One of the well known changes that happens in woman’s hands is a thinning or skeletonization look that can develop to them with aging. This is due to the loss of the subcutaneous fat on the back of the hands, creating greater exposure of the extensor tendons and the space between the bones of the hand. Rejuvenation of the aging hand, therefore, requires the addition of volume through some form of injectable filler.
While a variety of synthetic injectable fillers are available to be used for hand rejuvenation, the use of one’s own fat offers the only long-term solution. It is also the most natural filler product given that it is the patient’s own tissue that is being injected. Fat injections to the hand are simple to place and are done with small blunt cannulas to prevent injury to the many veins that exist on the back of the hand.
While hand injections are fairly easy to perform, their greatest aesthetic issue is their potential for clumping. Unlike synthetic fillers, fat does not come out of an injection cannula in a perfectly uniform manner. This makes it very prone in thin tissues to be somewhat lumpy. If the fat is not perfectly smooth after injection, lumps or even fat cysts can form afterwards on the very visible back of the hands which can be difficult to treat.
The use of a small pastry roller can be very effective at helping smooth out the back of the hands after fat injections. Once the fat is injected, the hand is rolled back and forth until the smoothest dorsal contour is obtained. Fat is very easy to move around on the back of the hands after injection since it is placed in the subcutaneous space above the fascia. It becomes spread out like a very thin layer of rolled out pasta across all the back of the hands from thumb to the little finger.
While massaging the fat around is one method of smoothing it out once placed under the skin, I have found the use of a roller creates a more even distribution of fat and has eliminated postoperative problems of visible fatty lumps.
Dr. Barry Eppley