Hand fat transfer can complete rejuvenation

Kimberly J. Butterwick, M.D., who has a cosmetic practice and is on the staff at Scripps Memorial Hospital, LaJolla, Calif., says that many cosmetic patients realize their hands can give away their true age after they've undergone facial cosmetic procedures.

These problems can be alleviated by injecting fat - harvested from a part of the patient's body where it will not be missed - into the dorsum of the hand, as Dr. Butterwick described at the recent American Society of Dermatologic Surgery Meeting here.

"We usually take the fat from an area that is resistant to dieting and weight loss. Oftentimes, that's the hips or the abdomen. If it's fat that is resistant to dieting, if the patient gains or loses weight, the result will be stable," she explains.

She says some articles recommend using fat from the outer thigh because it is relatively avascular, so it is fairly easy to retrieve and can survive a period of hypoxia after transfer.

Dr. Butterwick uses the tumescent technique to numb the donor site using a very diluted lidocaine, 0.1 percent, and places the fluid under the skin within the fatty compartment. After a few minutes she extracts the fat with a blunt-tipped cannula attached to a 10 cc syringe.

"It's best to retrieve the fat with a syringe rather than a liposuction machine because it allows for gentler handling of the fat." The syringe is pulled back 1 or 2 ccs so that it doesn't apply too much pressure to the fat cells and gently removes them.

"Gently removing the fat improves the chances for its long-term survival in its new location," Dr. Butterwick says. "We want the fat, when it's injected, to set up its own blood supply and survive permanently. We don't want to smash or traumatize the fat cells excessively.

"Then we centrifuge the fat so that when we inject it, we have a lot of fat cells per cc that are injected - it makes it a very concentrated graft."

The centrifuge helps remove enzymes and other products that might affect the longevity when it's injected, she says.

Entire dorsum

Dr. Butterwick then injects the fat into the entire dorsum of the hand from one site.

"I attach a 1 cc syringe of centrifuged fat attached to an injection cannula and inject little parcels of fat as I pull the cannula out - laying down 5 ccs to 10 ccs of little strands of fat - depending on how old the hand looks - and directing the cannula in a fan-like pattern to fill in the back of the hand between the metacarpal bones and a little bit over them."

She says the strands of fat should be small enough that they can survive and develop their own blood supply.

Although some doctors vigorously massage the fat once it has been injected, Dr. Butterwick says she still thinks gentle treatment leads to prolonged results. She prefers to have the patient press the back of the hand lightly to create a smooth appearance.

She says she has seen fat last up to two to four years out so far, with about a 50 percent improvement long-term.