OCT 2018

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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Page 39 of 68

© GETTY IMAGES "Two main factors have led to an increase in patients re- questing hand rejuvenation," says Neil Sadick, MD, founder of Sadick Dermatology in New York City. He has written several articles on hand rejuvenation and regularly lectures on the topic at dermatologic congresses. "First, patients are now familiar with devices and fi llers for the face and feel comfortable and confi dent with them. Secondly, a plethora of new types of treatments can quickly, safely and effectively restore volume, smoothness and softness in the hands." Chemical peels, intense pulsed light (IPL), broad-band light (BBL, Sciton) and laser therapies can improve lentigines and uneven skin tone, while autologous fat and dermal fi llers can help remedy soft tissue loss. Many of the same dermal fi llers routinely used in the face are also effective for hands, but currently only two products have FDA approval specifi cally for hands. The fi rst, Radiesse (Merz Aesthetics), a calcium hydroxylapatite (CaHA) der- mal fi ller, was approved in June 2015 to treat volume loss in hands. The second, Restylane Lyft (Galderma), became the fi rst hyaluronic acid (HA) fi ller to gain FDA approval for hand rejuvenation in May 2018. "Since the approval of Radiesse, we have had a consis- tent number of patients asking about this procedure," says Joel L. Cohen, MD, clinical educator and director of About Skin Dermatology and DermSurgery serving patients in Denver. "With the approval of Restylane Lyft, I hope the marketing efforts of the two companies will be much more effective at growing the hand fi ller market." His typical hand rejuvenation patients are those who have successfully received fi llers for facial concerns and want to similarly improve the appearance of volume loss in their hands. Dr. Cohen uses the fi ve-point Merz Hand Grading Scale that he helped to develop to show patients how their hands rate. He then shows them before-and- after photos of patients he has personally treated to dem- onstrate how fi llers can improve volume loss. Miguel Angel Aristizabál Torres, MD, an aesthetic medi- cine specialist who practices in Bogotá, Colombia, regularly trains other doctors around the world in aesthetic tech- niques. He says that increased awareness of the aging pro- cess of the hands has led to an increased interest in hand rejuvenation. "Women and men today are less tolerant of the contrasts between youthful facial skin and hands with wrinkles, and visible veins and tendons. We create social media campaigns specifi cally showcasing hands before and after volume correction or before and after solar lentigines removal," says Dr. Torres. New Orleans dermatologist Mary P. Lupo, MD, agrees that today's patients show more interest in hand rejuvena- tion, but the number of hand rejuvenation procedures in her practice has increased only slightly. "The barrier is that people often run out of discretionary income after completing the face," she says. While most hand rejuvenation patients come from among those who have successfully used fi llers for facial rejuvenation, Phil Werschler, MD, of Werschler Aesthet- ics in Spokane, Washington, reports attracting another patient group as well: "Recently, we have been seeing male-to-female transgender patients for hand 'softening,'" he says. "And it makes sense: Adding volume increases the appearance of 'softness' and beautifi es the backs of hands to complement fi ngernail grooming." TREATMENT OPTIONS "Hands start to lose volume due to fat atrophy around age 40, leading to thinning skin, fi ne lines and bulging veins," says Dr. Sadick. "Moreover, as one of the most exposed- to-the-elements body parts, hands are likely to have more photodamage." For pigmentation complaints, Dr. Werschler recom- mends topical tretinoin, TCA peels, intense pulsed light (IPL) and lasers. For volume loss, he suggests dermal fi llers or fat transfer, and for general skin aging, platelet-rich plasma (PRP) therapy. "My favorite combination is Radiesse followed by Fraxel (Solta Medical) and continued home care including treti- noin/hydroquinone and daily sunscreen use," he says. Dr. Sadick uses a three-step combination approach. "First, I perform liquid or foam sclerotherapy to remove bulging veins and smooth the surface of the dorsal hand. About a month post sclerotherapy, I restore lost volume with a dermal fi ller. I prefer Radiesse as it has a great safety profi le, lasts two to three years and has biostimulatory properties that promote new collagen formation. Finally, | OCTOBER 2018 37

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