The hands are continuously subject to external ageing triggers, such as sun exposure and friction forces due to movement. This manifests in the formation of wrinkles, folds and lines, and substantial changes in overall contour with time. In addition, declining levels of collagen and elastin in the dermis lead to skin thinning and laxity; deeper down, atrophy of the subcutaneous fat often results in increased visibility of the underlying bone, tendons and blood vessels on the dorsum of the hands.3,4 Similarly, in the décolletage, ageing and environmental factors (particularly ultraviolet radiation) lead to dermal thinning and lipoatrophy over time, resulting in increased muscle visibility as well as lines and wrinkles that are often particularly deep.1
Patients and aesthetic practitioners therefore increasingly recognize the value of treating the hands and décolletage. A number of options are available, including fillers, intense pulsed light, laser, microfocused ultrasound, fat injections, and chemical peels.1,2,4,5
Hyaluronic acid (HA) fillers may offer a compelling mix of benefits for rejuvenating these areas, including improvements in the appearance of lines as well as volumizing and hydrating effects.6,7 However, compared with the face, there are relatively few trials of HA fillers in the treatment of the hands and décolletage. Among recent studies, most assessed low molecular weight/small-particle HA fillers based on intradermal deposition,8–11 with results typically lasting for up to 6–9 months. In addition, a randomized trial showed the efficacy and safety of a large gel particle (20 mg/mL) HA filler in the treatment of the hands,12 and this led to the first approval by the US Food and Drug Administration of an HA filler for use outside the face.
VYC-17.5L is an HA filler with intermediate elastic modulus (G’) and cohesivity, containing 17.5 mg/mL HA.6 It has demonstrated high levels of aesthetic improvement and patient satisfaction and low complication rates when used in the face, with results lasting up to 18 months.13–17 VYC-17.5L was designed to be sufficiently cohesive for volume restoration and treatment of deep skin depressions, but it retains the capacity to be spread horizontally. Thus, it may have significant potential for use in the hands and décolletage. However, to the best of our knowledge, there are currently no published data on the use of VYC-17.5L in either of these areas. The purpose of this study was to evaluate