Thursday, April 7, 2011

Hand Rejuvenation with Fat Transfer (Fat Grafting)

Younger Looking Hands With Fat Transfer?
The hand, as well as the face, is one of the most visible areas of the human body where one can detect aging.  Even with a successful facelift to make one look youthful, one can determine the presence of aging by looking at one's hands.  A youthful hand is not a "fatty hand".  However, aging dissipates the fullness of the dorsal hand which makes the tendons of the hand more visible through the thinner skin of the aged dorsal hand.  With the advent of dermal filler injections to achieve a youthful face, hand rejuvenation using autologous fat and dermal fillers has been gaining popularity among patients who desire to look younger.
The Creation of Adam Hand by Michaelangelo (File courtesy of Wikimedia Commons)
Hand Rejuvenation Options
  • Dermal filler injection, such as Radiesse, which is an off-label use and not FDA-approved as of April 2011.
  • Autologous Fat graft/transfer 
  • Surgical excision of excess skin of the hand
  • Laser treatment

Fast Facts about Hand Rejuvenation with Fat Transfer
  • Fat is harvested by liposuction (using the Coleman technique) from the abdomen or thighs.
  • The fat is then injected onto the dorsum of the hands (back of the hand.)
  • Approximately 15-20 mL of fat may be injected into the dorsum of each hand, as described by Sydney Coleman M.D..
  • After the procedure, patients will typically experience swelling of the hands.
  • All patients in one study recognized improvement in the texture of the hands. 
  • Wrinkling of the hands will still occur despite fat grafting.
  • No significant tendon problems reported after the procedure according to Coleman's study.

Best Candidates for Hand Rejuvenation with Fat Transfer
  • Patients with noticeable loss of fullness of the dorsal part (back of hand) of their hands with apparent thinning of the skin.
  • Patients with no history of extensor tendon problems, such as tenosynovitis.
  • Patients with intermetacarpal wasting of the hands.


Hand rejuvenation may seem to be a simple procedure whether it is with fat grafting or with a dermal filler injection, such as Radiesse.  However, with the complex anatomy of the hand and with the potential hand complications that can occur, one should be cognizant of who performs these type of procedures.  As a surgeon, I recommend seeing a plastic surgeon to discuss the different options available for hand rejuvenation.

Emmanuel De La Cruz M.D.
    Reference:
    Bidic, Sean, Daniel Hatef, and Rod Rohrich. Dorsal Hand Anatomy Relevant to Volumetric Rejuvenation. Plastic & Reconstructive Surgery. 2010 July; 126(1): 163-168
    Coleman, SR.  Hand rejuvenation with structural fat grafting. Plastic & Reconstructive Surgery. 2002 Dec;110(7):1731-44
    Edelson KL. Hand recontouring with calcium hydroxylapatite (Radiesse). Journal of Cosmetic Dermatology. 2009 Mar;8(1):44-51.  
    Giunta, et al.  Structural fat grafting for rejuvenation of the dorsum of the hand. Handchir Mikrochir Plast Chir. 2010 Apr;42(2):143-7.

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