The hands are the most aged part of the body due to sun exposure, wind and chemical exposure, skin stretch, and fat atrophy. Moisturizers can rehydrate the skin but medical treatments can improve wrinkles, altered pigmentation, and inelasticity. Skin resurfacing with chemical peels, lasers, or dermabrasion removes superficial skin and after healing, the skin is more elastic, evenly pigmented, and exfoliated. Direct excision of skin can tighten the lax skin of the hands and scars are planned to minimize visibility. Increased vein prominence on the back of hand are another tell-tale sign of aging. This is not typically due to enlargement of the veins but due to atrophy of the surrounding fat. Numerous fillers can be used to replace this lost fat. Autologous fat grafting from elsewhere on the body is the best technique for large volume replacement.