Cosmetic dermatology patients are increasingly seeking hand rejuvenation procedures to eliminate appearance discrepancies between the face and hands, reported Ramin Fathi, MD, and Joel L. Cohen, MD, FAAD, who reviewed the benefits and complications of soft filler methods.
Pre-procedure evaluation includes assessing volume of lost fat from the skin via the Merz hand grading scale. Prior to augmentation, a detailed patient history, including medications, medical problems, and bleeding abnormalities, is typically taken, as well as assessment of patient lifestyle issues involving extensive hand activity, such as typing on a keyboard or playing piano. The authors reviewed three hand rejuvenation methods: autologous fat grafting, hyaluronic acid (HA), and poly-L-lactic acid (PLLA).
Although autologous fat grafting is still done in some practices, it is more invasive compared with soft tissue fillers, and can result in complications such as infection, cyst formation, temporary dysesthesia, and significant edema, the authors noted. PLLA is not approved for dorsal hand augmentation, and is used off label.
Hyaluronic acid (HA) fillers such as Restylane, Belotero, and Juvederm are approved only in the United States for facial soft tissue augmentation, and are also used off label for hand rejuvenation. The authors cited a small study of 16 patients evaluating small gel particle HA in the dorsal hand, in which vascular, tendon, bony prominence, and skin turgor were improved by 60.9%, 65.2%, 73.7%, and 26.3%, respectively, 2 weeks after treatment. “A distinct advantage of HA is that imperfections or undesired product can usually be reversed in the short term using hyaluronidase enzyme,” they added.
Despite the common adverse effects of erythema, pruritus, ecchymosis, and edema, “hand augmentation with soft tissue filler, alone or in conjunction with other rejuvenation modalities, can have a significant impact on improving appearance of the dorsal hands,” satisfying patient cosmetic objectives, the authors concluded.
Read the full article in the Journal of Drugs in Dermatology (J Drugs Dermatol. 2016;15[7]:809-15).