Hand rejuvenation with dermal fillers: Key aspects and a comparison of commonly used fillers

There has been an increasing demand for hand rejuvenation procedures. Hand evaluation is critical before any such procedure, and recently proposed five-point scales, including the Merz Hand Grading Scale and Allergan Hand Volume Deficit Scale, provide an objective assessment of volume loss of soft tissues. Dermal fillers, including hyaluronic acid (HA), calcium hydroxylapatite (CaHA), and poly-L-lactic acid, can address volume loss, contour irregularities, and texture changes associated with aging. Our literature review includes 12 studies with HA, seven with CaHA, and two with poly-L-lactic acid fillers. One study used a hybrid HA-CaHA filler. The superficial lamina contains minimal vascular or neural structures, making it the safest plane for filler placement. Techniques such as proximal-to-distal fanning allow smooth and homogeneous filler placement with minimal trauma. A blunt cannula is often preferred to minimize vascular injury. All fillers discussed here-HA, CaHA, and poly-L-lactic acid-have a good safety profile and provide acceptable aesthetic outcomes associated with high patient satisfaction. HA fillers provide instant volume restoration and hydration, whereas CaHA and poly-L-lactic acid are advantageous for improving texture and skin quality. Patient counseling on available options and selecting the most suitable filler that aligns with patient expectations are crucial to achieving successful outcomes.