Small-Particle Hyaluronic Acid Gel Treatment of Photoaged Hands

Combination Approaches to Hand Rejuvenation: A Review of the Literature and Discussion

BACKGROUND

Various noninvasive/minimally invasive modalities for hand rejuvenation exist, and the efficacy and safety of these procedures as both monotherapy and same-day procedures is increasingly being studied.

OBJECTIVE

To review data on the efficacy and safety of hand rejuvenation modalities and suggest a practical combination approach for these procedures.

METHODS

The PubMed database was queried for peer-reviewed articles regarding hand rejuvenation techniques, including chemical peels, laser and light sources, sclerotherapy, autologous fat transfer, and injectable volumetric fillers.

RESULTS

Chemical peels have been studied the least, with most studies evaluating the use of fillers and laser/light-based devices. Most studies reported overall good results with high patient satisfaction. Satisfaction rates were lower in laser/light-based treatments compared with other modalities. Transient erythema, edema, or pain after procedures was common; most studies did not report serious postprocedure complications. Importantly, there was no significant increase in adverse effects after same-day procedures.

CONCLUSION

Using same-day procedures allows practitioners to address hand rejuvenation from different aspects, seems to improve outcomes, and reduces time spent in the office for patients. The authors suggest a practical framework for combining cosmetic approaches to achieve the most optimal outcome for hand rejuvenation.

Autologous fat transfer for hand rejuvenation: systematic review on technique and outcome

Background

Age-related changes to the dorsum of the hand present as dyschromia, soft-tissue atrophy, and volume loss, resulting in wrinkles and prominent deep structures. Volume augmentation by means of autologous fat transfer (AFT) is one of the options to rejuvenate the hand; theoretically, autologous fat is the ideal filler because of durability and biocompatibility.

Objective

This systematic review aims to summarize and describe the current evidence on the technique, effectiveness, and safety of AFT in hand rejuvenation.

Methods

Three major databases, PubMed, Embase, and Web of Science, were systematically searched up to November 2020 for studies reporting on AFT and hand rejuvenation.

Results

A total of 10 articles were included, reporting on a total of 320 patients treated by AFT to improve the aesthetic appearance of the dorsum of the hand. Some degree of postoperative oedema was present in nearly all patients. Other complications were infection (0.67%), cysts/irregularities (1.3%), temporary dysesthesia (5.3%), and ecchymosis (7%). There were no major complications. Of all patients, 97.6% self-reported to be satisfied with the result.

Conclusions

Overall, by combining the current evidence, AFT is considered a promising and safe technique to rejuvenate the aging hand with very high patient satisfaction. Future research, using validated patient questionnaires, objective volumetric measurements, and longer follow-up, is needed to confirm these results.

Level of Evidence

3

Dorsal Hand Rejuvenation: A Systematic Review of the Literature

BACKGROUND

Dorsal hand appearance undergoes changes with aging. Grading systems have been designed to provide numerical scores to dorsal hand appearance. Various modalities have been utilized to improve the aesthetic appearance and rejuvenate the dorsal hand.

METHODS

The MEDLINE database was searched for articles investigating dorsal hand rejuvenation. Studies were grouped by method including fat grafting, injectable filler, laser/light-based treatments and miscellaneous treatments. Treatment protocols and outcomes were compiled along with patient information and complications.

RESULTS

Forty-six articles were identified for inclusion. This included 9 studies of fat grafting procedures, 20 studies of injectable filler, 10 studies of laser/light-based treatments and 7 miscellaneous. Most studies showed overall good results with high patient satisfaction. Satisfaction rates were lower in laser/light-based treatments compared with the other modalities. The average patient age for included studies ranged from 41.5 to 69. Across all studies, 96.8% of patients were female and 3.2% male.

CONCLUSIONS

Procedures for dorsal hand rejuvenation in the literature include procedures to address volume atrophy and superficial wrinkling. These procedures are overall safe with most studies reporting no complications or only mild adverse events. With high satisfaction rates and anecdotal reports of increasing patient interest, these procedures represent a developing area in aesthetic surgery likely to continue increasing in popularity.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Blinded Evaluation of Hyaluronic Acid Hand Filler Injections and Effects on First Impressions

BACKGROUND

The hands are the second most common body part visible after the face. In the aging hand, the dorsum loses volume, becomes uneven, veins become more prominent, and there is an increase in spots and wrinkles.

OBJECTIVE

To determine the effects of large-particle hyaluronic acid filler injection into the dorsal hand on first impressions.

MATERIALS AND METHODS

Ten subjects underwent filler injections in the bilateral dorsal hands with large-particle hyaluronic acid filler. Photographs of the hands were taken at baseline and 2 weeks after the optimal correction result. A survey to evaluate first impressions was then completed by blinded evaluators on defined categories of perception.

RESULTS

A total of 209 evaluators completed the first impression questionnaire. Overall, 10,032 individual assessments of first impressions were completed. There was a significant improvement in mean first impressions in all categories of perception and overall first impression scores.

CONCLUSION

Cosmetic treatments to the hands is a growing field with the use of hyaluronic acid fillers to restore volume, decrease wrinkles, and improve the appearance of prominent veins. This study revealed an improvement in first impression scores in all categories following treatment with large-particle hyaluronic acid filler to the dorsal hands.

Twelve-month prospective study of polymethylmethacrylate/collagen dermal filler for volume loss of the dorsal of hands

BACKGROUND

Dermal fillers have been used safely and effectively to revolumize aging hands. We assess the effectiveness of polymethylmethacrylate (PMMA) to treat the volume loss of photoaged dorsal hands for up to 12 months.

METHODS

In a 12-month prospective study, 15 subjects were treated with PMMA filler in the bilateral dorsal hands. PMMA was injected 4 weeks after an initial screening visit, and touch-up treatments were provided if needed 4 weeks later. Effectiveness was assessed by the provider using the validated Merz Hand Grading Scale (MHGS) and the Global Aesthetic Improvement Scale (GAIS). Subjects completed the Subject GAIS and the Subject Satisfaction Survey.

RESULTS

All subjects had at least 1 point of improvement on the MHGS starting from 1 month to 12 months after treatment. 75% of subjects had a 2-point improvement at 12 months. Investigators reported that 92% of subjects had some degree of improvement at 12 months, while 75% of subjects self-reported some degree of improvement. Approximately 75% of the subjects reported that they were satisfied with the treatment. Adverse events were minor and limited to swelling.

CONCLUSION

PMMA is a safe and effective treatment for volumizing the dorsal hands with improvement that is sustained for up to 12 months.

A randomized study showing improved skin quality and aesthetic appearance of dorsal hands after hyaluronic acid gel treatment in a Chinese population

BACKGROUND

Patients are increasingly aware of the aesthetic appearance of aging hands.

AIMS

To evaluate efficacy and safety of a hyaluronic acid gel for improving skin quality in aged skin of the dorsal hand.

METHODS

This was a 15-month randomized, multi-center, evaluator-blinded, split-hand, no treatment-controlled study. Three treatments with hyaluronic acid gel were administered in the same hand in adult Chinese subjects with grade 2 or 3 (mild or moderate aging) on the Hand Grading Scale (HGS). The primary objective was to evaluate the difference at 3 months between treated and untreated hands, based on the blinded evaluator's HGS assessment. Secondary assessments included the Global Aesthetic Improvement Scale (GAIS), biophysical measurements (skin elasticity, skin roughness and hydration), and subject satisfaction. Safety was evaluated by incidence of adverse events.

RESULTS

A total of 100 subjects were enrolled. Clinically relevant differences in HGS favored HA gel (P < .0001). At 15 months, 87%-96% of treated hands were still improved according to GAIS (per evaluator and subject, respectively). Objective measures of skin quality improved, confirmed by evaluators and highly satisfied subjects. Treatment was well tolerated.

CONCLUSIONS

Hyaluronic acid treatment improved skin quality and reduced the aging appearance of the hand, with high subject satisfaction.