Dr. WorldWide | Frank Agullo, MD

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Last month, a producer over at GB News got in touch and posed a simple question: What is one change you would recommend to keep your hands from aging?

Sunscreen. And the talking did not stop, for the obvious reason that you do not fix 100 percent of life in a $15 tube of moisturizer. I wanted them to remember how completely ridiculous it was.

Here’s what I actually tell patients, in the order I tell them.

Why Your Hands Age Faster Than Your Face

I spend most of a facelift consultation talking about fat pads, retaining ligaments and skin quality on the face. Nearly no patient will ask me the same question about their hands even though it is exactly the same biology occurring on their hands, only more quickly.

Back of your hand skin is much thinner than the skin on your face anyway; the fat pad on it is smaller and thinner, thinning out faster over time. Over a lifetime your hands get a good amount more sun exposure than your face will get because NOBODY remembers sunscreen while they are at a car steering wheel, pulling a shopping cart, working on a computer laptop, etc.

Brown spots and thin, crinkled texture on the backs of hands often show up years before similar changes on patients’ faces. This phenomenon is a normal aging process rather than a disease and occurs because years of unprotected sun damage take their toll on the delicate, less pliant skin of the hands.

The Habit That Actually Works

Sun protection is the single most important habit, and I stand by that answer. Most of the brown spots and crepey texture I see on the backs of hands trace back to sun exposure, not age by itself.

The fix is boring and that’s exactly why it works. Broad-spectrum SPF 30 or higher, every morning, on the backs of both hands. Reapply after you wash your hands, because soap and water strip it off faster than most people expect. That’s it. No serum, no device, no appointment required.

The Four-Step Routine I Give Patients

Sunscreen buys you prevention. It doesn’t rebuild what’s already thinning or fade a spot that’s already there. So I layer three more habits on top of it.

Be upfront with the timing as I do not want to give a false impression with a claim. Both retinoid and vitamin C need to be applied 2-3x weekly and titrated upwards as tolerated, and no patient of mine has really seen significant changes from these before 8-12 weeks. That is not marketing hyperbole; that is an educated estimate on observed effects using either/both of those ingredients on the face; hand skin works on pretty much the same biological timescale as skin on your face.

What the Sunscreen Evidence Actually Shows

I get skepticism about sunscreen more than almost anything else in my practice, usually some version of “does it really matter that much?” It does, and hands are actually the cleanest proof I have.

Cumulative UV exposure breaks down collagen and triggers the pigment changes that show up as brown spots. Hands take that exposure in a way faces mostly don’t anymore, because most of my patients already wear a facial sunscreen or a moisturizer with SPF built in and have for years. Almost nobody extends that same habit past the wrist. The result is a natural experiment running on every patient who drives, gardens, or works outdoors: protected face, unprotected hands, and a visible gap in aging between the two by the time they’re in their forties or fifties.

Sunscreen applied every single day is the main contributor to collagen decline. No other part of a regimen, be it ceramides, retinol or vitamin C, will be as effective without it; the latter two work as helpers to the skin’s underlying support system. It is of no use to treat the problem if the problem source remains unchecked.

When Home Care Isn’t Enough

A consistent routine can preempt many of those future problems, as well as improving skin that has begun showing such changes. Of course, it has limits.

Deeper pigment, more established crepey texture, and visible tendons and veins from real volume loss are not things a cream alone will reliably clear. That’s when I bring in-office tools into the conversation: laser resurfacing and IPL for spots and skin quality that creams can’t touch, and chemical peels for texture. If the issue is actual lost volume rather than skin quality, that’s a different conversation entirely, and I’ve written about it separately, because filler and biostimulators solve a different problem than sunscreen and retinoids do.

Why I Think About Hands Like a Face

I did my plastic surgery fellowship at Mayo Clinic and I’m a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. Castle Connolly has named me a Top Doctor for thirteen straight years running.

Yet, the above points do not make me a dermatologist by trade. My process for the hands is just the same as my approach to the face: 1) assess what is truly the underlying cause (UV damage/texture changes, compromised moisture barrier, loss of hyaluronic acid/collagen, fat loss). 2) Once that is defined, reach for the correct skincare or tool to address that specific concern. Basically, do what you do with your face for your hands.

One More Thing About Filler

A variety of fillers and biostimulators can be considered for hands; these are both regularly utilized in my practice. However, I will caution that neither is a substitute for an effective skincare routine.

A patient who’s been sun-damaging their hands for thirty years and shows up asking for filler still needs the sunscreen, the barrier repair, and the retinoid, whether or not they add volume on top. Filler restores what’s missing underneath the skin. It doesn’t fix the skin quality sitting on top of it. Skip the routine and you’re paying to maintain a result the sun is actively working against.

Why Choose Dr. Agullo for Hand Skincare in El Paso

Patients come to me from across Texas and beyond, and roughly sixty percent of my current patients travel in from outside El Paso. I think about hand aging the way I think about facial aging: as a structural problem with a preventable component and a treatable component, not as a single product decision.

Ready to Talk?

A hand-skincare consult is short. I check the skin, the barrier, the pigment, and tell you honestly whether a routine will do the job or whether you need something more.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

Cross-links

• Patient-facing version on agulloplasticsurgery.com: “The Hand Routine I Actually Recommend Before Filler” (link once live)
• Practice version on swplasticsurgery.com: “Southwest Plastic Surgery’s Hand Prevention Protocol” (link once live)
• Companion post: Hand filler and hand rejuvenation, published on all three sites (drworldwide: https://www.drworldwide.com/hand-filler-rejuvenation-surgeon-read/)
• Source: GB News, “How to look younger: Doctor shares the ‘single most important habit’ to slow ageing on your hands,” Sarra Gray, July 20, 2026. https://www.gbnews.com/lifestyle/spf-how-to-look-younger-hands

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The Last Stretch of Summer: The August Med Spa Specials I’d Actually Book

I put together this month’s Med Spa board in late July, sitting at my desk after clinic, and I kept coming back to the same thought while I looked at what my team had lined up. August in El Paso still has the pool open, the sun is still doing real damage between about ten in the morning and five in the afternoon, and by this point in the summer most of my patients are not asking me about sunspots anymore. They are asking about their eyes. Tired eyes, puffy eyes, the kind of look that concealer does not really fix because concealer was never built to fix skin that is worn out.

So the board this month has three things on it, and honestly two of them are going after that same eye problem from two different angles, while the third one is about getting ahead of your own body before summer runs out. I want to go through all three the way I would if you were sitting in the chair across from me, because a flyer with a percentage sign on it does not tell you much on its own.

Renew. Laser Hair Removal, 15% Off Bikini and Underarms Packages.

I tell people August is actually a smarter month to start laser hair removal than January, and most people do it the other way around because January is when the resolutions hit.

The way the laser works is not complicated once somebody walks you through it. The device is tuned to a wavelength of light that gets absorbed strongly by melanin, which is the pigment sitting inside your hair. That light turns into heat once it hits the follicle, and if there is enough heat the follicle gets damaged, and damaged follicles either grow back thinner and sparser or, for a good number of them over time, stop growing hair at all. None of that is controversial and it has been understood for a long time.

The part that trips people up is that your hair is not all on the same clock. Every individual follicle has its own cycle, an active growing phase and then a resting phase, and it goes through that cycle more or less on its own schedule, not in sync with the follicle next to it. The laser can only damage a follicle that happens to be actively growing right when you are being treated, which means a follicle that is resting that day walks away untouched and will need to be caught on a later visit once it wakes back up. That is the actual reason this is sold as a series of appointments spread a few weeks apart rather than as one visit that finishes the job. You are not buying one treatment, you are buying enough visits to eventually catch most of your follicles somewhere in their growth phase.

Bikini and underarms get bundled together as a starter package mostly because they are both areas that cycle relatively quickly and respond well, so pairing them tends to be a better deal than paying for each one on its own schedule.

I will also say, because I think every patient deserves to hear it before they book, that skin tone changes how this has to be done. Darker skin has more melanin in the skin itself and not just in the hair, and that changes both the risk of a burn or a lingering pigment change and the settings the device needs to be run at. That is a judgment call for trained staff working under a physician, not something that should be run the same way for every single patient who walks through the door regardless of skin type.

Restore. Morpheus8 Under Eye, $800 for a Package of Three.

Morpheus8 has been part of my practice for a while, and I have mostly used it on the body for tightening skin. Using it specifically under the eye is a more targeted application of the same machine, and it tends to be the first thing I bring up when a patient’s problem is really about their skin and not about lost volume.

Here is where I slow down with patients, because this is the part that gets confused constantly and the two things genuinely look almost identical staring back at you in a mirror. Tired under-eyes can come from losing volume, meaning fat under the eye that has thinned out or shifted with age, and that reads as a hollow spot or a shadowed groove that makeup cannot fill in. Or the tiredness can come from the skin itself, crepey texture, a little bit of sag, fine lines, none of which has anything to do with volume and everything to do with the collagen underneath getting thinner with time. Morpheus8 is not going to put volume back where it used to be. If a patient’s real issue is a hollow from lost fat, I say that to their face and point them somewhere else, because pretending otherwise would just waste their money. What Morpheus8 does handle well is that second category, the actual skin.

Mechanically, the device pushes a grid of very thin, insulated needles just under the surface of the skin and sends radiofrequency energy through them at a controlled depth. The needling by itself starts a healing response in the tissue. The radiofrequency energy on top of that adds heat at a specific depth under the skin, which is what remodels the collagen and tightens things from underneath, with no incision and without touching the visible surface of the skin at all. Around the eye, where the skin is thinner and more delicate than almost anywhere else on the face, that lets us treat crepiness and mild sagging in a spot where a lot of other energy-based devices are simply too aggressive to use safely.

The reason it comes as a package of three rather than one appointment is that collagen does not remodel itself overnight. On the body, where I have used this device for years, patients see part of the result right away and then watch it keep improving for about two months as new collagen forms, and the same general timeline holds under the eye. Downtime is minimal, we numb the area with a topical anesthetic first, and most patients deal with some mild redness or sensitivity for a few days afterward rather than anything that keeps them off work. A single session softens things a bit. A full series of three is closer to the change most people are actually picturing when they ask me about this.

Revive. EZ Gel, 20% Off Per Session.

Anyone who has read my writing for a while has probably seen me write about PRP and PRF before, platelet-rich plasma and platelet-rich fibrin, both made from a patient’s own blood, usually in the context of microneedling and what people call the vampire facial. EZ Gel takes that same underlying biology one step further, and by coincidence it is aimed at the exact same tired-eye problem as the Morpheus8 special above, just coming at it from the opposite side.

The prep work starts out the same way PRF prep always starts. We draw a small amount of blood and spin it down to isolate the platelet-rich fibrin, and for EZ Gel specifically we also pull albumin out of that same sample. What we end up with is a gel made entirely of the patient’s own material, loaded with growth factors and proteins that tell the body to start laying down new collagen wherever we place it. The areas people use it on most tend to be the same spots where both volume and skin quality fade first as we age, which is under the eyes, around the mouth, and at the temples.

That overlap is exactly why it pairs well with Morpheus8 instead of competing with it for the same appointment slot. Morpheus8 works on the collagen scaffold that is already sitting there under your skin. EZ Gel adds a small amount of your own biological material into a spot that has genuinely thinned out, which edges closer to replacing lost volume than Morpheus8 ever will. One is a quality treatment, the other is closer to a volume treatment, and neither one involves putting something synthetic into your face.

I ask for the same patience here that I ask for with any biostimulator. It takes weeks after each session for your own collagen response to build, a maintenance visit once or twice a year keeps the result going, and nobody walks out of the office that same afternoon looking noticeably different. If a med spa somewhere is telling you otherwise about a treatment like this one, it is worth asking exactly what they are injecting.

A Clean Comparison

Where to Come, East or West

The Med Spa at Southwest Plastic Surgery runs out of two El Paso locations, and all three August specials are valid at both of them.

The Eastside office is at 1387 George Dieter Drive, Building C, El Paso, Texas 79936.

The Westside office is at 5925 Silver Springs Drive, Suite C, El Paso, Texas 79912.

The same team and the same protocols run at both sites, so pick whichever side of town works better with your schedule. If you want to see the fuller menu before you call, the Med Spa page on our practice site is a good place to start.

A Note on Who Is Doing the Work

When you book at my Med Spa, it is worth knowing whose name is actually on the room. Mine. I trained in plastic surgery at Mayo Clinic, I am double board-certified, I teach residents at Texas Tech as a Clinical Associate Professor, and Castle Connolly has named me a Top Doctor for thirteen years running now. The Med Spa runs on that same standard, not on a slogan painted on the wall.

Ready to Talk?

Call our Med Spa at (915) 590-7907 to book any of the August specials at the Eastside (1387 George Dieter Building C) or Westside (5925 Silver Springs Suite C) office, or text 1-866-814-0038. For surgical or combined consults, call my main office at (915) 590-7900 or book online at agulloplasticsurgery.com/appointments. Follow me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful