Like the face, the hands are a visible reminder of a lifetime of environmental exposure and the constant stress of repetitive movements. On the back of the hand, aging becomes apparent as thinning or loss of volume between the flexor tendons, very evident and prominent veins, wrinkled skin, and numerous age spots and brown discoloration. Most of the skin rejuvenation methods, such as peeling and exfoliation and light therapies, can improve the texture of the skin but can not replace the ‘gaunt look’ of the aging hand.
Injectable fillers are the only option for adding volume to the dorsum or back of the hands. While all filling materials will work, those with the longest known volume retention are best. While fat can be used, it is not a practical in-office treatment method. Of the synthetic fillers, I prefer Radiesse in my Indianapolis plastic surgery practice.
Radiesse consists of 30% spheres of calcium hydroxyapatite in an aqueous carrier gel. Based on its experience in the face, it has proven to be durable and long lasting out to about a year. It is eventually absorbed as its ceramic spheres are gradually degraded. It can be easily injected into the thin tissue on the back of the hand. Because it can be now mixed with a local anesthetic, hand rejuvenation can be a near pain-free experience. Even though Radiesse is white in color, it does not appear that color when under the skin.
Hand rejuvenation injections is simple to perform and a fairly quick procedure. I do like to apply a topical anesthetic cream first to the back of the hands for about 15 or 20 minutes. By first using a micro-roller and then applying the cream, the onset of skin anesthesia is more rapid and profound. The skin is then lifted on the back of an outstretched hand between the second and the fifth ray which leaves the veins behind and out of the way. About .65 ccs of Radiesse (1/2 syringe) is injected as a bolus into the back of each hand. With the patient now making a closed fist, the material is then massaged to spread it evenly throughout the subcutaneous space over the entire back of the hand. Another technique is to inject it in smaller volumes in three areas between 2-3, 3-4, 4-5 rays. Either way, keep massaging until the dorsum looks even.
The results of hand rejuvenation are immediate. It will typically last a year or so. There is no recovery and bruising is either absent or very minimal. I don’t give any particular restrictions afterwards other than not to do any strenuous or excessively repetitive hand movements for the rest of the day. With a simple 30 minute total treatment time and less than one day of recovery, one can have rejuvenated hands that last for the rest of the year.
Dr. Barry Eppley