Hand fat grafting is becoming more and more popular as a means for reversing a not so subtle, tell-tale sign of aging. So many people maintain a more youthful facial appearance with skin care, laser treatments, injectables and the occasional ‘nip and tuck’; yet if you ignore the appearance of your hands then they may well be giving away your actual age.

The aging process gradually results in changes to the appearance of the back of the hands that we all know fairly well: there is loss of subcutaneous fat making the extensor tendons appear more prominent, and there is thinning of the skin that makes both dorsal veins and extensor tendons more easily visible. This process is accelerated in fair-skinned people by long-term sun exposure, who do not have the protective benefit of deeper skin pigmentation. 

Structural fat grafting is an almost miraculous means of rejuvenating the back of the hand. Fat is placed diffusely in multiple tissue planes, including in the intervals between extensor tendons, in the intervals between the knuckles, and superficially below the skin to conceal the extensor tendons and veins to create a sense of greater soft tissue volume in the back of the hands. 

This procedure is performed under IV sedation. Fat is harvested from some area of excess, most commonly the abdomen, flanks, hips or thighs. This fat is processed to give microfat which has greater longevity than conventional structural fat in terms of survival.

The typical volume of fat placed in each dorsal hand is between 20 to 30 cc. This is done through multiple mini-incisions primarily at the wrist and around the knuckles, which heal imperceptibly. Patients do not require deep sedation for this procedure, and it is often helpful to have them flex and extend their fingers a bit in order to fully assess the immediate result of the grafting procedure.

Foam tape is applied to the dorsum of the hands with a topical adhesive. This is primarily to keep patients from pushing on the grafted sites with their fingertips. Patients resume routine activities of daily living immediately and return to full-effort physical activity by three to four weeks postop. 

As with any fat grafting procedure, fat survival is variable. In the vast majority of cases, a dramatic enhancement of dorsal hand contour and appearance is achieved. However, some patients do require a second and rarely even a third fat grafting procedure to achieve their desired endpoint in improvement. The final result of any individual fat grafting procedure is usually evident at three months. 

If you feel that the backs of your hands are giving away your age, structural fat grafting of the hands may be an ideal procedure for you. Make sure that the surgeon you see for hand fat grafting is experienced with structural fat grafting in general and with fat grafting of the hands in particular. Success in fat grafting requires experience, patience, a meticulous approach, well-maintained equipment, and a careful attention to detail.

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