Hand Rejuvenation Research Articles

Half-side comparison between adipose tissue stem cell-enriched fat versus standard fat injection for hand rejuvenation

Half-side comparison between adipose tissue stem cell-enriched fat versus standard fat injection for hand rejuvenation

Hand rejuvenation: Combining dorsal veins foam sclerotherapy and calcium hydroxylapatite filler injections.

Background The hands are an important aesthetic feature that can reveal aging through surface pigmentary changes, loss of skin thickness and ectatic dorsal hand veins. Techniques addressing these changes already exists but are not routinely combined for optimum results. Objective The combination techniques of dorsal hand veins sclerotherapy and sub-dermal filler injections are described. Methods The dorsal hand veins are treated with sclerotherapy (0.5% Sodium tetradecyl sulphate). This is then followed by subdermal injection of 0.75 mL-1.5 mL calcium hydroxylapatite (Radiesse, Merz) per hand, in conjunction with tumescent anaesthetic. The dorsal hands should be gently massaged for 2 min (per hand), twice a day for two days. If necessary, the procedure can be repeated after one month for further improvement. Results The techniques of sclerotherapy and filler injections complement each other well in hand rejuvenation. Calcium hydroxylapatite is safe and effective for hands and associated with high patient satisfaction. In suitable patients, the reduction in ectatic veins from sclerotherapy results in a longstanding improvement that complements volume restoration with fillers. Conclusion Aging hands with ectatic dorsal hand veins and skin atrophy/wrinkling not fully responsive to filler correction alone can further improve with the combination of sclerotherapy and filler injections.

Hand Rejuvenation Using a Combination Approach.

Hand rejuvenation has been recognized to play a key role in complementing and restoring an overall youthful look. Aging hands present specific characteristics that require a carefully designed combinational treatment for a successful clinical outcome from a practitioner's and patient's perspective. A Medline search was performed on hand rejuvenation from 1990 to 2015, and results are summarized. The authors' personal experiences with specific technologies are discussed. Review of available clinical studies revealed successful rejuvenation of the epidermis and dermis of the hands with topicals, chemical peels, intense pulsed light, and laser energy devices. Reports of sclerotherapy and laser veins ablation for dorsal hand veins were identified. Several studies on hand volume restoration with injectable volumetric fillers such as hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, autologous fat transfer including the authors' personal experience with them are described. A plethora of noninvasive treatment options for hand rejuvenation have been thoroughly studied as monotherapy, but there is insufficient number of studies evaluating the best combination of therapies for this indication. It is likely that their strategic combination and sequence of application by a trained clinician will ensure a favorable outcome in addressing patient concerns.

Hand rejuvenation using standard Intense Pulsed Light (IPL) in Asian patients

In recent years, facial rejuvenation using Intense Pulsed Light (IPL) is in demand and there have been many reports. However, hand rejuvenation, which aims to treat lentigines on the dorsal hand and wrinkles, is in demand but with few reports. In this study, hand rejuvenation was attempted using two wavelengths of a standard IPL system. It focuses mainly on improvement of lentigines, and efficacy on wrinkles on the dorsal hand will be discussed as well. The subjects were 128 Japanese patients (average age 58.1) who had lentigines and wrinkles on the dorsa of both hands, and the wavelength spectra of 560 - 1200 nm and 515 - 1200 nm were applied. In general, the number of treatments was not fixed, and further treatments beyond the first treatment were added only when asked for by the patient. Lentigines were assessed on 4 levels and wrinkles on 3 levels. The results in lentigines were graded "Excellent" in 45.3%, "Good" in 14.8%, "Unchanged" in 37.5% and "Bad" in 2.3% of the patients. Dark-toned lentigines in particular improved after one treatment. On the other hand, the results in wrinkles were graded as "Effective" in 25.0%, "Hard to tell" in 39.1% and "Ineffective" in 35.9% of the patients after the first treatment, but there was increased improvement in some cases after multiple treatments. By using appropriate IPL parameters with specific cut-off filters, dark-toned and flat senile lentigines could be treated effectively with a small number of treatments. On the other hand, improvement of fine dorsal wrinkles was noticed but more finesse is needed as to how to apply IPL and to decide on the number of treatments. Further study is necessary, but overall it can be said that IPL is an effective choice for hand rejuvenation.

Hand: Clinical Anatomy and Regional Approaches with Injectable Fillers.

Cosmetic physicians are more and more frequently asked for hand rejuvenation. They commonly propose the same techniques as for the face. The authors undertook an anatomical study of the hand dorsum to understand the optimal location for an injected filler and to design the safest technique of placement. The first part of the study included dissections of 19 fresh cadaveric hands and duplex ultrasounds investigation of 28 healthy hands. A technique of injection specifically designed from anatomical findings was then tested on 8 fresh cadaveric hands using magnetic resonance imaging and dissection in comparison with 3 other commonly used techniques of rejuvenating injections. Between the dermis and the tendons, the thickness of the fascial plane was measured from 0.3 to 2.2 mm. Because of numerous fibrous septa, the entire plane was found as a 3-dimensional sponge-like framework. Veins could be located in all levels of this framework. There was no predefined free space. The optimal place for the deposition of a filler was found to be the undersurface of the dermis. The specific technique named Scrape Skin Threading Technique and using a cannula scraping the deep side of the dermis was checked as the only technique which could give a perfect placement of product restricted to the fascial layer. The Scrape Skin Threading Technique was designed to inject safely and accurately any kind of injectable in contact with the undersurface of the dermis, which appeared anatomically as the optimal location of a filler for enhancing the outer appearance of the dorsum of hands.

Lipomodeling: An Innovative Approach to Global Volumetric Rejuvenation of the Hand.

Rejuvenation of the hand, particularly the dorsum, has garnered increased attention because of its unique aesthetic importance. Various methods have been advocated for achieving optimal aesthetic results. The authors describe their experience applying lipotransfer to total hand rejuvenation, including rejuvenation of the radial and ulnar aspects of the fingers. The authors conducted a retrospective review of 22 women who underwent global hand rejuvenation by lipotransfer. Aesthetic outcomes were assessed objectively by serial photography and subjectively by patient self-assessments. No major postoperative complications were observed. Of 22 patients, 21 indicated that they were "satisfied" or "very satisfied" with the procedure. Plastic surgeons noted improvement in the aesthetic appearance of the hands after treatment. Global hand rejuvenation should aim to restore volume and reduce skin laxity to reverse the signs of extrinsic aging. The fingers represent almost 50% of the length of the hand and should be included in treatments to achieve optimal aesthetic outcomes. 4 Therapeutic.

Comparative study of the effectiveness of 2940-nm, 1340-nm laser and intense pulsed light use on global rejuvenation of hands

Comparative study of the effectiveness of 2940-nm, 1340-nm laser and intense pulsed light use on global rejuvenation of hands

Combined treatment for hand rejuvenation using an intense pulsed light followed by a fractional nonablative laser

Combined treatment for hand rejuvenation using an intense pulsed light followed by a fractional nonablative laser

Hand Rejuvenation by Ablative Fraction CO2 Laser

Background: Ablative fractional CO2 laser (AFCL) has been reported to be safe and effective to use for preventing hand photoaging in a recent pilot study. Objectives: This study aimed to evaluate the efficacy of AFCL in improvement of hand photoaging in 25 patients. Patients and Methods: A prospective, before- after, single blind study was conducted in 25 patients who presented for desired treatment of hand photoaging. Patients received three treatments sessions with AFCL. Results: All enrolled patients were female and received three treatment sessions. There was no incidence of significant adverse effects such as scarring, prolonged erythema sever edema, post inflammatory pigmentary changes, or infection. Mean improvement one month after three treatments was 48.3% (95% CI, 42.6 - 53.9) for skin wrinkling, 53.3% (95% CI, 47.9 - 58.8) for skin pigmentation, 46.9% (95% CI, 41.4 - 52.2) for skin texture, and 54.9% (95% CI, 49.3 - 60.5) for overall cosmetic outcome (all P < 0.05). Conclusions: AFCL can be used safely and effectively in the treatment of hand photoaging.

Efficacy of Calcium Hydroxylapatite Filler versus Hyaluronic Acid Filler in Hand Augmentation

Purpose: This study compared long-term safety and efficacy of the dermal fillers calcium hydroxylapatite versus hyaluronic acid in hand augmentation in a head-to-head design. Patients and methods: The partially blinded, randomized study was conducted from July 2012 to November 2013. Subjects aged 45 – 65 years presenting for hand rejuvenation with a score of 3 or 4 on the validated Merz 5-point hand grading scale were included. Subjects were injected in a randomized manner with calcium hydroxylapatite (Radiesse ® ) in the one hand and hyaluronic acid (Juvederm ® Ultra 4) in the other hand. Observation time per patient was 12 months. Data were assessed at baseline, week 4 – 6, and months 3, 9, and 12. The primary efficacy variable was changes on the hand grading scale. Other assessments included cosmetic result, global esthetic improvement, patient and physician satisfaction, and procedural pain. Adverse events were documented at each follow-up visit. Results: Thirty-seven female patients participated in the study. Both dermal fillers led to significant improvement from baseline on the hand grading scale. 13 patients required a touch-up for both hands, 3 more patients required a touch-up in the hyaluronic acid filler-treated hand only. After 12 months, the treatment effect was still visible for both fillers. The cosmetic result was rated very good or good and global esthetic improvement was concurrently confirmed for both dermal fillers by the blinded and the unblinded physician. There was no difference in terms of satisfaction with the cosmetic result and procedural pain. In total, 11 transient adverse events related to the injection with calcium hydroxylapatite were documented in 6 patients. Conclusion: Calcium hydroxylapatite and hyaluronic acid are equally suited for achieving long-term results in hand augmentation. Calcium hydroxylapatite was more effective in attaining short-term results with a smaller injection volume. Both dermal fillers were well tolerated and did not induce any serious or unanticipated adverse events.

Comparing the efficacy of surgical vs. non-surgical options for hand rejuvenation – A systematic review

Introduction The efficacy of surgical versus non-surgical options of hand rejuvenation has not been explored in the literature. We present an interesting analysis comparing surgical and non-surgical options for hand rejuvenation with results obtained from a systematic review of the literature available. Methodology A Medline search of MeSH term “Hand rejuvenation” was conducted. A total of 83 articles were found and articles containing clinical data on surgical and non-surgical techniques of hand rejuvenation were selected. The selection criteria were that each study contained 5 of more patients and a post intervention follow-up analysis was available. Each study had to refer specifically to a technique of hand rejuvenation alone and not done in combination with separate procedures. Results A total of 10 articles were identified and selected. A total of 405 hands were treated using various non-surgical and surgical methods. Non-surgical methods include fillers such as hyaluronic acid, polylactic acid, Juvederm, calcium hydroxylapatite and Dermicol P350G. Surgical methods include the current popular technique of structural fat grafting and skin excision/reduction techniques. Complications are also comparable to each technique. Conclusion Surgical techniques appear to have a higher patient satisfaction compared to non-surgical methods but invariably involve different types of complications.

Long-term clinical outcomes of fat grafting by low-pressure aspiration and slow centrifugation (Lopasce technique) for different indications

Autologous fat grafts have been used successfully for structural fat grafting in facial, lip, and hand rejuvenation, body contour improvement, and traumatic defect restoration. The purposes of this study were to define a new fat graft harvesting and processing technique, which is named the “Lopasce technique” (low-pressure aspiration and slow centrifugation technique), and to evaluate the late clinical outcomes of fat grafting by this technique for different indications. A retrospective study was performed using the medical records of 21 patients (17 women and four men). The mean injected fat volume was 33.2 ± 34 cc (range 6–125 cc). The mean follow-up period was 13.2 ± 5.6 months (range 6–26 months). Postoperative results were evaluated by subjective and objective methods. In the subjective evaluation, 19 patients stated that there had been little resorption and that it was not necessary to repeat the fat grafting, one patient reported that the fat was resorbed in part, and one patient reported that the fat was resorbed completely. In the objective evaluation, the amount of fat graft taken in the recipient sites was between 60%–80% (average 70%) when compared with preoperative and late postoperative photographs of the patients at the 6- and 26-month follow-ups. Fat grafting is a simple, effective, and reproducible technique with a high satisfaction rate and few disadvantages or complications. We consider that structural fat grafting with the lopasce technique is an easy, effective, and long-lasting treatment for correction of congenital or acquired defects associated with various medical conditions.

A five‐patient prospective pilot study of a polycaprolactone based dermal filler for hand rejuvenation

Hand rejuvenation is becoming more popular as a complementary procedure to facial treatments. Current options include the relatively invasive lipofilling and the less invasive dermal fillers treatments, of which the latter often is too short lasting. An ideal product would therefore be minimally invasive, however, providing longer lasting results. The objective of this pilot study is to evaluate the safety and efficacy of a polycaprolactone based dermal filler for hand rejuvenation. The dorsum of the hands of five subjects was treated with 1.0mL polycaprolactone based dermal filler per hand. Subjects were seen for follow-up visits after 1, 4, 16, and 24weeks. The results showed consistent and high patient satisfaction throughout the duration of the study using a Visual Analog Scale. Satisfaction was rated at 82% at 24weeks and patients were 88% likely to return for repeat treatments on average. On the subject GAIS assessment, all subjects reported an improvement compared to pretreatment throughout the duration of the study. The physicians' GAIS results were very much improved (90%) and much improved (10%) compared to pretreatment throughout the 24weeks follow-up. The data of this small pilot suggest that the polycaprolactone based dermal filler is safe, well tolerated and effective for hand rejuvenation, and potentially offers a valuable addition to the current treatment armamentum. Additional studies in a larger patient population should be performed to confirm these findings.

Comment on Grippaudo et al.: Radiolabelled white blood cell scintigraphy in the work-up of dermal filler complications

Dear Sir, I read with great interest the recent article by Grippaudo et al. [1]. The authors evaluated the role of WBC scintigraphy in the diagnosis and follow-up of patients with suspected soft tissue infection caused by dermal fillers in the face. They concluded that scintigraphy with radiolabelled WBC was found to be the most accurate method for diagnosing infection in patients with long-term dermal filler complications, particularly using qualitative analysis of single photon emission computed tomography (SPECT) images. I think infection should be classified as an acute or subacute complication related to dermal fillers. Rather, foreign body granuloma is a delayed or long-term dermal filler complication [2, 3]. Therefore, it is reasonable to say that infection can be accompanied by a granulomatous reaction. Although accurate diagnosis has been made using scintigraphy with radiolabelled WBC, this novel method cannot affect the treatment modality. Clinically, once physicians suspect filler-related infection, they should commence adequate culture followed by appropriate antibiotic therapy [4, 5]. In my opinion, it would be more practical if clinicians could exclude soft tissue tumour in the cases of foreign body granuloma by use of scintigraphy with radiolabelled WBC. Diagnosis of dermal filler-related infection with such a novel method is less cost-effective. In addition, depending on such a novel method for follow-up of patients with suspected soft tissue infection caused by dermal fillers cannot be justified in all cases. I think scintigraphy with radiolabelled WBC only reveals inflammatory reactions without providing additional information about the injected materials or otherwise while incurring additional costs to the patients. Due to its cost-effectiveness, surgeons have ceased to conduct a routine diagnostic imaging study once clinical diagnoses are confirmed. In my opinion, clinical challenges originate not from an insufficient diagnostic method but mainly from the difficulty in obtaining an accurate history. Above all, accurate diagnosis based on clinical suspicion is the most important to define treatment [4]. However, as dermal filler injections have become widespread and subsequent infection/inflammation or granuloma have increased, I agree with Grippaudo et al. that physicians treating these complicated conditions should be familiar with the novel diagnostic method [1]. With various dermal fillers, attempts to rejuvenate the aging hands also have recently gained popularity [5]. I suggest that further study with complications of hand rejuvenation can also be of great interest to many clinicians with the novel method introduced by the authors. To the best of our knowledge, the article by Grippaudo et al. is the first study to introduce scintigraphy with radiolabelled WBC for the diagnosis and follow-up of injected filler complications. This issue itself has special merit to many surgeons as well as other physicians treating this complicated condition and further studies with granulomatous lesions caused by dermal filler are warranted.

Hand rejuvenation using a dermal filler to promote volume and skin hydration

Dorsal hand rejuvenation using dermal fillers to restore hydration and volume is now commonplace on the treatment menu of aesthetic clinics. This is a case study of 60-year-old Carol, whom the author treated with Restylane Vital for the rejuvenation of her hands. Carol had previous aesthetic treatments to her face and decolletage using hyaluronic acid (HA) fillers Restylane and Restylane Vital, and botulinum toxin type A, with excellent results. Her hands presented with premature senile actinic purpura, extreme loss of dermal volume, severe tissue atrophy, architectural changes with visible dorsal veins and tendons, and fragility with a lack of skin elasticity and hydration. Following the success of Carol's treatment, with no complications and high patient satisfaction, the author has formed a simple grading scale protocol for hand rejuvenation procedures in her clinic.

Treatment of Foreign Body Granuloma of the Hand Associated with Unregulated Material Injection for Aesthetic Purpose

Recently, rejuvenation of the aging hand has gained popularity. Various medical fillers have recently become popular, and patients have more options to rejuvenate their aging hands. However, in our country, unregulated material injections by unlicensed practitioners are still wide spread and its related complications have been considered as a serious problem. The aim of this retrospective study is to introduce our experiences regarding 17 cases of foreign body granuloma following hand rejuvenation using unregulated material. A retrospective review from December 2002 to October 2012 was performed. We analyzed data for 17 patients who underwent perilesional surgical excision for treatment of a foreign body granuloma of the hand associated with unregulated material injection by unlicensed practitioners. Injected materials include paraffin, silicone oil, and other unknown materials. Four patients were injected with paraffin, 3 patients with silicone oil, and remaining 10 patients with unknown materials. The main symptom was palpable mass and contour deformity. The patients were asked to rate their overall satisfaction following treatment. The average patient satisfaction score was 3.7. To prevent foreign body granuloma following unregulated medical practice, it is very important to inform the public about the disastrous consequence of unregulated material injections by unlicensed practitioners. (Archives of Aesthetic Plastic Surgery 19: 71, 2013)

Comment: Clinical experience with complications of hand rejuvenation

Comment: Clinical experience with complications of hand rejuvenation

Reply to ‘Comment: Clinical experience with complications of hand rejuvenation’

We would like to thank Dr. Freshwater for his comments regarding our article “Clinical Experience with Complications of Hand Rejuvenation.” As with our previous publications,1–4 most patients in our present work were referred to our institution from other hospitals.5 We totally agree with Dr. Freshwater that knowing the exact fillers injected is important to give patients proper treatments. As a tertiary medical center in our country, we received a letter of medical request without exceptions. Among those patients, 15 patients treated at our institution with prior medical records including proven injected materials were selected in this work.

Clinical experience with complications of hand rejuvenation

Prominent signs of ageing of the hands have recently been treated with permanent or longer-lasting injectable dermal fillers. However, few previous studies have described the long-term complications of such hand rejuvenation. The purpose of our report was to share our experience of 15 cases with long-term complications following hand rejuvenation using various medical fillers. We performed a retrospective review of the management of 15 patients who presented with complications from the injection of synthetic fillers for hand rejuvenation at a tertiary medical centre over a period of 10 years from March 2002 to January 2011. Injected materials included polymethylmethacrylate (PMMA) microsphere filler, calcium hydroxyapatite filler, hyaluronic acid filler, poly-l-lactic acid (PLLA) filler and other medical fillers. Of the total study sample of 15 patients, nine underwent surgical excision, six patients with a history of PMMA or PLLA filler injection received intralesional steroid therapy and three patients with a history of hyaluronic acid filler injection received injection therapy using hyaluronidase. Hand rejuvenation complications can be successfully treated according to our proposed algorithm.

Diabetes and Peripheral Arterial Occlusive Disease Impair the Cutaneous Tissue Oxygenation in Dorsal Hand Microcirculation of Elderly Adults: Implications for Hand Rejuvenation

In spite of potential implications for anti-aging therapy regarding the selection of the most suitable therapeutical method and potential perinterventional complications, cutaneous microcirculation of the aging hand in healthy individuals as well as in those with diabetes mellitus or peripheral arterial occlusive disease (PAOD) has never been evaluated. Functional microcirculation of the dorsal hand differs between healthy individuals and individuals with diabetes or PAOD at the same age. Prospective controlled cohort study. One hundred ten individuals were allocated to group A (healthy individuals, n = 37), group B (diabetes mellitus, n = 36), and group C (PAOD, n = 37). Microcirculatory data were obtained using combined laser-Doppler and photospectrometry. Cutaneous oxygen saturation at the dorsal hand of healthy individuals was 11.1% higher than of those with diabetes mellitus (p = .04) and 18.8% higher than of those with PAOD (p = .001). Cutaneous capillary blood flow in participants with PAOD was 20% higher than in healthy individuals (p = .047). This is the first study demonstrating that capillary microcirculation of the dorsal hand differs between healthy individuals and those with diabetes or PAOD of the same age. Further studies should explore whether ameliorating cutaneous tissue oxygen saturation could emerge as a viable antiaging strategy for elderly hands.