INJECTABLE TREATMENTS | Hand rejuvenation with hyaluronic acid
effective solution for augmentation of the ageing hand is available through the injection of a soft tissue filler, such as Varioderm®, a highly cross-linked hyaluronic acid filler. Varioderm® was injected using a tunnelling technique with a blunt 18 gauge cannula. Adverse events did not occur, and patients were very satisfied with the result. This article explains in detail all the aspects with regard to the injection technique.
T
Background With ageing, cutaneous atrophy
and a loss of subcutaneous fat, with a prominence of underlying veins and tendons, can occur in the hands. Although the more superficial changes can been addressed using a range of methods, the deeper changes — namely the loss of volume — have usually been ignored. In order to correct lipoatrophy of the dorsum of the hands, and to improve total skin appearance, a number of injectable fillers can be used. Since the use of hyaluronic acid
fillers in aesthetic medicine was first introduced, the problem with resorbable fillers has been the inverse relationship between safety and the lasting effects once injected. A new kind of hyaluronic acid filler, Varioderm® (Adoderm, Langenfeld, Germany), uses an innovative technology — Monophasic Particle Technology (MPT®) — to increase the duration of the filler in soft tissue, with no detrimental effect on safety.
he ageing of the hands is a common complaint of many patients. A very simple, safe and
Therefore, using a technique free of the difficulties of autologous fat transfer, it is possible to achieve a long-lasting filling effect of the ‘canals’ that show on the dorsum of the hand, with the added bonus of simplicity and safety of the technique applied.
Materials and
methods ■ Varioderm® Plus, a box of which contains two 1 cc syringes of highly cross-linked hyaluronic acid, with a concentration of 18 mg/ml
■ Lidocaine with adrenaline for injection
■ Insulin syringes ■ Sterile 20 G needle ■ Sterile blunt cannula (70 mm), 18 G disposable or reusable
■ Sterile gauze, iodinated antiseptic solution
■ Retrograde injections, subdermal level.
Injection technique Place the patient’s hands on a
procedure table, palms down, with an sterile cloth beneath, then proceed to undertake correct antisepsis using the iodinated solution.
On the skin crease that forms on the wrist with the hyperextension of the hand, the author injects 2 cc of local anaesthetic per hand. The papule that forms is gently spread in a radiating fashion to fully disseminate the anaes thetic agent. Then, using a 20 gauge sterile needle, the author makes a small hole in the skin of the area previously anaesthetised (Figure 1). A blunt, sterile cannula,
20 ❚
disposable or reusable (according to the preference of the injector), is
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then inserted through the perforation previously made in the skin (Figure 2) and advanced in a distal direction along the canals, surrounded on both sides by the tendons (Figure 3). Once in the most distal position, retrograde injection of the filler is commenced (Figure 4). A slight grey hue is visible owing to the Tyndall effect. Some gentle massage along the line of the injections will help to distribute the Varioderm® Plus product more evenly. There is no need to completely extract the needle to re-start injecting in the neighbouring canal. The laxity of the tissues in the zone makes a rotation of the cannula to re- position it very easy to perform. It is possible to immediately
compare results of the hand already treated with the untreated hand (Figure 5). To highlight the results, the author asks the patient to make a fist. Once the procedure is finished, the author recommends applying an ice pack and compression bandages to both hands. Some bruising is expected but overall, the procedure is completely painless.
Conclusions The injection of Varioderm® Plus to
"Varioderm was injected by the
author using a tunnelling
technique with a blunt 18 gauge cannula.
address the loss of volume in the dorsal of the hand is a very simple, safe and effective technique to rejuvenate the ageing hand. The combination of this technique with other procedures, such as chemical peels, intense pulsed light,
or mesotherapy, will achieve very gratifying results. Furthermore, long- lasting results are achieved as a result of the highly cross-linked characteristics of Varioderm®, with an estimated duration of at least 12 months in the author’s experience.
Figure 1 A 20 G sterile needle is used to make a hole in the previously anaesthetised skin
Figure 2 A blunt, sterile cannula — disposable or reusable — is inserted through the previously made perforation
Figure 3 Advance the blunt cannula in a distal direction
Figure 4 Retrograde injection of the filler
Figure 5 Treated (right) and untreated (left) hands
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