commonly reported after CaHA dorsal hand treatments include
transient erythema, pruritus, as well as ecchymosis and edema that can last up to 2 weeks.17 Difficulty performing
activities with the hands has also been described (such as keyboarding or playing piano etc). Itching has been reported to improve with a high-potency topical corticosteroid.24 The
most frequently reported reaction to PLLA treatment is the formation of nodules.25 Many practitioners have discontinued use of PLLA in the dorsal hands due to the risk of formation of nodules and the availability of other soft tissue augmentation
agents.24 Hyaluronic acid adverse events in general use, also include edema, hematoma, redness, and pain.1 But, hyaluronic
acid has the benefit of having a potential reversal agent (the enzyme hyaluronidase). If hyaluronic acid is injected too superficially, there is a risk of a blue discoloration of the skin. This blue discoloration is likely due to the Tyndall effect.26 The
Tyndall effect has yet to be reported in the hand with HA fillers, but a theoretical risk exists. Treatment includes extraction of the superficial hyaluronic acid with a small nick using a surgical blade or injection of hyaluronidase to help with dissolution.
Potential complications of fat transfer to the hand include infection, cyst-formation, temporary dysesthesia, and
marked edema.27
Specific studies focused on hand complications from soft tissue
augmentation exist. One study retrospectively identified 15 patients injected with various agents over a 10-year period with complications secondary to soft tissue augmentation. Injected
materials included PMMA microsphere filler, CaHA filler, HA filler, PLLA filler, and other medical fillers.28 Complications
mentioned in this study included contour deformity (12/15), sensory dysfunction (4/15), inflammatory signs including foreign
body granuloma (8/15), and stiffness (4/15).28 However, only 1/15 of these patients reported not being satisfied with
the outcomes after soft tissue augmentation treatment for hand rejuvenation.
Park et al describe a method to try to minimize filler-related complications
of the dorsal hand. This report recommended that all patients immediately begin applying ice to the area of injection,
along with aggressive massage and hand elevation. At regular follow-up, if a complication has arisen such as a granuloma or evidence of infection, they began treatment with two-drug antibiotic
therapy composed of a second-generation cephalosporin plus a third-generation macrolide. If there are still unsatisfactory
results such as irregular contour, the course of treatment depended
on the type of filler. For HA fillers, they initially started a trial of hyaluronidase injections – but went as far as surgical excision
if there was no improvement. CaHA fillers were treated with surgical excision. With all other fillers, the authors attempted intra-lesional corticosteroid injections with subsequent surgical removal if there was no improvement. The authors emphasized that surgical excision was a last resort option for filler-related granulomas.28 Improvement of various types of persistent filler-
related nodules with intra-lesional injections has been reported, including utilizing 5-FU (50 mg/mL) as well as triamcinolone
(up to 40 mg/mL).29 We would emphasize repeating trials of non-surgical treatment options, until it is deemed definitively non-efficacious, before considering surgical excision.
Al-Qattan reported 3 cases of foreign body granuloma after use of PMMA suspended in bovine collagen for soft tissue augmentation
of the dorsal hand.30 The patients developed granulomas greater than 1 year after the hand augmentation procedures, and all responded to intralesional triamcinolone. Although the granulomatous reactions resolved, the authors noted subsequent hyper- and hypopigmentation. It is unclear if this was secondary to the granulomatous reaction or the injection of corticosteroids.
