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Fat transfer to the hands

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As you age you lose fat in key places: the face and the hands.

I’ll never forget a bouncer at a bar when I was younger and had no ID. Where did he look to see how old I was? My eyes for crows feet, and my hands. Many people do not think about hands being a telltale sign of aging, but for sure it is. And just like we use fillers and fat transfer to the face, we can also use it for the hands. In clinic I can use fillers like Juvederm and Restylane Lyft to add volume to the hand to make it more youthful, but it takes usually around 4 syringes of filler and lasts for about 6 months. This is an area where fat transfer is better, as there is a more plentiful supply, and whatever fat forms a new blood supply can be there for years.

Fat grafting to the hands uses your own body fat, harvested by liposuction, and then injected into the hand. There are no scars. Downtime and pain are minimal.

What does hand surgery look like?

Fat grafting to the hand is a surgery done in the operating room. Fat is harvested by doing liposuction of another place on your body (think: love handles or inner thigh), the fat is then centrifuged and transferred into small syringes. Fat is injected in small amounts diffusely throughout the back of the hand onto the proximal part of the fingers.

  • This fat transfer helps add volume to the back of the hand, which you lose as you  age.
  • As you age, you see elements of the hand: the tendons and veins. Volume helps hide these.
  • The stem cells in the fat help repair the quality of the overlying skin, which is also an issue.
  • Just like all fat transfer surgeries, the amount of fat which survives (and therefore the result) varies from person to person.

When do you see final results?

As with all fat grafting, immediately after surgery your hand is puffy. Never does 100% of fat survive, and survival varies by person. (Studies have not shown a way to predict fat survival. It does not correlate with age, gender, BMI, and other parameters.)  The range usually varies from 20-70%, though the stem cell effect would happen regardless of fat survival. The puffiness resolves over the course of weeks.

filler vs fat which is better?

You can use filler or fat to add volume to the back of the hand. Which is better?

FILLER WITH HA (Think: Juvederm and Restylane Lyft)

  • PROS: In office procedure. Immediate results. Predictable change.
  • CONS: Costly. You need to do every 6 months. Requires 4 syringes or more to add fill. No skin quality improvement.

FILLER WITH SCULPTRA

  • PROS: Adds more volume than HA fillers. Lasts longer (1-2 years)
  • CONS: More costly. Variable amount generated. If you do Sculptra, because the mechanism of action is inflammation to create the collagen, fat grafting will not survive in the future.

FAT GRAFTING TO THE HAND

  • PROS: Can last for a long time. Whatever fat gets a new blood supply can be there for years.
  • PROS: Unlimited supply. You aren’t paying by the syringe.
  • PROS: Stem cells. Science, histologic biopsy proven improvement in skin quality.
  • PROS: More cost effective over time if you will redo filler over and over.
  • PROS: No scar
  • CONS: In OR procedure. Variable fat survival.

what does it cost?

Cost varies based upon what else you are doing.

The most common time I do fat grafting to the hands is part of a bigger procedure, particularly when I am fat grafting other areas like the face. As an “add on”, the cost is around $2500.  This may sound expensive, but if you are doing 4 syringes of filler every six months, you are spending $6000 a year for filler for your hands.

As a stand alone procedure, the cost is around $4500. (remember: it is done in the operating room)