Soft Tissue Augmentation of the Hands

Introduction

Aging of the hand becomes appreciable as of the fourth decade of life. Following chronic exposure to ultraviolet radiation, pollutants, irritants, and mechanical stress, hands are subject to visible senescence. Superficial damage including discoloration, textural variation, and the development of neoplastic lesions is often seen. Aging of the hand involves changes to underlying structures as well. The process is characterized by loss of subcutaneous fat and increased visibility of bones, tendons, and veins. In certain diseased states, aberrant microcirculation may be an exacerbating factor.

Rejuvenation treatments for the hands have become increasingly popular. In one study on first impressions, evaluators rated images of hands that underwent soft tissue augmentation. Perception scores for social skills, academic performance, and various areas of success were significantly higher for images of treated hands in comparison to untreated ones. Blinded evaluations by experts and patients alike report the degree of volume loss and vessel prominence as major indicators of aged hands. While a number of topical and device-based therapies can target superficial damage, soft tissue augmentation is the treatment of choice for restoration of volume and reduction of laxity. A variety of grading scales such as the 5-point photonumeric grading scale, the Global Aesthetic Improvement Scale, and the Merz Grading Scale were developed to evaluate the degree of volume loss and improvement in hand rejuvenation following soft tissue augmentation. Interventions must account for local anatomical structures and mobility of the hand, in addition to safety, durability, and tolerability of injected products. Several materials have been used for this purpose, each demonstrating variable levels of success. This chapter will discuss the techniques and outcomes of different modalities, touching upon risks and benefits of each option.

Soft Tissue Augmentation of the Hands