Safety at Hand with Dr Lorenzo

Safety at Hand: Elevating Standards in Hand Rejuvenation
The thin line between hand function & aesthetics.

My 20 year experience in hand surgery and aesthetic medicine has led to an increased awareness of the strict correlation between the appearance of the hand, and the function of the hand. Multiple patients attending hand surgery clinics for pathological conditions of the hand, also express their concern about the altered appearance caused by their disorder, or, via the natural ageing process.

The same is true when treating children with hand anomalies. My experience of paediatric hand surgery includes working in a multidisciplinary environment where I see patients and their families with congenital and post-traumatic hand differences. They require not only treatment strictly aimed at improving their hand function but also need to gain increased confidence about hand appearance. This is due to the fact that our hands are not only a wonderfully intricate tool, but they also represent an extremely important means of communication and social interaction. Furthermore, the hand is the only part of the human body that is always before the eyes. Therefore any change is noticeable at all times.

It is also well known that increased confidence leads to an improved use of the hands, and improved hand function, leads to an improved appearance. Therefore functional improvement leads to an improved aesthetic appearance and vice versa.

Certain surgical procedures that have been traditionally aimed at improving only pain or function have a secondary benefit of leading to an improved contour and overall appearance of the hand. For instance procedures that treat joint deformities either arthritic or post traumatic, often lead to an increased patient satisfaction on hand appearance and overall patient confidence. For this reason, outcome measure questionnaires ‘Patient Reported Outcome Measures’ (PROM) that are used in hand surgery, now also include the domain of hand appearance.

My practice overlap of surgical intervention combined with aesthetic medicine, results in patients being educated about the options to provide improved aesthetic outcome alongside the improved function & pain relief of surgical procedures.

Patients are increasingly aware that after many years of facial treatments, there is now a need for their other exposed areas, namely neck and hands, to be treated for complete harmonisation. The hand market is growing rapidly and we owe it to our patients to be well informed of their options. Likewise, it is our responsibility as medical aesthetic practitioners to have a thorough knowledge of hand anatomy if we are offering hand treatments.

Before performing hand rejuvenation injections, an aesthetic practitioner must have a solid foundation of knowledge, skills and judgment to ensure both safety and good outcomes. My thoughts on the main considerations regarding their knowledge and preparation:

Anatomical Knowledge

A deep and precise understanding of hand anatomy is absolutely essential. Practitioners must know:

• Vascular anatomy, especially the course of the radial and ulnar arteries, superficial and deep palmar arches, and dorsal veins, to avoid intravascular injection
• Nerve pathways, particularly the superficial branch of the radial nerve and dorsal digital nerves, to minimise risk of nerve injury or pain
• Tendon and fascial planes to understand where to place product safely and effectively (usually in the subdermal or suprafascial plane)
• Age related changes, loss of subcutaneous fat, visible tendons/veins, skin laxity, and volume depletion patterns

Product Knowledge

Practitioners should be fully informed about:

• Type of filler being used, hyaluronic acid vs calcium hydroxyapatite and other options
• Rheological properties, viscosity, elasticity, cohesivity and how they affect product choice and placement.
• Dilution techniques for certain fillers
• Longevity and reversibility
• Compatibility with other treatments like laser, microneedling & skin boosters

Injection Technique and Equipment

• Mastery of injection depth and plane for different regions of the hand
• Choice between needle vs cannula, and understanding the risk profile of each
• Proper aspiration, slow injection, and small aliquot techniques to minimise embolic risk
• Sterile technique and aseptic field setup to prevent infection

Complication Awareness and Management

Before treating patients, practitioners must:

• Understand the early signs of vascular compromise, blanching, pain, coolness & discolouration
• Be trained in emergency management protocols
• Recognise delayed complications such as granulomas, nodules, or infection
• Keep rescue medications and emergency kits readily available

Clinical Judgment and Patient Selection

• Assess suitability of the patient
• Manage expectations, hand rejuvenation improves but doesn’t “reverse” age completely
• Ensure informed consent, explaining potential risks, downtime, and complications clearly
• Consider contraindications

Continued Education and Competence

• Undertake formal training in hand rejuvenation from accredited providers.
• Stay up to date with current guidelines, best practices, and anatomical updates
• Maintain competence with regular hands on experience

So, before you tell me the most common statement I hear when meeting members of the medical aesthetic community, ‘I already do hand rejuvenation,’ ask yourself if you are completely happy to tick off all of the points above!

Lorenzo Garagnani, OSI MD PGDip (Aesthetic & Wellness Medicine) FRCS EBHS Diploma in Hand Surgery

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