An anatomical approach to hand rejuvenation: the AB (Anatomically Based) techniques for aesthetic injections in the hand

Main Article Content

Lorenzo Garagnani

Keywords

Hand anatomy, Aesthetic injection, Injection technique, Rejuvenation, Dermal filler, Skin booster

Abstract

Background: the focus of non-surgical rejuvenation has historically been predominantly on facial treatments, with facial anatomy being a regular training topic in aesthetic injection and aesthetic medicine courses and training programmes. Although the importance of addressing hand rejuvenation concerns has become increasingly acknowledged, the literature on this topic remains limited only to some aspects.


Aim: this study aims to address the gaps in the current literature on detailed techniques for hand rejuvenation injections, describing an anatomically based approach to dermal filler and skin booster injections and addressing the specific hand changes caused by muscular wasting.


Methods: the techniques described in this study are based on consolidated knowledge and widely known anatomical concepts, further confirmed by the author’s own experience as a hand and wrist surgeon and aesthetic doctor and on cadaveric hand dissections.


Results: injection sites and approaches have been developed based on the anatomical features of the hand, in areas where the risk of damaging vessels, nerves, tendons, ligaments, muscles and other structures can be reduced.


Conclusions: sound anatomical knowledge with awareness of the risks and potential complications allows for appropriate and safer planning and performance of aesthetic hand injections. An anatomical study based on twenty-six cadaveric hand dissections, with proposed clinical applications for hand rejuvenation is described.

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References

1. Jakubietz RG, Jakubietz MG, Kloss D, Gruenert JG. Defining the basic aesthetics of the hand. Aesthetic Plast Surg. 2005; 29(6):546-51.
2. Butterwick KJ. Rejuvenation of the aging hand. Dermatol Clin. 2005; 23(3):515-27.
3. Shamban AT. Special Topic: combination hand rejuvenation procedures. Aesthet Surg J. 2009; 29(5):409–13.
4. Fabi SG, Goldman MP. Hand rejuvenation: a review and our experience. Dermatol Surg. 2012; 38(7 Pt 2):1112-27.
5. Kühne U, Imhof M. Treatment of the ageing hand with dermal fillers. J Cutan Aesthet Surg. 2012; 5(3):163–9.
6. Har-Shai L, Ofek SE, Lagziel T, et al. Revitalizing Hands: a comprehensive review of anatomy and treatment options for hand rejuvenation. Cureus. 2023; 15(2):e35573.
7. Coleman SR. Hand rejuvenation with structural fat grafting. Plast Reconstr Surg. 2002; 110(7):1731-44.
8. Fantozzi F. Hand rejuvenation with fat grafting: a 12-year single-surgeon experience. Eur J Plast Surg. 2017; 40(5):457-64.
9. Conlon CJ, Abu-Ghname A, Davis MJ, et al. Fat grafting for hand rejuvenation. Semin Plast Surg. 2020; 34(1):47-52.
10. Edelson KL. Hand recontouring with calcium hydroxylapatite (Radiesse). J Cosmet Dermatol. 2009; 8(1):44-51.
11. Busso M, Applebaum D. Hand augmentation with radiesse (calcium hydroxylapatite). Dermatol Ther. 2007; 20(6):385-7.
12. Busso M, Moers-Carpi M, Storck R, et al. Multicenter, randomized trial assessing the effectiveness and safety of calcium hydroxylapatite for hand rejuvenation. Dermatol Surg. 2010; 36:790-7.
13. Bank DE. A novel approach to treatment of the aging hand with Radiesse. J Drugs Dermatol. 2009; 8(12):1122-6.
14. Marmur ES, Al Quran H, De Sa Earp AP, Yoo JY. A five-patient satisfaction pilot study of calcium hydroxylapatite injection for treatment of aging hands. Dermatol Surg. 2009; 35(12):1978-84.
15. Sadick NS. A 52-week study of safety and efficacy of calcium hydroxylapatite for rejuvenation of the aging hand. J Drugs Dermatol. 2011; 10(1):47-51.
16. Khosravani N, Weber L, Patel R, Patel A. The 5-step filler hand rejuvenation: filling with hyaluronic acid. Plast Reconstr Surg Glob Open. 2019; 7(1):e2073.
17. Micheels P, Besse S, Sibon M, Elias B. Hand rejuvenation with a hyaluronic acid-based dermal filler: a 12-month clinical follow-up case series. J Drugs Dermatol. 2021; 20(4):451-9.
18. Man J, Rao J, Goldman M. A double-blind, comparative study of nonanimal-stabilized hyaluronic acid versus human collagen for tissue augmentation of the dorsal hands. Dermatol Surg. 2008; 34(8):1026-31.
19. Redaelli A. Cosmetic use of polylactic acid for hand rejuvenation: report on 27 patients. J Cosmet Dermatol. 2006; 5(3):233-8.
20. Joo A, Phelan AL, Xu J, et al. Defining key features in patient perspectives of hand aesthetics. Ann Plast Surg. 2023; 90(6S Suppl 5):S634-S638.
21. Park TH, Yeo KK, Seo SW, et al. Clinical experience with complications of hand rejuvenation. J Plast Reconstr Aesthet Surg. 2012; 65(12):1627-31.
22. Bağır M, Eskandari MM. Longitudinal extensibility of the dorsal skin of the hand. J Hand Surg Eur Vol. 2019; 44(10):1013-8.
23. Bidic SM, Hatef DA, Rohrich RJ. Dorsal hand anatomy relevant to volumetric rejuvenation. Plast Reconstr Surg. 2010; 126(1):163-8.
24. Sulaiman S, Soames R, Lamb C. The sensory distribution in the dorsum of the hand: anatomical study with clinical implications. Surg Radiol Anat. 2015; 37(7):779-85.
25. Abrams RA, Brown RA, Botte MJ. The superficial branch of the radial nerve: an anatomic study with surgical implications. J Hand Surg Am. 1992; 17(6):1037-41.
26. Lhuaire M, Wavreille G, Hivelin M, et al. Venous system mapping of the digits and the hand: an anatomical study and potential surgical applications. JPRAS Open. 2022; 14:171-83.
27. Hussain W, Rasool N, Yaseen M. ADVIT: using the potentials of deep representations incorporated with grid-based features of dorsum vein patterns for human identification. Forensic Sci Int. 2020; 313:110345.
28. Prasetyono TOH, Menna C. Cutaneous perforators and their clinical implications on intrinsic hand flaps: a systematic review. Plast Reconstr Surg Glob Open. 2022; 10(4):e4154.
29. von Schroeder HP, Botte MJ. Anatomy of the extensor tendons of the fingers: variations and multiplicity. J Hand Surg Am. 1995; 20(1):27-34.
30. Kirchgesner T, Demondion X, Stoenoiu M, et al. Fasciae of the musculoskeletal system: normal anatomy and MR patterns of involvement in autoimmune diseases. Insights Imaging. 2018; 9(5):761-71.
31. Nayak VS, Priya A, Bhat N, et al. Cadaveric study on morphology of dorsal interossei of hand and its anatomical variation. J Clin Diagn Res. 2016; 10(6): AC04-6.
32. Mardel S, Underwood M. Adductor pollicis. The missing interosseous. Surg Radiol Anat. 1991; 13(1):49-52.
33. Zhang SX, Schmidt HM. Clinical anatomy of the subcutaneous veins in the dorsum of the hand. Ann Anat. 1993; 175(4):381-4.
34. Rivkin A. Volume correction in the aging hand: role of dermal fillers. Clin Cosmet Investig Dermatol. 2016; 9:225-32.
35. Petrofsky JS, Prowse M, Lohman E. The influence of ageing and diabetes on skin and subcutaneous fat thickness in different regions of the body. J Appl Res. 2008; 8(1):55-61.
36. Lefebvre-Vilardebo M, Trevidic P, Moradi A, Busso M, Sutton AB, Bucay VW. Hand: clinical anatomy and regional approaches with injectable fillers. Plast Reconstr Surg. 2015; 136(5S):258S-75S.
37. Carmeli E, Patish H, Coleman R. The aging hand. J Gerontol A Biol Sci Med Sci. 2003; 58(2):M146-52.
38. Sharrak S, M Das J. Hand Nerve Compression Syndromes. 2023 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31613463.