Objectives: Hand Rejuvenation, anatomical guidelines, injection techniques

Introduction: Beside the face, first signs of aging are clearly shown in the hands. Due to the high demand, different techniques for hand rejuvenation using either structural fat grafts or injectable fillers to restore the volume have been performed. Mesotherapy, lasers, chemical peelings or sclerotherapy help to treat the superficial signs of aging. We wanted to demonstrate the right plane of injection for safe volumetric restoration.

Materials / method: Having dissected 12 cadaveric hands, evaluation clearly showed the best placement of volumetric fillers.

Results: Histologic examination showed three fatty laminae which are separated by thin fascias. No structures transversing the subcutaneous, superficial fatty lamina could be found. Dorsal veins and dorsal sensory nerves could be found within the intermediate lamina. The extensor tendons were found within the deep lamina.

Conclusion: Following anatomical dissection we could demonstrate the safe approach injecting into the intermediate lamina with minimal risk of adverse events.

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Objectives: The objective of this study is to analyze the best practices and strategies for hand rejuvenation

Introduction: Hand rejuvenation has been recognized to play a key role in complementing and restoring an overall youthful look.Aging hands present specific characteristics that require a carefully designed combinational treatment for a successful clinical outcome from a practitioner's and patient's perspective.

Materials / method: A Medline search was performed on hand rejuvenation from 1990 to 2015, and results are summarized. The authors' personal experiences with specific technologies are discussed.

Results: Review of available clinical studies revealed successful rejuvenation of the epidermis and dermis of the hands with topicals, chemical peels, intense pulsed light, and laser energy devices. Reports of sclerotherapy and laser veins ablation for dorsal hand veins were identified. Several studies on hand volume restoration with injectable volumetric fillers such as hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, autologous fat transfer including the authors' personal experience with them are described.

Conclusion: A plethora of noninvasive treatment options for hand rejuvenation have been thoroughly studied as monotherapy, but there is insufficient number of studies evaluating the best combination of therapies for this indication. It is likely that their strategic combination and sequence of application by a trained clinician will ensure a favorable outcome in addressing patient concerns.

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