One of the classic giveaways for the women who has had a facelift is how her hands look. While the face can be very successfully rejuvenated by many different techniques, the hands historically have been ignored until more recent times. It is now acknowledged that restoring volume through injectable fillers and fat injections can create hand rejuvenation. If combined with other skin resurfacing/remodeling techniques (laser skin resurfacing, brown spot removal by pulsed light therapies), a more complete hand rejuvenation approach can be done.
In the September 2015 issue of Aesthetic Surgery Journal, an article appeared on hand rejuvenation entitled ‘Lipomodeling: An Innovative Approach to Global Volumetric Rejuvenation of the Hand’. In this paper, the authors describe their approach with fat injections to total hand rejuvenation including adding fat volume to the radial and ulnar sides of the fingers. They term this ‘global hand rejuvenation’. In a review of 22 women who had global hand rejuvenation by fat injections, no postoperative complications occurred.. Aesthetic outcomes were deemed satisfied to very satisfied in almost all patients (21 of 22 patients) to both patients and plastic surgeons alike. The authors advocate that since the fingers represent almost 50% of the length of the hand, volumizing efforts of the hand should extend into the fingers as well.
Fat injections into the dorsum (back) of the hands is relatively easy to do as there is a natural tissue plane between the skin and the fascia overlying the finger bones and the spaces between them. One can introduce a long blunt cannula near the wrist and deliver the fat in long linear rows as the cannula is pulled back. Once in place the fat can be digitally manipulated and massaged into a smooth distribution all along the back of the hand. This minimizes the risk of lumps and irregularities forming.
Extending the fat injections out further into the web spaces is a logical extension of this hand rejuvenation technique. There is no anatomic reason why this can not be done short of a lack of adequate fat to inject. Entering the sides of the fingers for fat injections poses a slightly different risk than the rest of the hand due to the neurovascular bundles blood vessels and nerves) that are located in the web space and course along both sides of the fingers. One does have to be careful to not place too much fat volume in this area to avoid neurovascular compression. Fortunately fat is soft and as a natural body component has a very low risk of this potential problem.
Global hand rejuvenation offers an aesthetic improvement over isolated dorsal hand injections and requires minimal extra fat to do so
Dr. Barry Eppley