both photographic and live assessments when compared to the
Global Aesthetic Improvement Scale (GAIS).10
Technique
Pre-procedure evaluation of dorsal hand augmentation often
includes an assessment of how much volume loss has occurred, and a plan in terms of anticipated volume of filler, as
well as what specific filler, is anticipated to be used. As stated,
calcium hydroxyapatite (Radiesse) is currently the only agent
that is FDA approved for the purpose of dorsal hand augmentation,
but other filler agents have been and continue to be used
“off-label†for this specific purpose.
Prior to performing the augmentation, aesthetic physicians will
often get a detailed list of current medications, inquire as to a
history of medical problems and history of bleeding abnormalities,
as well as find out what type of work or hobbies the patient
may frequently perform that may utilize the hands (such as lots
of keyboard activity or playing the piano), as some degree of
swelling usually does occur.11 Anti-coagulant medications such
as aspirin, NSAIDs like ibuprofen, and vitamins and herbals
that are known to affect the coagulation pathways are often discontinued
5-7 days before treatment to minimize bruising12 but
the authors do not discontinue prescription anticoagulants or
even aspirin if the patient specifically has a personal history of
a heart attack, stroke, blood clot, or atrial fibrillation.
Various augmentation agents have been reported to decrease the appearance of aging in the dorsal hands. We will discuss
techniques for autologous fat grafting, hyaluronic acid (HA), poly-L-lactic acid (PLLA), and also the mentioned agent that has specific FDA indication for this purpose at this point, calcium hydroxyapatite (CaHA). See Table 2 for an overview of these fillers.
Irrespective of the agent or filler, the general technique for injecting
into the dorsal hand is often similar. Many physicians
have the patient use a topical anesthetic for 30-40 minutes
(sometimes under occlusion) prior to initiating the procedure.
Placing the patient in Trendelenburg position can reduce vein
pressure and thus potentially decrease bleeding, which can be
helpful in trying to minimize bruising and swelling. A very clean
technique should be used and consists of the patient washing
their hands with soap and water followed by the injector then
cleansing the treatment area diligently with an antiseptic. One
