title: Hand: Clinical Anatomy and Regional Approaches with Injectable Fillers.
abstract: BACKGROUND
  Cosmetic physicians are more and more frequently asked for hand rejuvenation. They commonly propose the same techniques as for the face. The authors undertook an anatomical study of the hand dorsum to understand the optimal location for an injected filler and to design the safest technique of placement.
  
  
  METHODS
  The first part of the study included dissections of 19 fresh cadaveric hands and duplex ultrasounds investigation of 28 healthy hands. A technique of injection specifically designed from anatomical findings was then tested on 8 fresh cadaveric hands using magnetic resonance imaging and dissection in comparison with 3 other commonly used techniques of rejuvenating injections.
  
  
  RESULTS
  Between the dermis and the tendons, the thickness of the fascial plane was measured from 0.3 to 2.2 mm. Because of numerous fibrous septa, the entire plane was found as a 3-dimensional sponge-like framework. Veins could be located in all levels of this framework. There was no predefined free space. The optimal place for the deposition of a filler was found to be the undersurface of the dermis. The specific technique named Scrape Skin Threading Technique and using a cannula scraping the deep side of the dermis was checked as the only technique which could give a perfect placement of product restricted to the fascial layer.
  
  
  CONCLUSIONS
  The Scrape Skin Threading Technique was designed to inject safely and accurately any kind of injectable in contact with the undersurface of the dermis, which appeared anatomically as the optimal location of a filler for enhancing the outer appearance of the dorsum of hands.
authors.affiliation: Carnac and Paris, France; Vista, Calif.; Coconut Grove, Fla.; and San Antonio, Tex. From E2e; private practice; Aesthetic Dermatology, Division of Dermatology and Cutaneous Surgery, University of Texas Health Sciences Center at San Antonio; and Bucay Center for Dermatology and Aesthetics.
authors.forename: Marc
authors.initials: M
authors.lastname: Lefebvre-Vilardebo
authors.forename: Patrick
authors.initials: P
authors.lastname: Trevidic
authors.forename: Amir
authors.initials: A
authors.lastname: Moradi
authors.forename: Mariano
authors.initials: M
authors.lastname: Busso
authors.forename: Allison B
authors.initials: AB
authors.lastname: Sutton
authors.forename: Vivian W
authors.initials: VW
authors.lastname: Bucay
mesh_terms: D003357:Cosmetic Techniques; D006225:Hand / Q000033:anatomy & histology*; D006801:Humans; D007267:Injections; D012060:Rejuvenation; D015595:Skin Aging / Q000187:drug effects*