Hand rejuvenation with fat grafting: A 12-year single-surgeon experience

Abstract

BackgroundFat grafting has been successfully used for reconstructive and esthetic surgery of the breast, face, and other body parts. In this article, we present our protocol for hand fat grafting and over a decade of clinical experience.MethodsFat tissue is obtained from the flanks, peri-umbilical region, or internal side of the thigh or knee. No centrifuge machine is used to prevent fat damage. After decantation, fat is injected into the dorsum of the hand using a cannula from the wrist and not from the fingers. Fat is distributed gently above the dorsal deep fascia to avoid perforation of the vessels.ResultsThe proposed technique was applied to 65 patients. The amount of fat injected ranged from 10 to 30 cm3. No allergic reactions were noticed. Each patient’s progress was followed-up for a minimum of 12 months. Over this period, contour changes and the effects of the procedure(s) on the skin were analyzed. Fifty-six patients (84%) were satisfied with the results during the observation period, 7 patients (12%) were somewhat satisfied and needed one more fat grafting procedure to achieve complete satisfaction, and 2 patients (4%) were dissatisfied with the results. Three cases of temporary swelling of the hands resolved naturally. No long-term complications were seen.ConclusionsThis study covers over a decade of practical experience in applying fat grafts to hands. The procedure is effective in reshaping and rejuvenating the hand as it shows long-lasting results after 1-year follow-up.

Fat Grafting for Hand Rejuvenation

“…A proximal incision distal to the extensor retinaculum provides access to the superficial lamina and the proximal dorsum of the hand. 10,23 An incision in the webspace between the first and second metacarpals accomplishes a similar goal. 17 Incisions in the other webspaces provide good access to the deeper lamina and the distal portion of the dorsum of the hand with minimal scar burden.…”

“…Cannulas sized between 14 and 17 gauge are standard. 2,10,17,[22][23][24] Cannulas larger than 14 gauge are associated with deposits susceptible to central necrosis. 24 Cannulas smaller than 17 gauge have an outer diameter smaller than the diameter of the dorsal hand veins and carry a greater theoretical risk of intravascular fat deposition.…”

“…2,6 The most recent suggestions agree that 15 to 30 mL of fat is indicated for grafting the dorsum of each hand, depending on the technique used and the degree of correction desired. 10,17,22,23 Some surgeons recommend an overcorrection in anticipation of graft loss, whereas others stress that apparent graft loss is in fact because of the prolonged resolution of edema and recommend against overcorrection. 6,10 There is a wide variability that exists in techniques described for fat harvest.…”

“…Satisfaction ratings are consistently reported in the mid-1990s in published case series. 10,22,23 Complications Edema is the most commonly reported complication following fat grafting. Some practitioners have proposed that edema is part of the natural healing process after fat grafting to the hand and not considered a true complication since edema in the dorsum of the hand resolves spontaneously.…”

“…Some practitioners have proposed that edema is part of the natural healing process after fat grafting to the hand and not considered a true complication since edema in the dorsum of the hand resolves spontaneously. 10,22,23 Compression dressings applied over several days can help manage the immediate postoperative edema. 6,17 Other spontaneously resolving complications include ecchymoses and paresthesias, which presumably occur due to damage to small vascular and neural structures, respectively.…”