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W H I T E P A P E R

aestheticmed.co.uk HAND REVOLUMISATION

Nine patients were evaluated between one and three compared to using needles (personal observations of Lowe,
years after their first treatments. They had maintained one NJ). The avoidance of vein puncture and bruising was also
grade severity of improvement at that time. Seven patients assisted by observation of the veins prior to injection using
received second treatments and had improvements of a laser vein imaging device as previously reported. 18
one to two grades on the severity score. These patients In the dorsal hands, it is important to obtain a smooth
had maintained improvement between six and 24 months result with an absence of nodules and irregular surface. One
after their second treatment. Patient satisfaction scores of the problems with using, for example, poly-L-Lactic acid
are summarised in Table 2, at the same time points as their (PLLA) in areas such as the hands, is the risk of the formation
severity grades following the first treatment. of nodules, which are often visible and difficult to
There was slight improvement in two, good reduce and remove. 8-19 One disadvantage of
satisfaction in seven and six patients were PCL filler is that it cannot be dissolved,
extremely satisfied. unlike a hyaluronic acid filler which can be
“PCL filler was reduced using hyaluronidase injections.
DISCUSSION determined to be For this reason, slow injection with
PCL is currently approved in numerous effective for improvement cannula to avoid over-volumising and
countries outside of the US. Further vascular injection is essential.
controlled studies are desirable to of dorsal hand volume PCL filler has been injected in
compare PCL with other volumising loss with minimal side patients at our clinic – with over 400
injectables including HA. All patients PCL treatments for the last four-plus
reported received 1ml of PCL per hand, effects” years with injections to the face for
however our current clinical practice is to volume replacement and atrophic scars
inject larger volumes of PCL (1.5 and 2mls per without serious adverse effect or allergy
hand) where there is severe volume loss. This (Lowe, NJ, unpublished data). Three of our
is achieving greater improvement, possibly patients developed transient small nodules, which
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resulting from the reported PCL-induced neocollagenesis , resolved without intervention over three months. Local
which may be the reason for the prolonged duration of swelling has been transient and usually clears within two to
improvement of hand volume. That said, these patients five days.
need to be followed for longer to determine whether there If persistent nodules or allergic reactions occur,
is any difference in duration of improvement. intralesional injections with corticosteroids would be
There may be several advantages of cannula delivery an option for treatment as with other non-HA fillers.
20
dorsal hand injection of injectables over needles. It is Physician and patient evaluation of their treatments
a minimally-traumatic procedure with reduced risk of showed significant improvement of the hand-ageing
vascular injections of filler. The use of 25G (1 1∕2 inch) changes immediately post-injection, which persisted during
cannula-assisted delivery reduced bruising, number of the observation period. Side effects were short lived, but
entry points and reduced risk of intravascular injections edema lasted longer than that reported and personally

Figure 5. Pre and post polycaprolactone injecton with self-limiting
edema lasting for five days

Aesthetic Medicine • June 2020 59