INTRODUCTION

Hand rejuvenation with minimally invasive, nonsurgical procedures has become increasingly popular to minimize the discrepancy between a rejuvenated facial appearance and the aged appearance of the hands. The dorsum of the hand is the most important target for rejuvenation due to its visibility and how it reflects the process of aging, from volume loss due to skeletinization to muscular atrophy, tortuous veins, and solar damage.

Multiple dermatological procedures are available for hand rejuvenation, including chemical peels, microdermabrasion, laser therapy (ablative and nonablative), sclerotherapy, dermal fillers, and fat augmentation. Dermal fillers are widely used for volume restoration because they can be expected to produce a natural, smooth appearance.

POLY-L-LACTIC ACID

Poly-L-lactic acid (PLLA) is semipermanent filler that is biocompatible and biodegradable. It is a synthetic polymer with microparticles of poly-L-lactic acid supplied in a clear glass vial as a sterile, freeze-dried preparation for injection. A carton of PLLA contains two vials, each containing 367.5 mg of powder. PLLA can be stored at room temperature up to 30 degrees Celsius during and after hydration. The manufacturer recommends that any remaining material be discarded seventy-two hours after reconstitution; however, we have found that the product can be safely stored for up to three weeks when it is mixed with bacteriostatic water.

PLLA is reconstituted by hydrating the powder with 4 mL of bacteriostatic water plus 1–2 mL of local anesthetic (lidocaine 1%).

Facial enhancement has long interested dermatologists and plastic surgeons. Other anatomical areas, such as the dorsum of the hands, have more recently become popular sites for enhancement because these areas can show signs of aging, such as lack of fullness, skeletinization, wrinkles, and tortuous veins, thereby reflecting true age.

The exponential growth of cosmetic procedures has resulted from the introduction of new products that last longer and produce superior results. These have been developed in response to increased demand for minimally invasive and cost-effective aesthetic treatments, an aging U.S. population, and a growing emphasis on self-image driven by the media.

A survey conducted by the American Society of Plastic Surgeons using digital photographs of hands identified factors that determine the age of the hands' appearance. The researchers concluded that specific factors characterize aging hands, including wrinkles, lack of fullness, veins, prominent joints, thin skin, deformities, and age spots. As a result, a patient's age can be estimated by viewing the hands alone.

According to the American Society for Aesthetic Plastic Surgery, the so-called hand lift will soon be one of the top most requested procedures. Multiple dermatological procedures are available for hand rejuvenation, including chemical peels, microdermabrasion, laser therapy (ablative and nonablative), sclerotherapy, dermal fillers, and fat augmentation. Dermal fillers are widely used for volume restoration and can be expected to produce a natural, smooth appearance.