PEER-REVIEW | CASE STUDY |
Figure 3 67-year-old female (A) before and (B) after treatment with CaHA
hands in 200717
Augmentation with CaHA was first described for the . Since then, there have been at least five
further publications which prove the safety and efficiency of the material. One study investigated the use of the filler in 101 patients6
. After 3 and
observation period of 1 year. The volume filler also proved safe in this case and provided lasting treatment results for 9–12 months19
. Before the start of
4 months, 66% and 56% respectively showed an improvement by at least one point on a standardized scale for evaluating signs of ageing on the hands (Busso Hand Volume Severity Scale, BHVSS ® Table 1). More than three quarters of patients were satisfied with the treatment, while among doctors this figure was over 85%. The treatment proved to be safe. Side-effects included temporary erythema, ecchymosis, and oedema, which healed within 2 weeks6–8, 16, 18
.
A further study was published which investigated the safety and efficacy of CaHA in this indication over an
Table 1 Busso Hand Volume Severity Scale (BHVSS)
DEGREE DESCRIPTION All three central tendons are fully exposed when hand is at rest
3
All three central tendons are partially exposed, with one or two tendons fully exposed when hand is at rest
All three central tendons are partially exposed when hand is at rest One or two central tendons are slightly exposed when hand is at rest No tendons exposed when hand is at rest
Table 2 Systematic approach to the ageing hands: five-point scale for consistent rating
DEGREE DESCRIPTION 4 3 2 1
0 32 ❚
Very severe loss of fatty tissue; marked visibility of veins and tendons Severe loss of fatty tissue; moderate visibility of veins and tendons Moderate loss of fatty tissue; mild visibility of veins and tendons Mild loss of fatty tissue; slight visibility of veins No loss of fatty tissue
January/February 2013 |
prime-journal.com
any treatment session, it is advisable to determine the nature of the baseline status objectively using a validated scale.
Treatment protocol Before the start of any treatment session, it is advisable to determine the nature of the baseline status objectively using a validated scale10, 18
. The Merz scales
(Table 2) are a modern and practical way of evaluating the loss of volume from the back of the hand19
. For increased patient comfort, CaHA
can be mixed with lidocaine prior to injection. A 1.5 ml syringe is usually mixed with CaHA, with 0.26 ml of a 1% lidocaine solution. However, different mixing ratios are possible depending on the practitioner. In the authorÕs experience, Radiesse implants and integrates particularly well at this location if a mixing ratio of 1 : 1 is used.
Injection method The substance is injected into the back of the hand. Both distal (between the distal ends of the carpal bones) and proximal (over the carpal bones) access is possible. After lifting the skin over the area to be injected, the
material is placed between the subcutaneous layer and the superficial fascia in the so-called Ô tenting techniqueÕ . All interdigital spaces are treated successively in this way. Blunt cannulae (25 G, 50 mm) or sharp 27 G cannulae are most suitable for implantation in the authorÕs experience. Using a sharp needle, boluses are inserted at three to four injection points (each around 0.2–0.4 ml). The ease of this method makes it suitable for less experienced users also. With the blunt flexible cannula, CaHA can be administered using the Ôlinear threading techniqueÕ (three to four threads), starting from one injection point only, which is usually placed in the middle of the area overlying the carpal bones. A typical injection quantity for both methods is 1–1.5 ml per hand. Immediately after the procedure, it is advisable to
massage the material (moulding) in order to ensure an even distribution.
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