The role of sclerotherapy in abnormal varicose hand veins

The 5-Step Filler Hand Rejuvenation: Filling with Hyaluronic Acid

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Many patients are pursuing simultaneous facial and hand rejuvenation with the latter receiving increased interest in recent years. Various materials have been purported to rejuvenate the hands including fat, calcium hydroxyapatite, and hyaluronic fillers. Despite the seemingly ubiquitous use of fillers, the Food and Drug Administration has approved only a select number for hand rejuvenation. This year, Restylane Lyft (Galderma, Texas) became the first hyaluronic acid filler to garner Food and Drug Administration approval for hand rejuvenation. The purpose of this video plus article was to demonstrate the technical nuances in administering hyaluronic filler in a safe and effective manner as it relates to hand rejuvenation.

Minimal-scar handlift: a new surgical approach

BACKGROUND

Removal of excess skin from the aging hand can cause scarring in one of the body's most visible areas, which is highly undesirable for patients. A minimal-scar approach to tightening this skin, in conjunction with the rejuvenating effects of minimally-invasive procedures, is therefore needed.

OBJECTIVES

The authors describe a new technique for limiting scar size and visibility by locating the incision in a unique position on the ulnar side of the dorsum of the hand.

METHODS

Eleven patients were treated with the authors' method between March and September 2009. Both hands were treated for each patient, but these procedures occurred separately, at an interval of two to four months. The surgical approach included skin flap advancement and rotation, and the procedure took place under local anesthesia and sedation. The resultant scar was S-shaped. Changes in postoperative stress ratio were visualized.

RESULTS

Patients reported being highly satisfied with this procedure with regard to scar size, quality, and location. No major complications were observed, such as infection, flap necrosis, and nerve damage. All minor complications were treated conservatively. Patients with Fitzpatrick skin types I-III profited from less scar visibility in their outcomes. All patients experienced quick recovery with minimal downtime, independent of skin type.

CONCLUSIONS

The minimal-scar handlift technique is an effective surgical approach to rejuvenating the hand and can be implemented concurrently with minimally-invasive techniques for volume restoration. The complication rate is low, and patient/surgeon satisfaction with outcomes is high.

Laser ablation of unwanted hand veins

BACKGROUND

Many patients express dissatisfaction with prominent and bulging hand veins. Abolishing these veins with sclerotherapy requires higher concentrations of sclerosing agents than are used for leg veins and often results in a tender, phlebitic cord. Phlebectomy is another treatment option. Endovenous occlusion and shrinkage techniques have been used successfully to treat varicose veins of the lower extremities. The authors demonstrate a new and unique endovenous laser technique to abolish unwanted hand veins.

METHODS

Fifty-four hands (28 patients) with prominent hand veins were treated using a 600-microm laser fiber. The Dornier MedTech 940-nm diode laser system was used. The laser fiber was introduced through a 4-French sheath, which tracked as a coaxial system over an 0.018-inch guidewire. Initial entry into the treated vein was accomplished with a 20-gauge angiocatheter percutaneously. On average, four veins were treated in each hand. Tumescent anesthesia was infiltrated around the laser fiber/sheath unit before activating the laser, and all procedures were performed in an office setting. A compressive dressing was used postoperatively.

RESULTS

All but one of the unwanted hand veins were cannulated successfully. The uncannulated vein was treated with sclerotherapy and eventually required phlebectomy. Hand swelling occurred in all treated hands and lasted 2 weeks or less. There was one skin burn of approximately 3 mm at a laser exit site. All 28 patients were satisfied with their results during follow-up, which ranged from 2 weeks to 31 months.

CONCLUSIONS

This is the first report of endovenous treatment of unwanted hand veins. Laser ablation of unwanted hand veins can be performed in an office setting. These cosmetically conscious patients were satisfied with their results.