Challenges, Considerations, and Strategies in Hand Rejuvenation

July 2016 | Volume 15 | Issue 7 | Original Article | 809 | Copyright © July 2016


Ramin Fathi MD1 and Joel L. Cohen MD FAAD1,2,3

1Department of Dermatology, University of Colorado Denver, Aurora, CO
2AboutSkin Dermatology and Derm Surgery, Greenwood Village, CO
3Department of Dermatology, University of California at Irvine, Irvine, CA

CONCLUSION

Hand augmentation with soft tissue filler, alone or in conjunction with other rejuvenating modalities, can have a significant impact on improving the appearance of the dorsal hands. The relevant anatomy includes three fatty laminae that are divided by fascial planes. The Merz Hand Grading Scale provides an objective measurement tool for assessing clinical improvement. Whether using a needle or a cannula, tenting the skin allows a plane of entry that may help in avoiding tendons and vasculature. Hyaluronic acid (HA), poly-L-lactic acid (PLLA), and calcium hydroxyapatite (CaHA) are the agents most commonly used for augmentation though CaHA is the only current FDA cleared for dorsal hand augmentation. Erythema, pruritus, ecchymosis, and edema are the most commonly encountered adverse effects.

DISCLOSURES

Dr. Fathi reports no conflicts related to this paper. Dr. Cohen indicates that related to soft tissue augmentation agents, he has served as a consultant or clinical trial participant for Allergan, Merz, Galderma, and Suneva.

REFERENCES

  1. Dallara JM. A prospective, noninterventional study of the treatment of the aging hand with Juvederm Ultra(R) 3 and Juvederm (R) Hydrate. Aesthet Plast Surg. 2012;36(4):949-54.
  2. Man J, Rao J, Goldman M. A double-blind, comparative study of nonanimal- stabilized hyaluronic acid versus human collagen for tissue augmentation of the dorsal hands. Dermatol Surg. 2008;34(8):1026-31.
  3. Kraemer R, Kabbani M, Sorg H, Herold C, Branski L, Vogt PM, et al. Diabetes and peripheral arterial occlusive disease impair the cutaneous tissue oxygenation in dorsal hand microcirculation of elderly adults: implications for hand rejuvenation. Dermatol Surg. 2012;38(7 Pt 2):1136-42.
  4. Marmur ES, Al Quran H, De Sa Earp AP, Yoo JY. A five-patient satisfaction pilot study of calcium hydroxylapatite injection for treatment of aging hands. Dermatol Surg. 2009;35(12):1978-84.
  5. Busso M, Applebaum D. Hand augmentation with Radiesse (Calcium hydroxylapatite). Dermatol Ther. 2007;20(6):385-7.
  6. Lefebvre-Vilardebo M, Trevidic P, Moradi A, Busso M, Sutton AB, Bucay VW. Hand: Clinical Anatomy and Regional Approaches with Injectable Fillers. Plast Reconst Surg. 2015;136(5 Suppl):258s-75s.
  7. Villanueva NL, Hill SM, Small KH, Rohrich RJ. Technical Refinements in Autologous Hand Rejuvenation. Plast Reconst Surg. 2015;136(6):1175-9.
  8. Bidic SM, Hatef DA, Rohrich RJ. Dorsal hand anatomy relevant to volumetric rejuvenation. Plast Reconst Surg. 2010;126(1):163-8.
  9. Cohen JL, Carruthers A, Jones DH, Narurkar VA, Wong M, Cheskin LN, et al. A Randomized, Blinded Study to Validate the Merz Hand Grading Scale for Use in Live Assessments. Dermatol Surg. 2015;41 Suppl 1:S384-8.
  10. Bertucci V, Solish N, Wong M, Howell M. Evaluation of the Merz Hand Grading Scale After Calcium Hydroxylapatite Hand Treatment. Dermatol Surg. 2015;41 Suppl 1:S389-96.
  11. Gubanova EI, Starovatova PA. A Prospective, Comparative, Evaluator-blind Clinical Study Investigating Efficacy and Safety of Two Injection Techniques with Radiesse((R)) for the Correction of Skin Changes in Aging Hands. J Cutaneous Aesthet Surg. 2015;8(3):147-52.
  12. Sadick NS, Anderson D, Werschler WP. Addressing volume loss in hand rejuvenation: a report of clinical experience. J Cosmet Laser Surg. 2008;10(4):237-41.
  13. Gargasz SS, Carbone MC. Hand rejuvenation using Radiesse. Plast Reconst Surg. 2010;125(6):259e-60e.
  14. Cohen JL. Utilizing blunt-tipped cannulas in specific regions for soft-tissue augmentation. J Drugs Dermatol. 2012;11(8):s40-1.
  15. Hexsel D, Soirefmann M, Porto MD, Siega C, Schilling-Souza J, Brum C. Double-blind, randomized, controlled clinical trial to compare safety and efficacy of a metallic cannula with that of a standard needle for soft tissue augmentation of the nasolabial folds. Dermatol Surg. 2012;38(2):207-14.
  16. Butterwick KJ, Nootheti PK, Hsu JW, Goldman MP. Autologous fat transfer: an in-depth look at varying concepts and techniques. Facial Plast Surg. 2007;15(1):99-111, viii.
  17. Fabi SG, Goldman MP. Hand rejuvenation: a review and our experience. Dermatol Surg. 2012;38(7 Pt 2):1112-27.
  18. Coleman SR. Hand rejuvenation with structural fat grafting. Plast Reconstruct Surg. 2002;110(7):1731-44; Discussion 45-7.
  19. Brandt FS, Cazzaniga A, Strangman N, Coleman J, Axford-Gatley R. Long- term effectiveness and safety of small gel particle hyaluronic acid for hand rejuvenation. Dermatol Surg. 2012;38(7 Pt 2):1128-35.
  20. Wang F, Garza LA, Kang S, Varani J, Orringer JS, Fisher GJ, et al. In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin. Arch Dermatol. 2007;143(2):155-63.
  21. Turlier V, Delalleau A, Casas C, Rouquier A, Bianchi P, Alvarez S, et al. Association between collagen production and mechanical stretching in dermal extracellular matrix: in vivo effect of cross-linked hyaluronic acid filler. A randomised, placebo-controlled study. J Dermatol Sci. 2013;69(3):187-94.
  22. Redaelli A. Cosmetic use of polylactic acid for hand rejuvenation: report on 27 patients. J Cosmet Dermatol. 2006;5(3):233-8.
  23. Rendon MI, Cardona LM, Pinzon-Plazas M. Treatment of the aged hand with injectable poly-l-lactic acid. J Cosmet Laser Ther. 2010;12(6):284-7.
  24. Riyaz FR, Ozog D. Hand rejuvenation. Semin Cutan Med Surg. 2015;34(3):147- 52.
  25. Palm MD, Woodhall KE, Butterwick KJ, Goldman MP. Cosmetic use of poly-l-lactic acid: a retrospective study of 130 patients. Dermatol Surg. 2010;36(2):161-70.
  26. Juhasz ML, Marmur ES. Temporal fossa defects: techniques for injecting hyaluronic acid filler and complications after hyaluronic acid filler injection. J Cosmet Dermatol. 2015;14(3):254-9.
  27. Butterwick KJ. Rejuvenation of the aging hand. Dermatol Clin. 2005;23(3):515- 27, vii.
  28. Park TH, Yeo KK, Seo SW, Kim JK, Lee JH, Park JH, et al. Clinical experience with complications of hand rejuvenation. J Plast Reconstr Aesthet Surg. 2012;65(12):1627-31.
  29. Conejo-Mir JS, Sanz Guirado S, Angel Munoz M. Adverse granulomatous reaction to Artecoll treated by intralesional 5-fluorouracil and triamcinolone injections. Dermatol Surg. 2006;32(8):1079-81; Discussion 82.
  30. Al-Qattan MM. Complications related to Artecoll injections for soft tissue augmentation of the hand: 3 case reports. J Hand Surg. 2011;36(6):994-7.

AUTHOR CORRESPONDENCE

Joel L. Cohen MD FAAD……................................. jcohenderm@yahoo.com
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