Hand Rejuvenation With A Hyaluronic Acid-Based Dermal Filler: A 12-Month Clinical Follow-Up Case Series

April 2021 | Volume 20 | Issue 4 | Original Article | 451 | Copyright © April 2021


Published online March 8, 2021

doi:10.36849/JDD.5154

Patrick Micheels MD,*a Stéphanie Besse MD,b Marc Sibon MD,a Badwi Elias MDc*

aPrivate practice, 8, chemin de la Fontaine 1224 Chêne-Bougeries, Switzerland
bMedImage radiologic institute, Route de Florissant 1, 1206 Geneva, Switzerland
cPrivate practice, 112 Route de Florissant 1206 Geneva, Switzerland

*Work performed at Patrick Micheels’ private office, Geneva, Switzerland.

Abstract
Background: Requests for hand rejuvenation, in particular with nonsurgical aesthetic procedures, are increasing. Several injectable dermal fillers are currently used to restore soft tissue volume; however, the anatomic complexity of the hand and extreme mobility of its underlying tissues involve the use of specific implants and adapted injection technique. We report a case series demonstrating the efficacy, durability, and safety of a hyaluronic acid-based dermal filler (HA-filler) for hand rejuvenation.
Methods: Five female subjects aged 56 to 67 with moderate to severe hand aging were treated by one physician (PM) at his private office. The HA-filler was injected in the hypodermis using a retrograde injection technique. A massage performed at the site of injection ensured optimal cosmetic results. Four subjects had a touch-up 3 months later. The aesthetic effect was evaluated on each hand, by 5 evaluators and the subjects, up to 12 months following the last injection. Adverse events, including pain, were collected.
Results: Merz Aesthetic Hand Aging Scale (MAS) and the Global Aesthetic Improvement Scale (GAIS) scores indicated stable and significant improvement in hand aging up to 12 months following the last injection. Despite a slight decrease over time, there was a durable enhancement of skin glow, quality, and hydration on the GAIS. The retrograde injection of the HA-filler, which was usually described as painless, was well tolerated by all subjects.
Conclusions: Hand rejuvenation using a HA-filler and a retrograde injection technique was associated with subjects’ satisfaction and was proved safe for the 5 subjects of this case-series.

J Drugs Dermatol. 20(4):451-459. doi:10.36849/JDD.5154

INTRODUCTION

Because, after the face, hands are the most visible part of the human body, requests for rejuvenation with nonsurgical aesthetic procedures are increasing.1 However, the anatomic complexity of the hand, the major thinness of its skin, and the extreme mobility of its underlying tissues involve the use of specific implants that respect hand dynamics.2-4 Specific injection methods have been developed to restore hand volume and hide veins and tendons that become visible during aging.4,5 Several dermal fillers commonly used for face rejuvenation have been tested for hand treatment, including hyaluronic acid-based dermal fillers (HA-fillers). The latter are generally well-tolerated and long-lasting and enable reversible interventions thanks to hyaluronidase injections.4-6 Just like for facial rejuvenation, the choice of the right HA-filler depends on the desired correction, the injection depth, and local specificities of the treated area (ie, skin thickness and soft tissues mobility).7,8

We present a case series that demonstrated the immediate aesthetic effect, durability, and safety of HA-filler retrograde sub-dermal injection in the dorsum of the hand for hand rejuvenation.

MATERIALS AND METHODS

Between August 2016 and December 2017, one physician (PM) carried out HA-filler injections among 5 subjects at his private office.

Subjects, 4 Caucasian and 1 Spanish-Native American women, with Fitzpatrick phenotypes II–V and moderate to advanced photoaging as assessed using the Glogau Wrinkle Scale, were aged between 56 and 67 years (Table 1). None had skin lesions on the hands or allergy to HA-filler or anesthetic agent (lidocaine). In compliance with the Helsinki declaration, all were informed about the product and injection procedure, and signed a consent form before the injection.

The HA-filler, Teosyal RHA® 3 (Teoxane SA, Geneva, Switzerland), is a viscoelastic, sterile, non-pyrogenic, clear, colorless, and biodegradable gel containing crosslinked sodium HA from
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