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DETAILS 24 MAY/JUNE 2017 | Med Esthetics we applied topical anesthetic, cleansed the hand and then tented the skin in between the areas of visible tendons. We injected one bolus into each of the areas on the dorsal hand between the tendons, as well as in the area between the thumb and fi rst fi nger. Depending on the de- gree of volume loss, patients received one to two syringes of fi ller per hand. After we completed the injections, we massaged the patients' hands to ensure that the fi ller was evenly dispersed. Following treatment, we asked them to avoid strenuous activity for 24 to 48 hours. OUTCOMES AND LONGEVITY Subjects were followed for six months post-treatment. The average hand grading scores demonstrated statistically signif- icant improvement at all time points compared to baseline. There was an average of a 48% to 55% improvement in the treated hands at one month following treatment, and a 25% to 45% improvement compared to baseline at six months. There were no serious adverse events reported. One of the nice things we found is that there really is little downtime. Patients saw immediate results and experienced minimal swelling after the procedure—less than we have seen with other fi llers. To achieve optimal aesthetic outcomes in clinical practice, we typically perform a series of intense pulsed light (IPL) or picosecond laser treatments in addition to the injections on the hands of those who have a signifi cant number of lentigenes. The fi rst treatment is performed immediately following Restylane Silk injection. PATIENT SELECTION The ideal candidate for this procedure is someone who has mild to moderate volume loss in the hands and a loss of skin luster. The most common risk of this procedure is bruising, which you can minimize by tenting the skin and keeping injections superfi cial. Overfi lling is also a concern. Because there is so little swelling, it is important to err on the side of caution—be conservative with your volume replacement. CONCLUSIONS Restylane Silk is a safe and effective method of improving the thinned and photoaged appearance of the hands. In addition to replacing lost volume, it offers wonderful hydrat- ing properties . Our study showed that the combination of volume and moisturization led to softer, younger-looking hands—a look that we have not been able to achieve with other hand fi llers. Bradley S. Bloom, MD, is a board certified derma- tologist with Skin Laser & Surgery Specialists of NY & NJ. Contact him at drbloom@skinandlasers.com. PHOTOS COURTESY OF RESTYLANE PRE-TREATMENT 6 MONTHS UNTREATED TREATED 3 MONTHS UNTREATED TREATED At six months postprocedure, patients retained 25% to 45% of volume.