Fat Grafting in Hand Rejuvenation
“Fat grafting to the dorsum of the hand has an extremely high satisfaction rate, a relatively fast recovery, and few complications compared with most aesthetic surgical procedures.”
- Sydney R. Coleman, New York Plastic Surgeon
Fat grafting can provide a long-lasting improvement to the appearance of the ageing hand. The placement of tiny fat parcels in many miniscule tunnels creates support for the skin and obscures or softens the shape of veins and tendons, creating an appearance of plump skin with a youthful fullness.
What does the procedure involve?
Fat is harvested from another body area with gentle liposuction through a very small cannula. Most commonly the fat is taken from the abdomen or thighs. The fat is immediately processed to remove excess oil and fluid. The fat is then placed in the hand with many passes through 6-7 tiny incisions (1-2mm), using a blunt cannula in a weaving pattern to separate tissue without damaging veins or tendons. Research has demonstrated that the tissues on the back of the hand are divided into three distinct layers separated by fascia; the placement takes this anatomy into account to give improved and consistent results.
Can filler be used instead?
Absolutely, hyaluronic acid, poly-L-lactic acid and calcium hyroxylapatite fillers can be used instead of fat and these do have good temporary results (3-15 months). However, using fillers can be expensive due to the volume required. I routinely transfer significantly greater volumes when using fat and recommend the use of fat as it is a completely natural product that can achieve long-lasting results.
Can other therapies be used to improve the hand appearance?
Yes. Chemical peels and laser and light therapies (Q-switched lasers, CO2 lasers, erbium lasers, intense pulsed light and photodynamic therapy) can improve the skin appearance by exfoliating, improving skin elasticity and removing sun spots and freckles. These treatments do not restore a youthful fullness to the hand but the aesthetic benefit that can be obtained by a combination of treatments (such as combining skin therapies with fat grafting) is greater than that which can be achieved with a single treatment method.
If, like many older Australians, you have sun damage with roughened areas of skin on your hands and forearms you may gain significant benefit from topical prescription creams containing powerful medications proven to treat actinic keratoses, solar keratoses and Bowen's disease.
Would a surgical hand lift help me?
Excision of skin can be of benefit in hand rejuvenation in certain patients, but is generally not recommended as an isolated treatment. In most patients simply tightening the skin will accentuate the veins and tendons, making the hand look older despite having fewer wrinkles.
What does a youthful hand look like?
The healthy, youthful hand has a subcutaneous fullness with soft skin and no wrinkles except for flexion creases over the finger joints. Veins may be visible, especially in slender and athletic individuals, but their blue colour is subtle. Tendons are often visible, particularly when the fingers are extended, but subtly so. Fullness of the skin and tissues prevents the hand from appearing bony.
What does an ageing hand look like?
We can all recognise an aged hand when we see it, but an understanding of the ageing process is important in determining what treatments can optimally transform your hands, leaving them looking younger.
The hand is constantly exposed to environmental factors which can accelerate the ageing process. Hand ageing is a three-dimensional process involving bone and subcutaneous tissues as well as the skin. The dermis in the skin becomes thinner. Loss of dermal thickness and atrophy of the subcutaneous tissues makes the veins more prominent, tortuous and blue in colour. Age spots become more common, as do pigmentation irregularities. The tendons become more obvious, even at rest. The fibres of the tendons may become visible. The skin becomes thin and wrinkled with reduced elasticity. The muscles become more wasted, leading to hollowing of the hand and a more prominent appearance of the joints. Arthritic nodules can further emphasise the prominence of the joints.
Can all these changes be addressed with fat grafting?
Improving the volume of the subcutaneous tissues of the hand will address the majority of changes of the ageing hand. The veins and tendons will become less prominent. Muscle wasting is disguised. Skin texture and appearance is improved. However, fat grafting will not address arthritic nodules on the fingers. The skin pigment and quality changes that occur with age may be improved after fat grafting, but are best targeted with combination therapies.
What type of anaesthetic is used?
This depends on the patient’s preference and anaesthetic risk. Local, regional, spinal or general anaesthesis can be used. Most commonly the procedure is done with twilight anaesthesia, which combines sedation and local anaesthesia.
What is the recovery period?
The area of the hand that is treated is initially quite swollen. The hand can be used immediately after surgery, but it is strongly recommended that your hands be kept elevated above your heart to reduce swelling. This will improve the long term outcome of surgery. It is also important not to touch, massage or compress the back of your hands during this first week. Cold compresses are recommended to reduce the swelling and oedema.
Dressings will be applied to your hand and your fat graft sites. These and your sutures will be removed at one week after surgery. At this time you will be instructed on how to perform daily massage and other techniques to maximise your outcome.
The swelling will reduce gradually, with the majority of swelling resolving in the first 2-3 weeks. If less fat is transferred this will minimise the trauma of transfer and minimise the swelling, but the long term outcome will also be less successful. There will still be mild swelling for many weeks; the eventual outcome of surgery can be judged at the 6 month stage.
What are the possible complications?
The main post operative issue is that of swelling, which resolves over time. Some patients may notice small lumps or irregularitites as the swelling resolves, perhaps caused by uneven fat distribution or migration. Other possible complications include infection, cyst formation and temporary alteration in sensation (numbness, burning or tingling).
Coleman S. Hand Rejuvenation with Structural Fat Grafting. Plast. Reconstr. Surg. 110: 1731, 2002.
Jakubietz RG, Kloss DF, Gruenert JG, Jakubietz MG. The ageing hand. A study to evaluate the chronological ageing process of the hand. J Plast Reconstr Aesthet. (2008) 61, 681-686.
Bidic M, Hatef DA, Rohrich RJ. Dorsal Hand Anatomy Relevant to Volumetric Rejuvenation. Plast Reconstr Surg. 126: 163-168, 2010.