The use of injectable fillers continues to enjoy widespread use and growth much of which is used in the face. There are not many body applications for injectable filler due to the high volumes needed and their temporary duration. One such body application is that of use in the hands for the treatment of age-related changes with loss of fat and skin atrophy. (skeletonization)
While a lot of different injectable filler materials exist, the only synthetic injectable filler that is FDA-approved is Radiesse. Radiesse is composed of hydroxyapatite microspheres in a dissolvable gel that has a long history of use in the face. It is a longer lasting filler due to the slow absorption of the calcium microspheres. While being white in color, that does not translate to such through the skin.
In the May 2018 issue of the journal of Plastic and Reconstructive Surgery, an article waspublished entitled ‘The Anatomy Behind Averse Events in Hand Volumizing Procedures: Retrospective Evaluations of 11 Years of Experience’. In this multi center clinical paper the authors review their experience with two hundred and twenty patients (440 hands, the vast majority who were women) who underwent bilateral hand rejuvenation using a calcium hydroxlapatite inject ate (Radiesse) over an eleven year period. Their clinical experience was supplemented with cadaveric dissections and select fluoroscopic, ultrasound and CT imaging.
Their clinical results showed that 7% of the patients adverse symptoms of swelling, redness, discoloration and pain in the first two weeks after treatment. Using needles to inject was associated with a higher incidence of these symptoms than that of a cannula. The injection technique that was superior (lower risk of adverse events) was the proximal to distal fanning technique with placement in the dorsal superficial lamina, a space within 1mm of the underside of the skin’s surface.
The options for hand rejuvenation are either fat injections or Radiesse. Each has their own advantages and disadvantages. But their injection principles remain the same, cannular delivery placed right under the skin.
Dr. Barry Eppley