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Hand Rejuvenation India

Restoration of volume to the dorsum of the hands

The adage “you can tell a woman’s age by her hands’” should not be valid any longer given the multitude of technological and technical advancements that allow rejuvenation of skin volume to skin surface. With time, the dorsum of the hands age intrinsically through photodamage. Fat grafting will restore the cushioning of the subdermis and smooth the skin over the underlying anatomy.

Preoperative Evaluation

  1. Skin surface
    1. Epidermal photoaging
    2. Dermal elasticity – if not much lost rejuvenating modalities may be used to improve
  2. Degree of volume loss: categorized to three groups
    1. Mild:
        1. skin tone and elasticity-good
        2. Mild fat atrophy causing tendons and veins to protrude

      In these cases Volume loss may be corrected with about 10-12 cc fat to each hand.

    2. Moderate:
        1. Mild to moderate loss of skin thickness and elasticity
        2. Moderate fat atrophy causing tendons and veins to protrude more and start to appear White

      In these cases Volume loss may be corrected with about 13-20 cc of fat to each hand.

    3. Severe:
      1. Almost transparent ( paper thin) – poor skin elasticity
      2. Severe fat atrophy causing the veins to protrude and tendons to appear white.
      3. Volume loss may be corrected with about 21-30 cc of fat to each hand.

Hand Rejuvenation with Stem Cell Fat Transfer

Aesthetics of the Aging Hand

After the face, the appearance of the hands is the second most visible telltale sign of one’s age. Facial rejuvenation treatments or procedures make a patient look younger, and can conflict with untreated hands that aesthetically do not match the face which may be aged-appearing. The hands may give away age more than the face, especially if the face has been medically rejuvenated the hands have not.

Hand aging factors

  1. Loss of fullness
  2. wrinkles and veins start showing
  3. Tendons and joints become prominent
  4. Skin becomes thin
  5. Contour deformity may be visible
  6. Spots

Treatment of Aging Hands

A comprehensive approach to hand rejuvenation includes both cutaneous rejuvenation and laser therapies using modalities such as.

  1. Topical medical grade skin care
  2. Microdermabrasion
  3. Chemical peeling
  4. Intense pulsed light sources
  5. LED devices
  6. Laser therapies
    1. Pigment lasers
    2. skin tightening lasers
    3. Oblateiv non-oblateiv resurfacing

Certain newer dermal fillers and collagen stimulators such as hyaluronic and acid fillers poly-1-lactic acid, PMMA and calcium hydroxylapatite, can be selectively used to improve the appearance of soft tissue atrophy of the hands.

However, soft tissue atrophy of the aging hand is best treated with autologous fat augmentation.

Currently, the ability enrich autologous fat grafts using platelet-rich plasma and/or regenerative cells which have been characterized as stem cells, stromal vascular fraction, mesenchymal cellular extracts (MCE), adipose derived regenerative cells and bone marrow derived regenerative cells provide an exciting opportunity to improve the ultimate retention of these fat grafts and superior outcomes of the fat augmentation procedure.

Stem Cell enriched and PRP enriched Fat Grafts to the Hand

Findings, have demonstrated that autologous fat transfer to the hands is becoming a more widely used procedure. Adipose derived regenerative cells have been identified as an ideal source of cells for regenerative medicine. Advances in tissue engineering suggest that enrichment of fat grafts with ADRCs isolated in the stromal vascular fraction may increase the longevity and quality of the fat graft. Research suggests that enriching fat grafts with growth factors as found in PRP as well as ADRC enrichment may be a great clinical tool.

Autologous fat grafting to the hands has several advantages including 100% biocompatibility, natural appearance, versatility and low donor site complications.

One promising approach to increasing the viability of the graft has been to enrich the fat graft with ADRCs before transplantation. Recent human studies show enriching fat grafts with adipose derived regenerative cells increased their concentration at least two to five times compared with non-enriched fat grafts, leading to a much better fat graft survival compared with that of non enriched lipotransfer.