What is the recommended approach for hand rejuvenation with Hyaluronic Acid (HA) fillers, such as Restylane (Hyaluronic Acid) or Juvederm (Hyaluronic Acid)?

Hand Rejuvenation with Hyaluronic Acid Fillers

Hyaluronic acid (HA) fillers are an effective and safe option for hand rejuvenation, providing significant improvement in hand aging with results lasting up to 12 months. The aging hand typically displays loss of dermal elasticity, subcutaneous tissue atrophy, prominent veins, tendons, and bony structures, along with skin thinning and wrinkling.

Assessment Before Treatment

• Evaluate the degree of volume loss using a standardized scale such as the Merz Aesthetic Hand Aging Scale 1
• Assess skin quality, pigmentation issues, and volume loss
• Identify any contraindications to treatment

Injection Technique for HA Fillers

1. Preferred Method: Retrograde Injection Technique

   • Inject HA filler in the hypodermis using a retrograde approach 2
   • This technique has been shown to provide stable and significant improvement in hand aging for up to 12 months
   • Post-injection massage ensures optimal cosmetic results

2. Volume Considerations

   • Average volume needed: approximately 13-14 mL per hand 3
   • Consider touch-up treatments at 3 months for optimal results 2

Post-Treatment Care

• Apply moisturizer after treatment to maintain skin barrier integrity 4
• Use lukewarm water (not hot) for hand washing to avoid skin irritation 4
• Avoid immediate exposure to extreme temperatures or activities that could displace the filler

Combination Approaches for Enhanced Results

• Laser Treatment + HA Fillers

  • Laser treatments can address pigmentation issues
  • Apply HA fillers after laser treatment (not before) as laser wavelengths could damage the filler 4
  • This combination can provide comprehensive rejuvenation addressing both volume loss and skin quality

• HA Fillers + Autologous Platelet Concentrates (APCs)

  • Research suggests a synergistic effect when combining HA fillers with APCs 4
  • An RCT by Hersant et al. showed that combining PRP and HA (50:50 mix) provided highly significant improvement in appearance and skin elasticity compared to either treatment alone 4

Potential Complications and Management

• Common Side Effects

  • Temporary swelling, bruising, and discomfort
  • Usually resolve within 1-2 weeks

• Rare but Serious Complications

  • Vascular occlusion (extremely rare in hands but possible)
  • Infection
  • Nodule formation

Alternative Options

If HA fillers are not suitable or preferred, consider:

1. Autologous Fat Transfer

   • Provides biocompatibility, revascularization, and long-term results 5
   • Changes overall skin texture and appearance with disappearance of visible superficial veins 5
   • Requires harvesting procedure and longer recovery

2. Calcium Hydroxylapatite

   • Can be administered via single-bolus injection 6
   • Alternative for longer-lasting results

Follow-up Care

• Evaluate results at 2 weeks post-treatment
• Consider touch-up treatment at 3 months if needed 2
• Results typically last up to 12 months, with maintenance treatments recommended annually

Key Considerations for Success

• Patient selection is critical
• Proper injection technique is essential for safety and optimal results
• Post-treatment massage helps ensure even distribution
• Combination with other modalities can enhance overall rejuvenation

The evidence strongly supports HA fillers as a safe and effective option for hand rejuvenation with high patient satisfaction rates and minimal downtime, making it an excellent first-line treatment for addressing the signs of aging hands.