PEER-REVIEW | INJECTABLE TREATMENTS |
Figure 9 (A) Multiple puncture points after native hyaluronic acid injection; (B) intradermal three-point injection with Restylane Vital Pen (Q-Med, Sweden); (C) shining trough of the needle during the intradermal injection
Conclusions
Rejuvenation of the ageing hands is experiencing a growing popularity owing to the recognition that the hands are the ‘new’ face. One of the most popular methods is volumisation with filling materials, which addresses the volume and contour loss, ‘bony’ appearance, prominence of the veins and tendons, and the loss of skin elasticity and thickness. Yet, there are only a few controlled studies regarding the anatomy and the use of different filling materials in the ageing hands. Fortunately, as our interest in rejuvenation of the hands is increasing, so too does our knowledge. As the primary concern should always be the correct
The author’s preferred
technique for hand volumisation is the single proximal insertion point (SPIP) technique with a 25 G or 23 G 2-inch (50 mm) blunt cannula.
Key points
■ After the face, the hands are the most conspicuous part of the human body
■ The optimal and safest layer in which to deposit the filling material is the underface of the dermis
■ A blunt cannula is the appropriate tool to ensure staying in the correct injection layer, thereby minimising the risk of damage to nerves and blood vessels
■ Every physician should have an exact knowledge of anatomy, product characteristics and injection techniques before starting the treatment
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functioning of the hands, followed by their aesthetic appearance, it is essential to avoid any kind of complications owing to cosmetic treatments that may interfere with their function. Therefore, it is essential that a practitioner should have an exact knowledge on the anatomy, characteristics of the range of products, advantages, disadvantages, and risks of different injection techniques, as well as the correct treatment in case of complications. The author’s preferred technique for hand volumisation
is the single proximal insertion point (SPIP) technique with a 25 G or 23 G 2-inch (50 mm) blunt cannula (Figure 5). From the single insertion located at the most proximal atrophic point at the dorsum of the hand, all atrophic areas can be
References
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2. Jakubietz RG, Kloss DF, Gruenert JG, Jakubietz MG. The ageing hand. A study to evaluate the chronological ageing process of the hand. J Plast Reconstr Aesthet Surg 2008; 61: 681–86
3. Bains RD, Thorpe H, Southern S. Hand aging: patients’ opinions. Plastic Reconstr Surg 2006; 117: 2212–18
4. Carruthers A, Carruthers J, Hardas B et al. A validated hand grading scale. Dermatol Surg. 2008; 34(Suppl 2): S179–S83
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augmentation of the dorsal hands. Dermatol Surg 2008; 34(8): 1026–31
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reached. This technique is less traumatic and less painful for the patient than other techniques that use multiple insertion points. Also, the risk of injuring the vessel and causing haematoma is lower when performing the single insertion point than with multiple insertion points. Furthermore, from this point it is easier to introduce the blunt cannula than from a distal position, as well as to place the material in the correct layer (immediately below the dermis). As the filler is already distributed during the injection, no massage after the treatment is necessary. The author’s
preferred material for hand augmentation is CaHA (Radiesse®; Merz Aesthetics, Frankfurt, Germany) because of its good volumising properties as well as induction of a new collagen deposition. The author recommends diluting a 1.5 ml syringe with 0.5 ml 2% lidocaine with adrenaline, and then injecting half of the material in each hand. In cases with more severe atrophy a second injection session after 6–8 weeks is recommended.
Declaration of interest None Figure images 2a–b, 3, 4b–d, 5–9 © Dr Tatjana Pavicic
October 2013 |
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