A simple, reliable technique of autologous fat grafting for long-lasting rejuvenation of the dorsum of the hand is presented. With this technique, small intact parcels of fatty tissue are harvested with a syringe and a blunt 3-mm cannula. Then, most of the nonviable components are removed from the harvested subcutaneous material by centrifugation, decanting, and wicking. Finally, a 17-gauge blunt cannula places the fat in minuscule parcels of tissue with many passes through five or six tiny incisions in the hand. Separation of the tiny parcels of fat maximizes contact between the surfaces of the transplanted fat and surrounding recipient tissues to encourage integration, anchoring, and long-term survival. Structured, purposeful placement of a thin layer of transplanted fat rejuvenates the dorsal hand by restoring a slight fullness to atrophic subcutaneous tissue, by softening the color and definition of exposed extensor tendons and dorsal hand veins, and by supporting the aging skin.
Hands are the most visible unclothed area of the human body other than the head and neck. Although we have sophisticated techniques for erasing the signs of aging from human faces, physicians have been largely unsuccessful at rejuvenation of the hands. In the late 1980s, autologous fat grafts demonstrated promise as a means of rejuvenation by restoring a youthful fullness to the dorsum of the hand. 1-3 However, almost all descriptions of fat grafting to the hand have warned of unpredictable results. From 1989 to 1992, I used a technique of placing fat as a lump into the dorsum of the hand and digitally manipulating the lump into a thin layer. After the edema subsided, I noticed a high rate of irregularities and inconsistent long-term survival similar to that reported by others. After I tried a major change in my instrumentation and placement technique in 1992, I have seen dependable results, longevity, and almost no complications.