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FILLER INJECTIONS
FILLER INJECTIONS
During the patient evaluation, the physician should obtain a thorough medical, drug, and allergy history. Each dorsal hand must be examined for areas of volume loss, tendon, and vein visibility, and the physician should formulate a plan as to which specific filler will be used and volume necessary. Specific techniques vary depending on the filler
used and physician preference.
Topical anesthetics applied for 30 to 45 minutes may help reduce pain, although this is typically unnecessary. The patient is then asked to wash their hands with soap and water, and chlorhexidine is used as a sterile prep for the entire hand, from wrist to fingertips. It is helpful to identify and mark entry points for the injections. The treatment area should be bounded by the handโwrist crease, metacarpophalangeal joints, and by the first and fifth metacarpals.17 The hand can be placed horizontally on a stand, or the injector may choose to hold the hand in order to have greater control. Some physicians place the patient in Trendelenburg position or elevate the hands above the lever of the heart in order to reduce venous return, which can potentially minimize edema and ecchymosis.11
Once the treatment is complete, ice can be applied to the hands for at least 10 minutes. Some physicians advise patients to sit on their hands immediately following the procedure in order to decrease edema.3 The hands are often wrapped with a compressive dressing, and the patient instructed to keep the hands elevated as often as possible. Exercise and other physical activities are generally avoided until the edema has decreased. Many fillers have been used for hand rejuvenation. Because of the paucity of data supporting the use of poly-methyl methacrylate (PMMA) and bovine collagen for hand rejuvenation, they are not frequently used for this purpose.