What is the recommended filler for hand rejuvenation?

Hand Rejuvenation with Fillers: Recommended Options

Calcium hydroxylapatite (CaHA) is the recommended filler for hand rejuvenation due to its dual volumizing and biostimulatory properties, providing both immediate volume restoration and long-term collagen stimulation for optimal results.

Understanding Hand Aging

Hand aging is characterized by:

• Loss of dermal elasticity
• Atrophy of subcutaneous tissue
• Increased visibility of veins, tendons, and bony structures
• Skin thinning and loss of elasticity

Recommended Filler: Calcium Hydroxylapatite (CaHA)

Why CaHA is Superior for Hand Rejuvenation:

• Provides immediate volume restoration lasting up to 12 months
• Creates longer-term correction through biostimulation and collagenesis 1
• Demonstrates improvements in skin quality parameters including:
  • Increased dermal thickness
  • Improved skin elasticity
  • Reduced transepidermal water loss 2
• Shows high patient and physician satisfaction in clinical studies 2
• Has comparable safety profile to hyaluronic acid fillers but with longer-lasting results 1

Injection Technique for CaHA:

1. Proper Anatomical Layer: Inject into the dorsal intermediate lamina, which is the appropriate layer where veins are present 3
2. Recommended Method: Use skin pinching technique to ensure safe entry points and guide the cannula into safe planes without compromising superficial veins 3
3. Injection Options:
   • Deep fat lamina injection
   • Subdermal injection (slightly higher patient satisfaction reported) 4
4. Equipment: 25-gauge needle or cannula for injection 5

Efficacy and Outcomes

Research demonstrates that diluted CaHA:

• Improves Merz Hand Grading Scale (MHGS) scores
• Enhances Global Aesthetic Improvement Scale (GAIS) scores
• Increases total collagen density from baseline
• Improves skin viscoelasticity measures and dermal parameters on ultrasonography 4

Alternative Options

Hyaluronic Acid (HA) Fillers:

• Provides temporary protection and improves skin hydration 6
• Fully reversible with hyaluronidase (unlike CaHA which is only adjustable)
• Generally shorter duration than CaHA 1

Autologous Options (Bio Fillers):

• Cost-effective ($92-119 per session vs. $500-800+ for traditional fillers)
• Natural results with lower risk of complications
• Requires multiple sessions for optimal results
• Duration of effects: 4-6 months before resorption 5

Treatment Considerations and Precautions

• Pain Management: Both deep fat lamina and subdermal techniques show similar pain profiles 4
• Adverse Effects: Typically mild and transient (pain, swelling, redness, bruising)
• Resolution: Most side effects resolve spontaneously within 30 days post-injection 2
• Follow-up: Regular assessment recommended to maintain results

Practical Algorithm for Hand Rejuvenation

1. Assessment: Evaluate degree of volume loss and skin quality
2. Primary Choice: CaHA for moderate to severe volume loss with skin quality concerns
3. Alternative: HA fillers for mild volume loss or patients wanting reversibility
4. Technique Selection:
   • For most patients: Subdermal injection technique (12% higher satisfaction)
   • For very thin skin: Consider deep fat lamina technique
5. Post-Treatment: Apply moisturizers regularly to maintain skin hydration

By following this evidence-based approach to hand rejuvenation with CaHA fillers, clinicians can achieve optimal aesthetic outcomes with high patient satisfaction and minimal complications.