Our hands are one of the first places that show signs of aging. Wrinkled skin with dark spots and prominent veins are the usual telltale signs of advanced aging. The appearance of the aged skin can be improved with comprehensive skin care and nonsurgical resurfacing. However, this does not correct the loss of skin volume and skin thickness resulting in unsightly appearance of the veins and tendons on the top of the hand.
Recently, we had a patient return for follow-up visit after skin care, face lift and selective laser resurfacing. She was delighted with her restored youthful and healthy facial appearance. However, she was aware that the appearance of her hands gave away her age and she inquired about the options available to improve their appearance.
A treatment plan was started for her, which included a blending in of the darkened age spots by a BBL Laser treatment and a technique to thicken the hand skin in order to hide the prominent veins and tendons below. Thickening of the skin can be accomplished by two methods:
- Fillers, including Restylane, Juvederm or Radiesse can be injected but we feel this technique can be overly expensive and the results are not permanent.
- We recommend the use of the patients own fat which we feel can provide a better and safer alternative and the results are permanent unlike the injection of the fillers noted above.
The procedure is done in the office under local anesthesia. Fat may be harvested from the lower abdomen, waist or hips, or any suitable area which can be concealed easily. The donor area is prepared and anesthetized, and fat is harvested using a syringe and a harvesting cannula. The fat component is transferred to a smaller syringe, then injected as a graft through a special blunt tipped cannula. The fat is placed under the skin, but above the level of the tendons and veins on top of the hand. After the fat transfer the treated area is gently massaged to produce a satisfactory smooth contour. The process may take about an hour in the office.
Recovery and Expected Outcome
Following the procedure, there will be swelling, some bruising. There are no incisions, just the punctures from the injecting cannula and from the harvesting cannula, which heal in a few days. Swelling and bruising will improve after a few days. The fat grafts fill the spaces where fat used to reside. In some cases, the texture of the overlying skin improves following fat grafting, because there is restoration of the suppleness and some elasticity. The below patient underwent a 20cc fat transfer to both hands. Her after photographs were taken one week after treatment.
Potential Risks and Complications
The main concerns are swelling, possible bruising. Use of the blunt tipped cannula reduces the risk of bleeding or injury to important structures like veins and tendons. Oral antibiotics help reduce the risk of infection in susceptible patients. Most patients have found that their hands are totally healed within one to two weeks.
Joseph W. Rucker M.D.