Several decades ago, anti-aging comprised only of dealing with signs of aging primarily on the face and neck. In due course of time, with advances in cosmetic science, rejuvenation of areas such as the décolletage, knees and hands are now of importance in achieving an overall youthful appearance.
Aging hands appear bony, and wrinkled with pronounced perceptibility of inner structures such as tendons, ligaments and vessels. Additionally, they may present with sun spots, age spots, freckles, lentigines, actinic keratoses, seborrheic keratoses, fine lines and dryness. Hand rejuvenation can be successfully achieved using a plethora of minimally invasive and non-invasive treatments such as topical medications, medium depth chemical peels, sclerotherapy, resurfacing lasers, Q-switch Nd: YAG lasers, vascular lasers, dermal fillers and autologous fat transfer.
5-point Hand Grading Scale
The grade of aging of hands can be determined by using the 5-point Hand Grading Scale as follows:1,2
- Grade 0 – No Loss of fatty tissue
- Grade 1 – Mild loss of fatty tissue and slight visible veins
- Grade 2 – Moderate loss of fatty tissue and mild visible veins and tendons
- Grade 3 – severe loss of fatty tissue and moderate visible veins and tendons
- Grade 4 – Very Severe loss of fatty tissue and marked visible veins and tendons
Dermal Fillers for Hand Rejuvenation
Among the number of treatments available for restoring youthful appearance of the hands, dermal fillers help restore the volume loss and help intrinsic signs of aging such as improving dermal elasticity and fine lines or wrinkles. Dermal fillers of the hands involves the use of hyaluronic acid (HA) and non-HA fillers with cautious consideration of anatomical characteristics of the hands and the extent of loss of fatty tissue.
For natural looking results, understanding the anatomy of the dorsa of the hands is of utmost importance. The basic layers of the dorsa of the hand consists of the following:
- The subcutaneous layer of the dorsa of the hand is divided into 3 fatty laminae that are separated by thin fascia.
- The superficial laminae and the subcutaneous tissues of the hand have no structures traversing them.
- Dorsal veins and dorsal sensory nerves pierce the intermediate fascia.
- Extensor tendons reside in the deep lamina.
- Thin fascia that separates the fatty laminae have perforations for blood vessels that run perpendicular through the laminae.
Technique of Injection2
- Theoretically, the superficial lamina is the ideal site of injection of the dermal filler
- A sub-dermal micro-bolus deposition of filler using a 25-32G needle or a blunt cannula by lightly lifting the skin can help achieve a good injection technique without damaging vessels. Roughly 20-25 injection droplets are administered randomly all over the dorsa of the hands by carefully avoiding visible vessels
- Another technique involves tenting the skin of the dorsa of the hand upwards and depositing a bolus of the filler material till a large bleb is formed. The bleb is then gently massaged over to the rest of the hand. The single bolus technique helps achieve satisfactory results with lesser bruising and hematoma formation
- The injection site for HA fillers in the dorsa of the hand is dermal to subdermal whereas the site for non-HA fillers is subdermal or deep dermal.
HA fillers and non-HA fillers both give greats results for volume restoration of the hands. HA, Calcium Hydroxyapatite mixed with 2% lidocaine HCl and poly-l-lactic acid are durable, biocompatible and safe fillers for hand volume restoration. Hybrid dermal fillers also exert dual action by restoring hand volume and stimulating neo-collagenesis over a course of few months. Fillers with unique combination of Hyaluronic Acid and Calcium hydroxyapatite (CaHA) have advanced tissue integration & provides a medium to high extrusion force which in turn promotes skin homeostasis, neo-collagenesis and more natural results.
- Nodules, rarely
- Infection, rarely
- Difficulty in performing daily activities
Fillers commonly used for hand rejuvenation
- Carruthers A, Carruthers J, Hardas B, Kaur M, Goertelmeyer R, Jones D, et al. A validated hand grading scale. Dermatol Surg. 2008;34:S179–S83.
- Kühne U, Imhof M. Treatment of the ageing hand with dermal fillers. J Cutan Aesthet Surg. 2012;5(3):163-169. doi:10.4103/0974-2077.101369
- Bidic SM, Hatef DA, Rohrich RJ. Dorsal hand anatomy relevant to volumetric rejuvenation. Plast Reconstr Surg. 2010;126:163–8.