Aging Hands: Structural Fat Grafting Remedies

NEW YORK, NY (December 21, 1998) — With vulnerability to sun damage and visibility that rivals the face, our hands may betray an otherwise youthful appearance. Although body contouring procedures usually involve removing unwanted fat, selected sites such as the top of the hands may be improved by having fat put back.

"Structural fat grafting to the hands can soften wrinkles, cover prominent veins and tendons, and disguise enlarged joints," says board-certified plastic surgeon Sydney Coleman, MD. "Restoring the soft tissue that is lost with age or disease can also fill out grooves between the bones of the hand and improve the color and texture of the skin."

The relatively new procedure, which is performed under local anesthesia, begins with the harvesting of fat. In an article in Aesthetic Surgery Journal, an official publication of the American Society for Aesthetic Plastic Surgery (ASAPS), Dr. Coleman notes that the site from which the fat is harvested does not affect the outcome. "I let the patients choose, or I use a site that is most convenient," he says. For every 1cc of "refined" fat injected, approximately 2 cc of fat must be harvested.

"The actual grafting requires five or six tiny incisions at the wrist and back of the hand. Each incision serves as an insertion site through which multiple passes of fat are made," explains the New York City surgeon. "The multiple crossing of fat trails are like threads weaving a cloth between the skin and the veins." Although it varies, approximately 10 to 25 cc of fat are injected into each hand.

As with any surgical procedure, a good result is dependent on an experienced surgeon and good technique. Dr. Coleman has found that the method of structural placement is crucial. To create a change in the texture of the skin, he layers the fatty tissue against the skin, creating a vector that pushes the skin outward. If enlarged joints exist, several "3-D" layers of fat are injected into carefully marked areas.

After the procedure, the incisions are taped closed and multiple layers of paper tape are applied to the back of the hands to keep the patient from touching them. To minimize swelling, which can be significant, the hands are elevated and cold compresses are applied for 48 hours. Dr. Coleman notes that bruising is minimal and is caused primarily by the injection of the local anesthetic - not the fat injections themselves. Normal activity can be resumed almost immediately. Possible complications of fat placement in the hands include over- or undercorrection, clumping or irregular deposits of fat, and migration of the fat. Although unlikely, infections and damage to underlying structures also may occur.

"Structural fat grafting is safe, predictable, and longlasting," says Dr. Coleman, "when fat is handled atraumatically, an accurate volume of fat is injected, and proper methods of structural placement are adhered to."


The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.


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