In addition to the face and neck, the hands can show signs of age before the rest of the body. Hand rejuvenation with fillers has become an increasingly popular minimally invasive cosmetic procedure that can be offered to restore the signs of aging hands.
Aging of the hands is due to a combination of dermal and subcutaneous thinning, resorption of bone, increased skin sagging, laxity, and pigmentation and textural changes. As the dermis quality and quantity diminishes, veins, bones, and tendons become more prominent.1,2 Many factors can influence the appearance of these changes such as genetics, smoking, alcohol abuse, exposure to UV radiation, patient’s occupation, and associated diseases that can affect the hand structures such as rheumatologic disorders.3
One of the best ways to improve the appearance of the dorsal hands is to re-volumize and minimize the appearance of prominent veins and tendons with fillers in an easy, in-office, 1-day procedure. Radiesse—a calcium hydroxylapatite product—is the only FDA-approved injectable filler for hand augmentation to correct volume loss in the dorsum of the hands.4 This article discusses the use of calcium hydroxylapatite to rejuvenate and restore youthful volume to the dorsal hands in 1 of our patients.
A 63-year-old woman presented to our office inquiring about procedures to enhance the appearance of her dorsal hands. Her past medical history was noncontributory, and she has had multiple facial cosmetic procedures but none on her hands. Upon physical examination, the patient’s hands showed thinning of her skin with pronounced veins, tendons, and bony prominences (Figures 1A-C). Different options, risks and benefits, and expected outcomes were discussed with the patient and she agreed to proceed with injection of calcium hydroxylapatite for hand rejuvenation.
The procedure began with application of cold compresses to the area for 10 minutes. After this, clorhexidine scrubs where applied to both dorsal hands that were comfortably placed on a flat surface with the fingers extended. Initially, calcium hydroxylapatite was mixed with lidocaine 1% using a 2-sided syringe connector. Calcium hydroxylapatite was injected in the depressions along side the bony prominences and veins with a retrograde technique, inserting the needle on the most proximal part of the dorsal hand and always aspirating before injecting. Before injecting, the skin was pinched and retracted to make sure the injection was on the superficial lamina. The area was massaged and a second set of injections was done in a fanning technique on the areas where the depressions were still present for a total of 1.3cc of calcium hydroxylapatite. The areas were massaged again followed by cold compresses for comfort measures. The patient tolerated the procedure well and no adverse effects were observed. At the 3-week follow-up, the patient was extremely satisfied with the results and denied any side effects. The same procedure was performed on the contralateral hand (Figures 2A-C).