Treatment of the ageing hand with dermal fillers

Abstract

Following the trend in facial cosmetic procedures, patients are now increasingly requesting hand rejuvenation treatments. Intrinsic ageing of the hands is characterized by loss of dermal elasticity and atrophy of the subcutaneous tissue. Thus, veins, tendons and bony structures become apparent. Among the available procedures, intrinsic ageing of the hands is best improved by restoring the volume of soft tissue. Volume restoration can be achieved with a number of long-lasting dermal fillers with varying degrees of improvement and treatment longevity. The dermal fillers used in hand rejuvenation include autologous fat, collagen, hyaluronic acid, calcium hydroxylapatite and poly-L-lactic acid. Here, we describe our preferred injection method for hand rejuvenation using calcium hydroxylapatite and a single-bolus injection.

Keywords: Calcium hydroxyapatite; dermal fillers; fat grafting; hand rejuvenation; hyaluronic acid; poly-L-lactic acid.

Figure 1

Procedure for mixing calcium hydroxylapatite (CaHA) with lidocaine:[30] (a) pull lidocaine into a 3-mL syringe, (b) connect the syringe to a connector, fill with lidocaine, (c) connect syringe containing CaHA to connector, (d) push contents of CaHA syringe into the syringe containing lidocaine, push plungers back and forth ³10 times, inject with CaHA syringe

Figure 2

Examples of dermal filler injection techniques for hand volume restoration: (a) tenting of the skin,[7] (b) microdroplet technique showing injection points at the dorsal hand (20 microdroplet injections per hand, random injection point distribution avoiding blood vessels),[41] (c) injection site forming a bolus of calcium hydroxylapatite mixture (0.5 mL bolus) in the areolar plane[7]

Figure 3

Bolus injection with calcium hydroxylapatite and lidocaine: A 54-year-old, treatment-naïve, female patient (a) before treatment, (b) after injection, in the central part of the dorsum of the hand and (c) after sitting on the hand for 10 min

Figure 4

Injection with calcium hydroxylapatite (1.5 mL) and prilocaine (0.3 mL) in each hand: A 62-year-old female patient (a) before treatment, (b) 6 weeks after treatment and (c) 6 months after treatment

Figure 5

Injection with calcium hydroxylapatite (1.5 mL) and prilocaine (0.3 mL) in each hand: A 65-year-old female patient (a) before treatment and (b) 6 months after treatment