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  • As many patients seek facial cosmetic procedures, a discrepancy forms between the rejuvenated look of their face and the aged appearance of their hands.

  • Hand rejuvenation addresses both surface changes and volume loss, and combination multimodality approaches may be best.

image Beginner Tips

  • A thorough understanding of hand anatomy is a prerequisite for procedural intervention.

  • IPL and lasers are highly effective at improving surface changes on the hands.

  • When using CaHA fillers, the scrape skin threading technique may help to avoid overly deep product placement.

image Expert Tips

  • If nodule formation occurs after filler injections: antibiotics -> hyaluronidase/ILK -> excision.

  • Overcorrect when performing autologous fat transfer.

  • Consider sclerotherapy if volumization does not solve vein prominence.

image Don’t Forget!

  • Sclerotherapy and autologous fat transfer should be performed separately.

  • Vein treatments should be performed at least 1 month prior to other procedures.

image Pitfalls and Cautions

  • When performing chemical peels on the hand, it is important to remember that treatments should be limited to superficial and medium depth peels because of the risk of impaired wound healing.

  • Since the dorsal hand skin is thinner, has decreased vascularity, and fewer pilosebaceous units than the face, the fluence, density, and number of passes should generally be reduced to minimize recovery time.

image Patient Education Points

  • Patients should understand that they will likely require multiple treatments.

  • Remember the 5–5–5 rule after filler injection: massage for 5 minutes at a time, 5 times per day, for a total of 5 days.

  • As always, appropriate patient selection and assuring adequate motivation are of vital importance.


The face, neck, and hands are not only the most visible parts of the human body, but are also the areas most susceptible to environmental factors which accelerate the aging process. As many patients seek facial cosmetic procedures, a discrepancy forms between the rejuvenated look of their face and the aged appearance of their hands. Therefore, both physicians and patients have become more aware of the need to treat the hands.


Aside from the face and neck, the hands are the most exposed part of the human body, and are therefore especially susceptible to environmental factors that are implicated in the aging process.1–3 The young hand has a supple, smooth, and uniformly pigmented epidermis with excellent elastic recoil. The skin is relatively free of rhytides with the exception of flexion creases over the proximal and distal interphalangeal joints. The telltale signs of the aging process typically become discernible in the fourth decade of life.4

Ultraviolet radiation contributes significantly to accelerated photoaging, which presents as solar lentigines, solar purpura, actinic keratoses, seborrheic keratoses, telangiectasias, and guttate hypomelanosis (Table 80-1). Chronic irritation from common household and workplace chemicals also contributes to ...

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