. Anything to stimulate collagen and thicken the skin on the hands is gonna help just in general.
Dr. Greer: Yes. And then when they get thin and you can see all the tendons and we start adding filler or fat grafting.
Dr. Gallus: Right. So, what is your filler of preference for the hands?
Dr. Greer: I’ve been using Radiesse for hands, which is nice, especially since it’s the 1.5 cc syringe and it spreads out so nice and evenly. So, that’s nice for volume. I know some people do Renuva, which is like the process-sterilized fat. What do you like?
Dr. Gallus: I have done both of those.
Dr. Greer: I haven’t.
Dr. Gallus: Do you ever do Lyft?
Dr. Greer: I should try though.
Dr. Gallus: I have done… Yeah, I like Radiesse. Do you do one syringe?
Dr. Greer: I do one per hand.
Dr. Gallus: Or you just split it? Or do you do one syringe each hand?
Dr. Greer: Yeah.
Dr. Gallus: So I like to hyper-dilute the Radiesse, and then… Well, not hyper-dilute it, dilute it a little bit more and then use that. Yeah. Because when you put the, you know, one and a half syringes of Radiesse, it’s like injecting chalk in someone’s hand.
Dr. Greer: Very stiff and then you rub it to spread it out and work it in.
Dr. Gallus: Yeah, and massage it. So I think originally when I was trained on it years ago, they had the patient sit on their hands, right?
Dr. Greer: Yeah, to, like, warm it up and then massage it out.
Dr. Gallus: Yeah. But then I was like, or I could just dilute a little bit and then it’s not so painful to do that. And then do you do a cannula or do you do needle?
Dr. Greer: I just do the needle. I am not a big cannula person.
Dr. Gallus: Same. So, yeah, I just do the needle. And so, yeah, we’re talking about a filler that is supposed to also stimulate collagen. So not only is it adding volume, but it should theoretically continue to stimulate collagen. I have Radiesse in my hands right now actually from, I don’t know, a couple of months ago. And then I’ve used Renuva. The verdict is still out on that on a patient. She’s very skinny, so I don’t know if it’s because she doesn’t have a lot of fat. Because it’s a scaffolding, so you’re not really adding volume, you’re adding this…you know, sterilize somebody else’s fat scaffolding in there, and then your body’s supposed to come in and put fat. And I’ve had it work with a BBL, like a supercharged BBL where we weren’t doing a ton. So taking one’s fat and mixing it with the Renuva, and then putting it in, and that’s worked really well. But in the hands, I just inject it into the hands and it’s sort of like… And I asked, you know, the company again about it, Usha, who does it a lot, and she’s like, “Oh, I just need to do another round.”
Dr. Greer: How does that compare price-wise to Radiesse? Yeah.
Dr. Gallus: It’s expensive. So, it’s about, for 1.5 ccs… It comes in 1.5 cc and 3 cc, and I feel like it’s $3,000 and $5,000. So it’s expensive. However…
Dr. Greer: Compared to Radiesse, it’s like $725, $750.
Dr. Gallus: Right. Yeah. So then you have to wait three to six months for the result. So I’m waiting to see how that is helpful to anybody.
Dr. Greer: Let me know.
Dr. Gallus. I know. I was excited because it seemed like a good alternative. Certainly, if it’s more permanent than a filler that would be nice, right?
Dr. Greer: Right, but if it doesn’t work and you drop $3,000, that’s not real fun. People love that.
Dr. Gallus: That’s not ideal. “I can’t see a difference.” “Oh, really? Let me see.” Yeah.
Dr. Greer: Oh, cat. Cat tail. Cat head.
Dr. Gallus: My dog is sleeping…
Dr. Greer: This is my massive cat.
Dr. Gallus: …behind the couch.
Dr. Greer: He’s like 16 months.
Dr. Gallus: Oh, yeah.
Dr. Greer: Really cat?
Dr. Gallus: Oh, my God.
Dr. Greer: He just smacked out my water. He just, like, flopped his big old butt right down. You can come back. You’re fine. Hilarious.
Dr. Gallus: You can see my dog in the background.
Dr. Greer: Oh my goodness.
Dr. Gallus: Where? Where is the cat? Okay, so yeah. So I have not used Lyft personally, but you can use it. It’s a hyaluronic acid, right? So…
Dr. Greer: Higher G prime so thicker projection. It’s more stiff. It’s, like, more structurally supportive. It interests me so much that we use all these stiffer high-G prime fillers for the hands. Like Radiesse is so stiff. I normally use it in cheekbones. And hands strike me as thin skin, and yet that’s what’s FDA approved.
Dr. Gallus: Yeah, that’s true. Like you’d think you want something softer.
Dr. Greer: Yeah, or like a contour, nice and fluffy, like the Restylane Contour.
Dr. Gallus: I think, I mean, well, Restylane Contour they probably just didn’t feel like doing studies to show…
Dr. Greer: I have to ask around though and see if anyone’s using that in the hands, because it’s nice, big fluffy particles with a low G prime so it’s softer.
Dr. Gallus: I just think if you’re gonna use a product, I feel like Radiesse is gonna last longer, right? And then the other one that I don’t have any experience with, but I bet someone’s injecting, why wouldn’t you inject Sculptra into the hands?
Dr. Greer: I was actually just questioning that myself. Like, you could. I mean, I don’t think it’s mobile enough where it’s gonna form, like, nodules.
Dr. Gallus: No, if you hyper-dilute it, like, then you just put it in and it should last just as long and just massage it… I guess maybe just some massaging part postoperatively it should work, post-procedurally, or whatever.
Dr. Greer: I know. These are the fun things we question ourselves. We’re like, “Can I inject this here?” Try it. Let’s try and see.
Dr. Gallus: Where can I put this? Why hasn’t somebody tried this yet? Why isn’t this… Maybe because Radiesse… I really feel like Radiesse is effective, and I think it’ll last longer. The only reason we don’t use Radiesse all over the face is that it’s not reversible easily.
Dr. Greer: Well, it is stiff too. I don’t like it in smile lines. I feel like it’s way too stiff.
Dr. Gallus: Yeah, I only put it basically in the cheeks.
Dr. Greer: Yeah, I’ll do a little to the jawline too.
Dr. Gallus: Yeah. The jawline is nice too actually, somewhere deep but not superficial. I have tried it in the neck…
Dr. Greer: Yeah, what’d you think?
Dr. Gallus: …for necklines, hyper-dilute and I wasn’t a fan.
Dr. Greer: Yeah, I’ve tried hyper-dilute in upper arms. I mean, you could tell it built some collagen but it didn’t look amazing.
Dr. Gallus: Yeah, I have used it successfully in the area above the knee, which is slightly different skin. So that worked. But again, it’s supposed to be bio-stimulatory and stimulating collagen. So, maybe that’s what’s really happening.
Dr. Greer: It’s hard to know, so many different fillers that vary just a little bit.
Dr. Gallus: Yeah, I mean, that’s all I have for the hands in my…
Dr. Greer: There’s not a ton we can do for those really.
Dr. Gallus: Lasers and fillers. There’s no hand tuck. No one’s created that yet.
Dr. Greer: Maybe we should make that up. Did you ever see the show “The League” about a fantasy football league? There was a plastic surgeon on there who specialized in, like, toe shortening. That was this thing. He would, like, shorten your long second toe. And I was like, “I need a really niche procedure like that.” Like maybe lobe tucks. Those are fun.
Dr. Gallus: Those are fun. I know. I notice… But that’s something that unless a patient notices, you don’t wanna bring up. But on some of my older patients, I’m like, “I can just…”
Dr. Greer: Your lobes are big y’all. We can just… It’s so fun. It’s just like a little snip. And then your ear is perky again and it’s good. You could do it in the office.
Dr. Gallus: Mm-hmm. Yeah. And if your earrings are, like, sagging, it’s dragging on the ear. It totally helps with all of that.
Dr. Greer: It does. Your lobes get bigger. They continue to grow.
Dr. Gallus: Yes. But somehow, the skin on your hands does not, so I’m not aware of any wrist lift.
Dr. Greer: No. I’d still like to have, like, a box you just stick your whole hand in. That’s fun. Does it do the fingers too or just the…
Dr. Gallus: Yeah, it’ll go all the way. I mean, literally, it shows a grid and it just goes across, and it’s on a piece of reinforced plastic.
Dr. Greer: That’s fun.
Dr. Gallus: So, you know, in between, it’s not hurting anything. It’s hitting that plastic. People are always like, “What else can I put in there?” I’m like, “That’s a weird question, but you could stick your whole arm through it if you wanted.
Dr. Greer: I remember, when I was in residency, I rotated with a dermatologist who did a lot of cosmetic derm. Like, I remember she was on one of the Latisse commercials. And she had, like, Fraxelled her entire arms multiple times. They looked amazing. But it was like, “God, that would take forever.”
Dr. Gallus: Yeah, I know. The thing is, yeah, you could do that. But it’s sort of like… Kim Kardashian had a post earlier this week on where she was getting…was it Morpheus8? She was getting basically…yeah, because she spelled it wrong, which I thought was hilarious. Sorry. Like, she was getting that done to her anterior abdomen, which I’ve done the Virtue for that. You just put topical numbing, the cooling jet, and just do that. I have had a handful of patients who’ve wanted that, and it just tightens the skin up a little bit. But it really is for people who have time and…you know, and you’re like, “Oh, I know what it could use.” I’m thinking, “Oh, I should do that.” But again, I can barely get around to my face, so I don’t know.
Dr. Greer: Oh, I know. My chest is getting like just a little vertical lines, you know, when you wake up and it’s been all smushed all night. So, I’m like, “Okay, I should really do that.” And then, I was going to do my second treatment last week. Did I do it? No. So I’m doing it tomorrow. It’s just like something else that always comes up.
Dr. Gallus: Right? Yeah. And then you’re like, “Oh, I’ll do it next week.” And then it’s three weeks later and you haven’t done anything. Yeah, 100%.
…
Dr. Greer Yeah, or that we haven’t talked about in a while? I mean I love all breast surgery
Dr. Gallus: I’ll be doing a massive weight loss breast lift this week. So we’ll see.
Dr. Greer: Yeah, I saw that.
Dr. Gallus: I mean, I definitely am going to use lateral breast tissue, because she has a lateral roll. I’m not going to throw that away. So I’m going to rotate that up. It’s just whether I do a superior medial pedicle or inferior one.
Dr. Greer: Yeah, I do one of those. I do superomedial pedicle and then I leave the breast tissue on the inferior pedicle and free it up and then tuck it up under. What is that, the Ribeiro technique?
Dr. Gallus: Right. Yeah, Ribeiro.
Dr. Greer: Yeah. Yeah. And that gives you really nice upper pole fullness.
Dr. Gallus: Right. It’s just then where do you rotate the lateral tissue in before you just…?
Dr. Greer: Well, the patient I did that on didn’t have a lot of lateral. So. Yeah. Because it’s nice if you can pull that in and make breasts out of it.
Dr. Gallus: Yeah, because she doesn’t have a ton of volume, so it’ll really… You know, we don’t like to throw things away as plastic surgeons.
Dr. Greer: Yeah, you have to bring that in. But then if there’s an inferior pedicle, how do you bring that lateral in? Wouldn’t the inferior pedicle just get…?
Dr. Gallus: They almost do like a central mound and bring everything up and around, kind of like, take the breast tissue off and then it’s a spiral or something comes around.
Dr. Greer: Sounds fun.
Dr. Gallus: It’s just superior pedicle once I wrap my head around it.
Dr. Greer: This is the fun part of plastic surgery is like a three-dimensional visualization of, “Where can I take that and then tuck it here?” And it’s crazy. Like, we just think of crazy stuff and lay awake at night. Which reminds me, have you read the book, “The Face Maker” by Lindsey Fitzharris that just came out?
Dr. Gallus: I did.
Dr. Greer: Oh my gosh, they were doing the craziest stuff. We’re talking like 1916 and they’re, like, doing these amazing facial reconstructions, but it would be, like, 25 stages.
Dr. Gallus: Right. Yes, I did read that. It was incredible. I also thought, “Wow, a lot of these people smoked when they did this.
Dr. Greer: Right, but they were, like, doing pedicles…like transfers, like, based on lateral pedicles here and they’d, like, take all of the skin on the chest. But what was blowing my mind is then they took skin grafts from just random people and put that on. Like, that doesn’t really work.
Dr. Gallus: I know. I was like… I know they were just making stuff up. It was crazy.
Dr. Greer: Yeah. But I loved it at the end of the book… So, this guy, pioneer plastic surgery, and then he does… he did a…what? Phalloplasty. He did a female-to-male transgender surgery. And we’re talking like 1940,1950.
Dr. Gallus: Right? Yeah.
Dr. Greer: Let me think on that.
Dr. Gallus: She is like, “What’s the idea? I’d love to check on that.” Yeah, that was a great book. It was really incredible. And it was… For people who aren’t plastic surgeons, it’s still interesting and I recommend it.
Dr. Greer: And the pictures at the end are just incredible. Did you read her other book, “The Butcher In Art?”
Dr. Gallus: No, I haven’t read that one.
Dr. Greer: So good. It was about the onset of sterile technique and, like, antisepsis in the 1870s, because people would just die from compound fractures and then they discovered carbolic acid would kill the germs. So it’s about Lister. It’s fascinating, though, because that was before they had anesthesia. At least for World War I, they had ether and they were knocking these people out. But then, it was like, “How fast can I amputate this leg? Let’s do a minute.” And then I don’t know how they got hemostasis. They didn’t have cautery. They weren’t like clamping and tying. I think they were just, like, wrapping it up and hoping for the best.
Dr. Gallus: I know. Yeah. It is kind of insane what they did, I guess it’s, you know, necessity, right? You don’t have an alternative, but it is kind of bananas. And it’s slightly depressing that it’s a catch-up to modern, or at that time modern warfare, right? So, like, weapons of destruction advanced faster than our ability to clean up after it. That’s how it became a necessity.
Dr. Greer: Although now, our ability to, like, preserve life… Well, I mean, you were in the Navy, so you were actually deployed. But it’s kind of crazy how they can pack people up, stabilize them, ship them, and then they have these major reconstructive surgeries in, like, Germany. And then you get somebody back who has like no arms, no legs, and no eyesight, and it’s like, “I don’t know. Was that good?”
Dr. Gallus: I know. Right. Yeah. Yeah. The ability to resuscitate because we’re moving so far forward means that people who would have never survived tend to survive. But yeah, definitely.
Dr. Greer: I’m gonna hit all the deep ethical questions now that it’s like, 8:57.
Dr. Gallus: Now that we’ve covered hand rejuvenation. Wildly variable. All right, cool. All right. Well, we’ll come up with some sort of surgical procedures for next time. All right.
Dr. Greer: You too. Bye.
About Restore SD & Dr. Katerina Gallus
As the Director of Restore SD Plastic Surgery, board certified female plastic surgeon Dr. Katerina Gallus has over 15 years of experience helping San Diego patients enjoy head to toe rejuvenation with face, breast and body procedures. After a successful career as a Navy plastic surgeon, Dr. Gallus founded Restore SD Plastic Surgery with the intention of creating a welcoming space for anyone seeking cosmetic enhancement.
Restore SD Plastic Surgery offers popular facial rejuvenation procedures like facelift & neck lift, facial fat grafting, and eyelid lift; breast augmentation with implants, breast lifts or breast reduction; body contouring procedures such as tummy tuck, liposuction, mommy makeover, and Brazilian butt lift (BBL), as well as aesthetician services, BOTOX, injectable fillers, and laser treatments.
Dr. Gallus and her highly-experienced aesthetics team are here to help you look and feel your best! To schedule a personal consultation, please contact us online or call our San Diego office at (858) 224-2281 today.
