What is the recommended approach for filler treatments for hand rejuvenation?

Hand Rejuvenation with Dermal Fillers

Calcium hydroxylapatite (CaHA) is the recommended first-line filler treatment for hand rejuvenation, as it is FDA-approved specifically for this purpose and demonstrates excellent safety and efficacy profiles.

Anatomical Considerations

When approaching hand rejuvenation, it's important to understand that aging hands typically display:

• Loss of dermal elasticity
• Atrophy of subcutaneous tissue
• Prominent veins, tendons, and bony structures
• Skin thinning and wrinkling

Treatment Algorithm

Step 1: Assessment and Planning

• Evaluate the degree of volume loss using a standardized scale (e.g., Merz Aesthetic Hand Aging Scale)
• Assess prominence of veins, tendons, and bony structures
• Identify skin quality issues (pigmentation, texture)

Step 2: Primary Treatment - Dermal Filler Selection

1. First choice: Calcium hydroxylapatite (CaHA)

   • FDA-approved specifically for hand rejuvenation 1
   • Provides long-lasting results (typically 12+ months)
   • High patient satisfaction rates

2. Alternative options:

   • Hyaluronic acid (HA) fillers
     • Good safety profile with sustained improvement for 6-12 months 2, 3
     • May require touch-ups at 3 months
   • Autologous platelet concentrates (APCs)
     • Natural option with regenerative properties 4
     • Can be combined with other modalities

Step 3: Injection Technique

• Apply topical anesthetic prior to injection
• For CaHA:
  • Inject 0.75-1.5 mL per hand subdermally 1
  • Use retrograde threading technique
  • Gentle massage for 2 minutes post-injection
• For HA fillers:
  • Retrograde injection technique in hypodermis
  • Massage to ensure optimal distribution 2

Step 4: Combination Approaches

For enhanced results, consider combining filler treatment with:

• Sclerotherapy for prominent dorsal hand veins 1
  • 0.5% Sodium tetradecyl sulphate is effective
  • Perform sclerotherapy before filler injection
• Laser treatments for pigmentation issues
  • Apply APCs after laser treatment to accelerate healing 4

Efficacy and Safety

CaHA demonstrates excellent outcomes:

• High patient satisfaction (>80% at 6 months) 1
• Significant improvement in vascular, tendon, and bony prominence
• Durable results lasting 12+ months with minimal side effects

HA fillers show:

• Substantial improvement maintained at 6 months (85% patient satisfaction)
• Approaching baseline at 12 months (50% satisfaction) 3
• Excellent safety profile with minimal adverse events

Important Considerations and Pitfalls

1. Avoid overfilling

   • Can create unnatural appearance
   • Start conservatively with 0.75-1.5 mL per hand

2. Vascular complications

   • Be aware of dorsal hand vasculature
   • Inject slowly and in small amounts
   • Have hyaluronidase available when using HA fillers

3. Patient expectations

   • Discuss maintenance requirements
   • Results typically last 6-12 months depending on filler type
   • Touch-ups may be needed at 3-6 months

4. Post-treatment care

   • Gentle massage twice daily for two days
   • Avoid strenuous hand activities for 24-48 hours
   • Consider repeat treatment after one month if needed 1

By following this structured approach to hand rejuvenation with dermal fillers, clinicians can achieve optimal outcomes with high patient satisfaction and minimal complications.