Fillers for hand rejuvenation: anatomical features and procedure protocol

The degree and rapidity of age-related volume loss in the area of ​​the hands depends on:

• genetic predisposition;
• presence of a history of rheumatological diseases;
• UV exposure;
• bad habits;
• physical activity.

A number of procedures are aimed at rejuvenating the hands, including filler injections, which allow you to restore lost volumes and hide protruding tendons and translucent vessels.

This article estet-portal.com provides information on important aspects of hand rejuvenation with fillers, presented by Dr. Medhat Abdelmalek (Medhat Abdelmalek).

• Which fillers are used to rejuvenate hands
• Anatomical features of the dorsum of the hands
• Filler hand rejuvenation procedure: important points
• Protocol for hand rejuvenation with dermal fillersand

Which fillers are used for hand rejuvenation

Different types of hand dermal fillers are available on the market to stimulate collagen synthesis and proliferation.

Studies show that poly-L-lactic acid has the most pronounced effect of collagen stimulation. Other effective fillers are based on calcium hydroxyapatite and hyaluronic acid.

Classification of fillers in cosmetology for volume and contours

The most common side effects of hand rejuvenation with dermal fillers include:

• temporary swelling;
• ecchymosis;
• erythema;
• itch.

Studies show that poly-L-lactic acid has the most pronounced effect on collagen stimulation.

The intensity and frequency of adverse events depend on the selected drug and the technique of the procedure.

Studies have shown that poly-L-lactic acid can cause nodules after injection into the arm area, while calcium hydroxyapatite causes more swelling compared to injections ofand hyaluronic acid.

Anatomical features of the dorsum of the hands

For successful hand rejuvenation with fillers, the doctor certainly needs to know the anatomy of the target zone.

In the area of ​​the hands, three fat layers are distinguished:

• surface;
• intermediate;
• deep.

The intermediate and deep layers are separated from the superficial dorsal superficial and intermediate fascia, while the dorsal deep fascia separates the lower portion of the dorsal deep fat layer from the dorsal interosseous muscles and metacarpals.

It is also important to locate the sensory nerves and dorsal veins located under the intermediate dorsal layer. The extensor tendons are located in the deep dorsal layer. Fascial sheaths surround arteries and veins that run along the fascial septum.

To avoid vascular damage and related complications when injecting fillers, the doctor must determine where the vessels of the treated area pass. The dorsal venous network of the back of the hands consists of deep and superficial veins.

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The choice of filler and injection technique is made after consultation and a thorough examination of the patient.

The practitioner needs to strike a balance between the patient's wishes and realistically achievableresults.

Hand rejuvenation procedure with fillers: important points

There are various forms of local anesthesia that doctors use before hand fillers:

• topical anesthetics;
• conduction anesthesia;
• local infiltration.

Depending on the doctor's preference, 1–2% lidocaine is typically used with or without adrenaline.

It is important to remember that the effect of topical anesthetics is limited to the epidermis – the top layer of the dermis. Accordingly, the deep layers of the dermis and subdermal tissues retain sensitivity.

Nerve blocks also have their drawbacks: patient discomfort and the risk of additional bruising. The effectiveness of the blockade largely depends on the experience of the injector. Local infiltration

can distort the anatomy and the doctor's perception of the result of the correction.

The exact location of the nerves varies from patient to patient. Taking into account this fact, in order to reduce the risk of damage to nerves and blood vessels, the author uses cannula

.

for hand rejuvenation. In addition, it is important to avoid inserting the filler over tendons and bone structures

to avoid uneven skin surface after correction.

To reduce the risk of damage to nerves and blood vessels, the author uses a cannula to rejuvenate the hands.

The injections are given under the veins and skin, but over the muscles. The author also uses a

retrograde linear

or

fan technique to avoid intravascular drug administration. In order to reduce the risk of bruising and bruising immediately after the injection, the doctor presses hard on the treated area.

Massage of the hands after insertion

ensures an even distribution of the injected product and a more natural

contour. Hand rejuvenation protocol with dermal fillers

The author prefers to use

lidocaine

only when working with particularly sensitive patients. In addition,

topical anesthetic cream is used in minimal amounts as it increases the chance of undercorrection. Patient sits comfortably with arms below heart level – this makes it easier for the injector to determine the location of the veins. The relaxation and comfort of the patient allows the doctor to concentrate and more accurately inject the filler into the target areas.

minimizes the risk of contamination before and during the procedure, so the skin is thoroughly cleaned with a disinfectant solution, and only then proceed to injections.

Everything is in our hands or effective methods of hand rejuvenation

The entry point

is located on the back of the hand, approximately at the point where it joins the wrist.

Next, using a 22 gauge cannula, the author works in three directions

, starting to inject the low molecular weight cross-linked filler

from the side of the elbow in a retrograde technique: towards the little finger;

in the center, towards the middle finger;
laterally, towards the index finger.
• As a rule, the author uses one filler syringe (1 ml) to correct one hand, however, the exact amount of the drug depends on the condition of the patient's hands.

After the filler is injected, the doctor performs a massage of the treated area and performs the procedure on the second arm.

Patient sits comfortably with arms below heart level – this makes it easier for the injector to determine the location of the veins.

After that, the author injects

natural hyaluronic acid

into 16 points at the level of the basement membrane. Only 0.05 ml of HA is injected into each point to hydrate and smooth the skin.

At the end of the procedure, a light massage of both hands is performed. The procedure is repeated every 8–9 months

.

Age can be hidden: hand rejuvenation with fillers

If the patient is concerned about swelling after the procedure (less than a week), the author prescribes methylprednisolone

.

In general, patient satisfaction with the results of hand rejuvenation with hyaluronic acid fillers

is very high.

Adapted from The

PMFA Journal.