Biostimulator in the hands: what is known and precautions

Hands show age as clearly as the face, and many patients who take care of their face want to treat the back of the hand. The skin becomes thin and spotted, tendons and veins become prominent, and loss of subcutaneous fat increases the "skeletal" look. The collagen biostimulator has entered this debate as an alternative or complement to filler. This page summarizes, at review level, what is known about this indication and what precautions it requires. Product, volume and technique follow the instructions for use and training, at the discretion of the qualified professional, according to the rules of their professional council (in Brazil, CFM, CFO and others).

What happens to the back of the hand over time?

The back of the hand has a peculiar anatomy: thin, mobile skin, a small subcutaneous layer and deep structures very close to the surface. Over time there is fat loss, skin thinning from photoaging, loss of elasticity and greater visibility of tendons and veins. The patient's concern is usually aesthetic, an aged appearance, and may come with spots, which do not respond to a biostimulator. See aging of the hands.

What are the options, and where does the biostimulator fit?

The biostimulator can be thought of as an alternative for patients who do not want the immediate volume effect, or as a complement in broader plans.

What does the literature allow us to say?

The evidence base for biostimulators in the hands consists mainly of case series and small studies, with limited follow-up and subjective assessments. This allows us to say there are reports of improved appearance and skin thickness, but it does not allow us to estimate effect size, durability or superiority over other methods. When citing the literature to the patient, be honest about this limitation. To practice critical reading, see how to read a clinical trial of injectables and evidence for biostimulators.

Specific risks

• Nodule and irregularity: thin skin and little fat make any deposit visible and palpable. See factors linked to nodules.
• Prolonged swelling: the back of the hand drains poorly in some patients, and the swelling can take a while to subside.
• Transient limitation of movement of the fingers or wrist from swelling.
• Hematoma, because of the superficial veins.
• Infection, rare, but the hands are highly exposed.
• Pain and tenderness, more intense than in other areas in some patients.
• Tendon or deep structure injury with inadequate technique.

Who is a good candidate?

In general, patients with thin skin, mild to moderate volume loss and realistic expectations of a gradual result. Patients whose main concern is spots need other approaches. Patients with active autoimmune disease, local infection, active skin lesions or use of immunosuppressants call for caution, and conditions such as localized scleroderma have their own discussion in localized scleroderma and fillers in HOF. The overview is in general contraindications in HOF.

How to run the consultation

Examine the hands at rest and in motion, with light that shows relief. Note color, texture, veins, tendons and signs of sun damage. Ask about occupation, hobbies and use of the hands, because mechanical wear changes the expectation of duration. Record standardized photos of the back of the hand, with a neutral background and constant light, and plan the follow-up. Consider sun protection and skin care together.

Care after the procedure

Hands are among the most used parts of the body, and post-procedure care needs to be realistic. Advise the patient on how long to avoid activity that overloads the hand (weight training, impact sports), on elevating the hand to reduce swelling when possible, on daily sun protection and on what to watch for: increasing pain, redness, heat, color change or loss of mobility. Hand it over in writing and confirm understanding.

Massage guidance, when there is any, follows the product and its instructions for use. Agree exactly what to do, for how long and how often, because excessive pressure, or pressure different from what was agreed, can change the distribution of the product. The follow-up is usually scheduled in a few weeks, to assess residual swelling, symmetry between the hands and palpation. Document with standardized photos, same light and position, the back of both hands at rest and with a closed fist.

Questions patients usually ask

Patients seeking treatment for their hands ask predictable questions: how long it lasts, whether it hurts, whether they can go back to work the next day, whether it works for spots, whether it is better than filler. Honest answers begin with "it depends": on the skin, the product, how the hands are used and the area. Avoiding absolutes is what preserves credibility. When the question is "which is better," explain that filler and biostimulator have different mechanisms, and that the choice starts from the concern, not from an order of preference.

Consent and records

The informed consent should mention the area, the risk of nodules and prolonged swelling and, if applicable, off-label use. The form template is in informed consent form for biostimulator. Also record the product, lot and total volume. See traceability of injectables.

Where does Harmy come in?