Hand: Clinical Anatomy and Regional Approaches with Injectable Fillers.

Area of Science:

• Anatomy
• Cosmetic Surgery
• Dermatology

Background:

• Increasing demand for hand rejuvenation procedures.
• Current techniques often adapted from facial rejuvenation.
• Need for anatomical understanding of the hand dorsum for safe filler injection.

Purpose of the Study:

• To conduct an anatomical study of the hand dorsum.
• To identify the optimal location for injectable filler deposition.
• To design a safe and effective filler injection technique for hand rejuvenation.

Main Methods:

• Anatomical dissections of 19 fresh cadaveric hands.
• Duplex ultrasound investigation of 28 healthy hands.
• Development and testing of the Scrape Skin Threading Technique (SSTT) on cadavers using MRI and dissection, compared to other methods.

Main Results:

• The fascial plane between dermis and tendons measures 0.3–2.2 mm, featuring a 3D sponge-like structure with veins throughout.
• No pre-defined safe space was identified; the undersurface of the dermis is the optimal filler deposition site.
• The SSTT was the only technique ensuring precise filler placement within the fascial layer.

Conclusions:

• The Scrape Skin Threading Technique (SSTT) allows safe and accurate injection of fillers.
• The undersurface of the dermis is the anatomically ideal location for hand dorsum filler enhancement.
• SSTT provides optimal filler placement for improved hand appearance.