Dr Michel Boksenbaum
The beauty and youthfulness of the hands are important factors for rejuvenation, as they contribute to a woman’s allure and elegance.
For a successful global treatment, four elements must always be in harmony: the face, the neck, the decolletage and the hands. The hands play a key role in our expressiveness – our non-verbal language – and give a glimpse of the fragility, sensitivity and beauty of our soul, perhaps even as much as our eyes. Rejuvenating the hands therefore requires a lot of care and attention for an optimal and natural-looking aesthetic result. Patients have always been conscious that their hands’ appearance is an important part of their overall beauty and is integral to the success and delicate balance of a global treatment. This corresponds to a demand that has become fairly common, and the techniques currently available involve covering the back of the hands with three different products: hyaluronic acid, autologous fat or Radiesse (calcium hydroxyapatite). Personally, I quickly developed a preference for using this filler for many reasons: its physiological viscous properties, the fact that it acts as a tissue inducer as well as inducing collagen and elastin production, and its duration, which can be up to eighteen months.
The “Hydro Smart Hands” technique for beautiful hands with harmonious volumes
In order to respect the complexity and nobility of the hands, we must provide a reliable and easily-reproducible technique with double objective: ensuring the injections are safe, and achieving a natural result, with densified skin covering the vessels, tendons and bones evenly but without creating a stuffed, swollen appearance. Ten years ago, at a symposium attended by a group of international doctors whose theme was the different uses of Radiesse, we opted for a technique that we called “Hydro Smart Hands”, which satisfied the demands and criteria for safety, efficacy and reproducibility in the indication of hand rejuvenation.
This technique is carried out in two steps. First, we perform a hydrotomy with a blend of saline solution and lidocaine, which allows us to detach the skin from the hands’ dorsal fascia while ensuring the patient remains comfortable thanks to the anaesthetic. We thus create a space in which to inject the filler product. This space offers comfort and safety, so that we do not inject the filler into the deep tissue where the noble elements are located, such as the blood vessels and tendons. The product is deposited in several boluses inside this space and is then massaged in, going from the tip of the metacarpals down to the wrist. The product is spread evenly across the entire back of the hand. We achieve very natural-looking and even results that camouflage the outline of the blood vessels and tendons while giving the skin some extra thickness thanks to its collagen-inducing effect. The technique is carried out using a needle, making it less traumatic and less painful than with a cannula, and it is completely safe.
An innovative and versatile product that allows us to treat several indications
This product containing calcium hydroxyapatite came to France in 2006 and many doctors have been won over by its properties and versatility of use. Injected into the deep dermis, it harmoniously tightens up the contours of the oval and corrects the facial volumes in a subtle way. This product can be used as a complement to hyaluronic acid in the skin’s superficial layers. It is popular for correcting the cheeks and tear trough with very natural-looking results. Deposited above the periosteum, it allows us to lift the muscle floor and thus prevents the excessive forward projection of the cheeks when the patient smiles. The facial expressions are not deformed during the different movements. The product also gives a particularly even appearance when treating the temples. In this area, it is best to use a cannula.
This technique allows us both to fill the temples and reposition the tail of the eyebrow and attract more light to the eye area.
Uses for preventing aging over the long term
The average dose required is around 1.2ml of product into each hand. With the rest, we usually make a few small corrections such as lifting the tear trough, which patients really appreciate as they go home with an extra, subtle touch-up. It can also be diluted and used for other indications such as vector lines for a lifting effect in the cheeks and oval, as well as for the neck. Since the product is resorbed fairly slowly, depending on the patient, the results can last up to 18 months. Studies have led it to be called a double tissue inducer because it also leads to the production of new collagen and elastin, which means it can help prevent aging.
Dr Michel Boksenbaum: Doctorate in medicine from Paris XII. Former intern supervisor, in charge of clinical teaching at the Paris XII medical faculty. Graduated in aesthetic medicine from the national college of aesthetic medicine (Paris V) in 2001.
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