Fat grafting and fillers · New York and New Jersey
Hand Rejuvenation
With age, the back of the hand loses volume, and the tendons, knuckles, and veins start to show. Hand rejuvenation puts that volume back, with your own fat or with a filler. Dr. Steven Ovadia is a board certified plastic surgeon who has published a systematic review of the research on hand rejuvenation, with offices in New York City and New Jersey.
The aging hand
Why hands start to look older
The hands are almost always on view, and they often show age before the face does. The main reason is lost volume. The back of the hand has only a thin layer of skin and fat over the tendons, veins, and bones. As that layer thins, everything under it shows more.
Volume loss
The thin layer of fat on the back of the hand shrinks. The spaces between the tendons sink in, and the hand looks bony.
Tendons that stand out
With less padding over them, the tendons that run to each finger become visible as ridges, especially when the fingers move.
Veins that stand out
The veins on the back of the hand sit just under the skin. As the skin and fat thin, they look larger and more raised.
Thin, crepey skin
The skin itself becomes thinner and looser, and wrinkles more easily when the hand is relaxed.
The gold shading marks where fat or filler is placed.
Candidates
Who hand rejuvenation is for
Hand rejuvenation tends to work well when:
- The back of your hands looks thin or bony, with sunken spaces between the tendons
- Your tendons, knuckles, or veins stand out more than you would like
- Your hands look older than your face, or older than you feel
- You are in good general health
- For fat grafting: you have a small area of extra fat, such as the abdomen or thighs, that can be used
- You understand that more than one treatment is sometimes needed
At your consultation, Dr. Ovadia examines your hands and talks with you about what bothers you, and tells you whether fat grafting or filler is the better fit.
What hand rejuvenation can do
- Restore volume to the back of the hand
- Make tendons, knuckles, and veins less prominent
- Give the hand a smoother, fuller, softer look
- Be done on its own or together with other surgery or treatment
What it does not do
- Remove veins, which stay where they are and keep working
- Change the shape of the fingers or the joints
- Treat arthritis, hand pain, or how the hand works
- Stop the hands from continuing to age
Options
Fat grafting or filler
Both treatments restore the volume the back of the hand has lost. The difference is what is used, how long it lasts, and where it is done.
| Fat grafting | Filler | |
|---|---|---|
| What is used | Your own fat, taken by liposuction from another area | An injectable filler |
| Where it is done | In the operating room | In the office |
| How long it lasts | The fat that survives is long lasting. Some is reabsorbed in the first months | Temporary. It wears off over months, and can be repeated |
| Other areas | The donor area is slimmed slightly by the liposuction | None |
| Downtime | Swelling of the hands for one to two weeks, plus the liposuction area | A few days of swelling or bruising |
| Good fit for | A longer-lasting result, or patients having other surgery | Trying a change first, or patients without fat to spare |
Fat grafting
Your own fat is moved from an area where you have some to spare into the back of the hand. Because it is your own tissue, the fat that survives becomes part of the hand and is long lasting. It is often done together with other surgery, such as a facelift, eyelid surgery, or liposuction.
Filler
An injectable filler is placed under the skin of the back of the hand in the office, through a few small injection points. It takes effect right away and gradually wears off over the following months. It is a good way to see the change before choosing a longer-lasting option.
Procedure
How fat grafting to the hands is done
Fat grafting to the hands is done through openings a few millimeters long, so there are no long incisions or visible scars.
The fat is taken
A small amount of fat is removed by liposuction through tiny openings, usually from the abdomen, flanks, or thighs. Only a small volume is needed for the hands.
The fat is prepared
The fat is processed to separate the healthy fat cells from fluid and oil, so only the fat that can survive is placed.
The fat is placed
Through a few tiny openings near the wrist or knuckles, the fat is placed in thin layers under the skin of the back of the hand, between the tendons, with a fine blunt instrument.
The hand is smoothed
The fat is smoothed so it lies evenly. The openings are tiny and close with a single stitch or none. A light dressing goes on at the end.
Every procedure has risks. For hand rejuvenation these include swelling, bruising, infection, lumps or an uneven surface, a difference between the two hands, numbness or tingling for a time, and the need for another treatment if part of the fat is reabsorbed. Fat grafting also carries the risks of liposuction at the donor area. Dr. Ovadia goes over the risks with you at your consultation.
The research
Dr. Ovadia's review of hand rejuvenation
Dr. Ovadia and his co-authors reviewed the published medical literature on rejuvenating the back of the hand, gathering the treatments, techniques, results, and complications reported across the studies.
Dorsal Hand Rejuvenation: A Systematic Review of the Literature
Read the abstract on PubMedMost patients in the studies were women, and the average age in each study ranged from the early forties to the late sixties. The review found that these treatments are safe overall, that most reported side effects were mild and temporary, such as swelling and bruising, and that interest in hand rejuvenation is growing. That work shapes how Dr. Ovadia plans treatment for his own patients.
Recovery
What to expect after fat grafting to the hands
Keep your hands elevated
Swelling of the hands is expected and usually most noticeable in the first several days. Keeping your hands elevated when you are sitting or lying down, such as resting them on pillows, helps it go down.
Light use right away
You can use your hands for light daily tasks soon after. Making a full fist may feel tight while the hands are swollen. Avoid gripping, heavy lifting, and pressure on the backs of the hands at first.
Some fat is reabsorbed
Not every fat cell survives the move. Part of the fat is reabsorbed by the body over the first few months. What remains after that tends to stay.
The donor area
The area where fat was taken is sore and bruised for a short time, much like after a small liposuction, and a compression garment may be used there.
After filler, recovery is shorter: a few days of swelling or bruising at the injection points, with no time off needed for most patients. After either treatment, increasing pain, spreading redness, a fever, or skin that turns pale or dusky should be brought to your physician's attention right away.
A general timeline after fat grafting
This is a general guide. Everyone heals differently. During your recovery, Dr. Ovadia will review your timeline with you.
Cost
Cost and insurance
Hand rejuvenation done to improve the appearance of the hands is unlikely to be covered by insurance. The cost depends on whether you choose fat grafting or filler, how much volume is needed, and whether it is done together with other surgery. We go over it with you once your plan is set.
If you have questions about cost, call or email us and we will go over it with you.
Your surgeon
Board certified and double fellowship-trained
Dr. Ovadia is board certified by the American Board of Plastic Surgery. After his plastic surgery training he completed two fellowships: gender-affirming surgery at Johns Hopkins, and craniofacial and pediatric plastic surgery at UT Austin / Dell Children's Hospital.
He is the lead author of a systematic review of hand rejuvenation published in Aesthetic Plastic Surgery, and uses fat grafting across his practice, from the hands to the face and breasts. He sees patients in New York City and in Jersey City and Millburn, New Jersey.
Questions
Common questions about hand rejuvenation
What is hand rejuvenation?
Hand rejuvenation restores the volume the back of the hand loses with age, so the tendons, knuckles, and veins stand out less and the hand looks fuller and smoother. Dr. Ovadia does this with fat grafting, using your own fat, or with an injectable filler.
Is fat grafting or filler better for the hands?
Both work well. Fat grafting uses your own fat and the fat that survives is long lasting, but it is done in the operating room and needs fat from another area. Filler is done in the office with less downtime, but it wears off and needs to be repeated. Dr. Ovadia helps you decide at your consultation.
How long do the results last?
After fat grafting, part of the fat is reabsorbed over the first few months. The fat that remains after that tends to be long lasting, although the hands keep aging naturally. Filler lasts months and wears off gradually, and can be repeated.
Will I need more than one treatment?
Sometimes. Because part of the grafted fat is reabsorbed, some patients choose a second session to add more volume. With filler, treatments are repeated as it wears off.
Will my veins disappear?
No. The veins are not removed, and they keep working normally. With more volume under the skin, they are covered and look less prominent.
Will it affect how my hands work?
The fat or filler is placed under the skin on the back of the hand, above the tendons. It is not placed in the joints or the palm and does not change how the hand works. While the hands are swollen, making a fist may feel tight for a short time.
Where does the fat come from?
Usually the abdomen, flanks, or thighs. Only a small amount is needed for the hands, so the change in the donor area is slight.
Is it painful?
Discomfort is usually mild. The hands feel swollen and tight for several days, and the donor area feels sore and bruised. Most patients manage with simple pain relievers.
Can hand rejuvenation be combined with other surgery?
Yes. Fat grafting to the hands is often done together with a facelift, eyelid surgery, or liposuction, since the fat can be taken during the same operation.
Is hand rejuvenation covered by insurance?
Hand rejuvenation done to improve the appearance of the hands is unlikely to be covered by insurance.
Can I have a consultation without coming to the office?
Yes. Phone and video consultations are available, in addition to in-person visits in New York City, Jersey City, and Millburn, New Jersey.
Next step
Start with a consultation
Dr. Ovadia will examine your hands, go over what you would like to change, and explain whether fat grafting or filler fits you better.
225 Broadway, Suite 3100, New York, NY
377 Jersey Ave, Suite 440, Jersey City, NJ
90 Millburn Ave, Suite 206, Millburn, NJ
Phone and video consultations available · info@ovadiaps.com