Micro-autologous fat transplantation for rejuvenation of the dorsal surface of the aging hand

Abstract

MAFT has changed the concept of fat grafting, from an operation with unpredictable clinical results to an easy and reliable procedure. MAFT demonstrated high patient satisfaction with long-term results and is an effective approach to rejuvenate the dorsal surface of the hand.

Fat Grafting for Hand Rejuvenation

“…The tenets of fat delivery to the hand are low pressure, low speed, and low volume through multiple tunnels and multiple planes. 6,10,22 During delivery, attention must be focused on delivering the smallest aliquots of fat possible in an even manner in the desired planes at a low pressure. Specialized devices are under investigation to facilitate the safe and effective delivery.…”

“…Specialized devices are under investigation to facilitate the safe and effective delivery. 22 Access incisions for fat grafting vary between protocols. A proximal incision distal to the extensor retinaculum provides access to the superficial lamina and the proximal dorsum of the hand.…”

“…Widespread agreement exists regarding the safety and efficacy of injecting into the superficial lamina only. 10,17,22 The superficial lamina contains no important structures, and the fat graft covers the deeper vessels and tendons. The intermediate lamina contains the dorsal veins, and some experts recommend avoiding this lamina to avoid intravascular fat deposition.…”

“…10 Others, however, argue in support of fat grafting to this lamina to maximize treatment efficacy without serious concerns about safety. 17,22 Similarly, grafting the deep lamina is recommended by some experts to correct concavity between the metacarpal bones, whereas others do not believe it is necessary to fat graft that deep in the hand. 10,17,22 Fat delivery by cannula is the preferred method.…”

“…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.…”