Hand rejuvenation with large-gel-particle HA

Patients seeking hand rejuvenation to correct volume loss have few treatment options available. In 2015, calcium hydroxylapatite (Radiesse, Bioform Medical, Inc.) was approved by the U.S. Food and Drug Administration (FDA) for hand rejuvenation. In 2018 a second option was FDA approved: Restylane Lyft with Lidocaine (Galderma Laboratories). 

Based on data from a small open-label study¹ that showed promising results for hand rejuvenation with small-gel-particle hyaluronic acid, Amir Moradi, M.D., et al., conducted a study² using large-gel-particle hyaluronic acid with 0.3% lidocaine (HAL; Restylane Lyft with Lidocaine; Galderma Laboratories) for correction of volume loss in the dorsal hand. 

This prospective, multi-center, split-hand study examined the safety and efficacy of 20 mg/mL HAL to improve hand volume. 

A total of 90 patients received HAL injections in one hand; for comparison, the other hand received no treatment. The primary endpoint was based on a minimum of 1 point of improvement on the Merz Hand Grading Scale (MHGS) in the hand treated with HAL.

Patients received treatments on day 0 in either the left or right hand in a randomized fashion, stratified by Fitzpatrick skin type. Each syringe contained 1 mL of gel. 

Injections were administered to all patients on day 0 and then at the six-month mark, including an optional touch-up four weeks after the initial injection. 

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Patients received a mean injection volume of 2.1 mL for primary treatment and 1.1 mL for touch-up treatment (total volume range, 1 mL to 5 mL).

Results showed a consistently high proportion of patients noting improvement throughout the study, including continued improvement at six months to one year. MHGS assessment determined a significantly higher response rate in the hands treated with hyaluronic acid (85.9%), compared with those that received no treatment (21.2%). And blinded reviewers were consistently able to differentiate between the treated and untreated hands through week 24. These improvements were consistent over the course of the study, which supports the clinical utility of HAL for restoring volume.   

Across the study, a majority of patients experienced injection-site reactions, including swelling (75%), tenderness (75%), redness (72%), bruising (60%), pain (44%), itching (14%) and impaired hand function (7%). However, most reactions were reported as mild in intensity. 

Notably, in weeks 4 through 24, the majority of patients demonstrated a slightly reduced flexion in both hands. 

Based on natural variability of joint function measurements in the hand, “These results suggest that the negative change in active flexion for thumb for treated and untreated hands found through week 24 do not constitute a clinically detrimental effect on hand functionality,” the study authors report. 

Furthermore, the numbers improved by the week 24 visit.

For those looking for safe and effective hand rejuvenation, this study provides clinical data demonstrating significant improvement in the appearance of dorsal hand volume through the use of HAL. With mostly mild adverse reactions and low adverse events, researchers documented stable improvements over the course of the study. 

HAL treatments appear to provide a safe and affective option for increasing volume of the dorsal hand.  
 

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Disclosures:

According to the article, the study and medical writing services were funded by Galderma Research and Development, LLC.

References:

1. Wilkerson EC, Goldberg DJ. Small-Particle Hyaluronic Acid Gel Treatment of Photoaged Hands. Dermatol Surg. 2018;44(1):68-74.

2. Moradi A, Allen S, Bank D, et al. A Prospective, Multicenter, Randomized, Evaluator-Blinded, Split-Hand Study to Evaluate the Effectiveness and Safety of Large-Gel-Particle Hyaluronic Acid with Lidocaine for the Correction of Volume Deficits in the Dorsal Hand. Plast Reconstr Surg. 2019;144(4):586e-596e.