Aesthetic hand surgery
Last updated date: 15-May-2023
Originally Written in English
Aesthetic hand surgery
Our hands, like our faces, reflect our age. Our hands lose firmness and plumpness as we age, and with vein protrusion and thin crepe-like skin texture, they might appear skeletal and brittle. The skin on our hands often develops dark spots as a result of sun exposure.
If you have a problem with your hand, surgery may be able to help. This form of highly specialized surgery is used to address illnesses that affect the strength, function, and flexibility of the wrist and fingers. Surgery is to restore to near-normal function the function of fingers and hands that have been harmed by trauma or to address birth defects.
Aesthetic hand surgery definition
Restoration techniques following accidents or cancer, as well as the production of a normal form and function in cases of congenital deformity, are the focus of plastic, reconstructive, and aesthetic surgery. Due to the wide range of defect sizes, types, and locations, a reconstruction requires a significant number and variety of procedures.
This surgery covers the full spectrum of current reconstructive treatments, from tissue transplantation to free microsurgical transplantation of perfused tissue with skin, bones, muscles, and nerves. In addition to functional recovery, the cosmetic component of all plastic surgery procedures is considered.
Is This a Good Option for You?
Hand Rejuvenation may be a good option for you if:
- You'd like your hands to appear more youthful.
- You're in good physical shape.
- You are not a smoker.
- You have a positive attitude and clear, but achievable goals for improving your appearance.
The hand's anatomy is intricate, complex, and fascinating. Its integrity is very necessary for our day-to-day survival. Many illnesses can affect our hands, the most prevalent of which being traumatic injury. Mastery of such anatomy is essential for any physician or therapist treating hand disorders to deliver the best possible care.
The fundamental skeleton of the wrist and hand is made up of 27 bones. The median, ulnar, and radial nerves all have sensory and motor components, and they all innervate the hand. The intrinsic and extrinsic groups of hand muscles are separated.
The basic skeleton of the wrist and hand is made up of 27 bones, as previously stated. Carpals, metacarpals, and phalanges are the three types of fingers.
The wrist is the body's most complicated joint. It is made up of eight carpal bones arranged in two rows, with very limited motion between them. The scaphoid, lunate, triquetrum, and pisiform bones make up the proximal row, which runs from radial to ulnar. The trapezium, trapezoid, capitate, and hamate bones make up the distal row, which runs in the same direction.
Except for the pisiform, which is a sesamoid bone through which the flexor carpi ulnaris tendon travels, all carpal bones have a role in wrist function. Because the scaphoid serves as a connector between each row, it is susceptible to fractures. The base of the second and third metacarpals are securely linked to the distal row of carpal bones, forming a fixed unit. In comparison to this stable unit, all other structures (mobile units) move. The roof of the carpal tunnel is formed by the flexor retinaculum, which joins ulnarly to the pisiform and hook of hamate and radially to the scaphoid and trapezium.
There are five metacarpal bones in the hand. Each metacarpal is divided into four sections: the base, shaft, neck, and head. The thumb is the shortest and most movable of the metacarpal bones. It articulates with the trapezium proximally. At the base, the trapezoid, capitate, and hamate articulate with the other four metacarpals. Each digit's proximal phalanges articulate distally with each metacarpal head.
Hand appearance and function
Patients care about the appearance of their hands since they are an important aspect of human relationships, communication, and social integration. According to recent research, hand aesthetics is a significant and meaningful patient-reported result. Several outcome measures exist in hand surgery that accurately measure functional outcomes, but aesthetics is frequently disregarded or measured imprecisely.
This makes comparing illness burden and therapeutic success in terms of aesthetics problematic. This special topic article discusses the aesthetic characteristics of the hand, how the look of the hand is evaluated in outcomes research, and presents a novel method for assessing hand aesthetics.
Patients are aware of their look because their hands are prominently visible to both themselves and the public. Normal hands go unnoticed, while a misshapen or diseased hand attracts unwelcome attention, which might have negative psychosocial implications. Hands are vital for human interactions, nonverbal communication, and social integration because they have personal value.
Furthermore, skin appearance, soft-tissue volume, and joint alignment can all be used to infer health. Patients will be concerned about the appearance of their hands for these reasons, even if they have a severe hand illness.
Despite the fact that functionality is definitely the most important outcome in hand surgery, doctors are coming to realize that patients are concerned about hand aesthetics. The use of hand appearance as a patient-reported outcome in observational research demonstrates this. Aesthetic evaluations can be a significant tool for demonstrating a patient's viewpoint on surgical procedures.
For rheumatoid arthritis patients with significant hand deformity who have silicone metacarpophalangeal arthroplasty, for example, hand appearance is a desired outcome. In fact, aesthetic considerations trumped function as the most significant result domain.
Accurate and reliable assessment methods are required to comprehend the value of hand appearance to patients.
Although hand-specific questionnaires exist, many researchers choose to evaluate aesthetics using ad hoc approaches. Having a systematic, global way to analyzing hand appearance would be great for bringing consistency to the hand surgery literature and providing direction to hand surgeons interested in evaluating a patient's aesthetic issues.
This is difficult since a patient's judgment of a hand's look is based on personal preference and the condition of their hand, rather than particular disease-related or surgical-intervention characteristics.
Diseases of the hand
Hand surgery is the treatment of acquired and congenital diseases of the hand. Commonly treated conditions include:
- Broken bones
- Carpal tunnel syndrome: Carpal tunnel syndrome is a disorder caused by pressure on the median nerve in the wrist. You may have discomfort, tingling, numbness in your fingers, weakness, or aching. Carpal tunnel syndrome is linked to a variety of disorders, including repetitive motion or overuse, fluid retention during pregnancy, carpal tunnel nerve injury, and rheumatoid arthritis.
- Congenital hand
- Cubital tunnel
- Dupuytren’s disease: Thick, scar-like tissue bands form within the palm and may spread into the fingers, resulting in a debilitating hand condition. It can limit movement and cause the fingers to bend into an unnatural position.
- Hand arthritis/pain
- Hand fractures
- Hand mass
- Management of peripheral nerve injuries
- Nerve reconstruction
- Nerve tumors
- Raynauds hand
- Scleroderma hand
- Skin cancers
- Sports injuries
- Syndactyly (webbed digits)
- Tendon repairs
- Tumors in the upper and lower extremity
- Wrist arthroscopy
- Wrist surgery
In addition, for patients who are missing a thumb, we provide a unique surgery called as a toe-to-thumb transplant. The procedure involves transferring tissue from a person's toe to serve as a working thumb.
Physiological changes associated with aging have an impact on the look of the hands. Intrinsic aging is characterized by skin and fat atrophy, deepening of intermetacarpal gaps, and conspicuous tendons, bones, and veins in the subcutaneous tissue. Extrinsic aging is caused by pathological changes in the dermal and epidermal layers (e.g., actinic keratosis) as well as environmental exposures such as ultraviolet rays.
wrinkle pattern, volume loss, visibility of subcutaneous structures, and trophic alterations to observe the chronological changes in aging. The first indicators of aging are prominent wrinkles, which are often noticed in the fourth decade. The wrist crease and the metacarpophalangeal joints show the most wrinkle growth.
Epidermal thinning, volume loss (especially thenar and hypothenar eminences), and large dorsal veins become increasingly noticeable around the sixth decade. Finger flexion no longer results in complete draining of inadequate dorsal veins as the dorsal skin becomes less elastic. Elderly hands have muscular atrophy, visible tendons, dorsal wrinkles, and hand pathology
Treatment options for Aging hands
There are many alternatives available today to make your hands look younger. Our surgeons can re-plump and refill the natural volume in the back of the hands using fillers like Juvederm® or Restylane® to give them a more supple and youthful appearance. Fat transfer to your hands is a longer-lasting option. Laser and other procedures for sun-damaged skin can enhance the surface of your skin and remove some of the brown pigmentation and uneven texture.
The plastic surgeons offer several options to improve the appearance of your hands. Conditions that can be treated include:
- Skin discoloration: The loss of skin firmness or the formation of cellulite is caused by a weakening of the supporting skin structure (collagen and elastin fibers).
- Pigmentation: Sun exposure causes freckles, sun spots, melasma, and other discolored regions of skin.
- Scars: Scars can be rolling (a wavy appearance to the skin), pitted, discolored, or have elevated borders as a result of acne or skin injury.
Hand Appearance as an Outcome of Interest
The efficiency of therapies and the morbidity of pathological hand disorders can both be affected by hand aesthetics. Here are some examples of pathological illnesses where hand appearance has been employed as a study outcome. provides instances of publications that have utilized aesthetics as a result of our conversation.
Degenerative and Inflammatory Joint Disease
Degenerative and inflammatory joint illnesses can have a big impact on hand features like digit length and alignment. Bony enlargement, soft-tissue swelling, Heberden's nodes, Bouchard's nodes, and squaring of the hand at the carpometacarpal joint are all common osteoarthritic hand abnormalities. Patients with hand osteoarthritis have significant aesthetic discomfort, which is linked to despair, anxiety, and a poor health-related quality of life.
When studying the surgical therapy of inflammatory joint disorders, hand appearance is usually used as an outcome measure. For rheumatoid arthritis patients receiving metacarpophalangeal joint arthroplasty, for example, hand aesthetics is a major motivator, and patients reported greater improvement in look than in function or pain alleviation.
Trauma and Burns
When treating severe injuries and burns to the hand, there are several cosmetic issues. Aggressive debridement of devitalized tissue, restoration of osteotendinous and neurovascular abnormalities, and soft-tissue reconstruction are all part of the treatment for hand trauma. Patients will be concerned about hand disfigurements, even though a surgeon's primary goal is to enhance functional recovery. As a result, surgeons should consider the cosmetic effects of surgical procedures without sacrificing structural reconstruction efforts.
When treating traumatic hand injuries, the cosmetic implications of digit restoration (vs. amputation) and soft-tissue coverage are frequently the most important. Distal replantation (done at centers specializing in replantation) is indicated for patients interested in restoring the length and improving the look of a severed digit because a shortfall in finger length is immediately noticed.
Pigmentation, shape, volume, glabrous skin matching, and incision placement are all important cosmetic characteristics in hand soft tissue reconstruction. Because palmar skin is different, soft-tissue covering is best taken from the hand to achieve the best functional, sensory, and cosmetic results. When glabrous skin is unavailable, soft-tissue reconstruction techniques such as partial toe transplantation, pedicled abdominal flaps, cross-finger flaps, reverse digital artery flaps, and reverse dorsal digital island flaps are available.
Hand tumors can appear as an ugly lesion or a deforming mass and can arise from the skin, soft tissue, or osseous structures. Topical treatments, electrocautery, cryotherapy, or simple resection are often effective for skin lesions (e.g., actinic keratosis, pyogenic granulomas, and keratoacanthomas), benign soft tissue (e.g., lipomas, ganglion cysts, schwannomas, glomus tumors, and neurofibromas), and vascular tumors (e.g., hemangiomas
Although aesthetic outcomes after treatment may be of interest depending on lesion size, nonsurgical treatment side effects (ie, hypopigmentation from sclerotherapy), and surgical incision position, these lesions are often irrelevant to hand appearance.
Malignant lesions, such as basal cell carcinoma, squamous cell carcinoma, melanoma, and soft-tissue sarcomas, on the other hand, may necessitate substantial resections, which might have significant aesthetic effects.
Sarcomas are cancerous tumors of the hand that have traditionally been treated through radial resection and amputation. When possible, current literature advises limb salvage because it has the potential to improve functional and cosmetic outcomes while providing no difference in long-term survival.
Because an atypical hand can affect a child's psychological, emotional, and social development, hand appearance as a clinical result is important in congenital abnormalities. Because ulnar polydactyly is rarely associated with function difficulties, beauty is frequently the major justification for surgical treatment.
When children with congenital hand malformations become aware of their physical disfigurements, research has revealed that they experience low self-esteem, stress, social anxiety, and melancholy. When compared to established norms, children with upper-limb reduction deficit exhibited more withdrawn behavior.
The surgical procedure
For surgical hand rejuvenation, a variety of techniques are performed, the most popular of which is fat restoration via autologous fat grafting, in which fat from your abdomen or thighs is used to plump up the back of your hands. Endovenous Laser Therapy can also be utilized to decrease the veins in the back of the hand while requiring minimal downtime. Hand tucks can be used to tighten loose skin on occasion.
In the course of hand rejuvenation, hand function should constantly be considered and maintained. Due to the complexity of this procedure, a brief description of what is necessary is insufficient, and a complete consultation with a full assessment is essential prior to surgery.
- Local Anaesthesia, Intravenous sedation.
- A day surgical procedure performed in the clinic.
- You will be permitted to leave the clinic on your own.
- Depending on the technique, pressure garments should be worn for varying amounts of time.
- After a few days, normal activities can be resumed.
- As quickly as possible, you will be encouraged to use your hands.
- By two weeks, all remaining bruising and swelling will be gone.
Hand and Wrist Surgery in Rheumatoid Arthritis
For RA of the MP joints, conservative treatment is recommended to evaluate if control may be achieved solely via pharmaceutical therapy. Post-synovectomy, recurrence is always a possibility, and 30-50 percent of patients may experience spontaneous remission.
Synovectomy is appropriate in RA patients who have chronic MP joint synovitis with limited joint deformity and minimal radiographic indications of RA and whose MP joint RA is unresponsive to 6-9 months of conventional treatment. Extensor tendon relocation with synovectomy is also recommended for RA patients with early volar subluxation and ulnar drift, especially if the patient is young and the disease is not developing rapidly.
The ulnar gutters of the MP joint are filled by subluxed extensor tendons. Once this finger is in the flexed position, the patient may not be able to extend it. If the finger is passively placed in this position, it can sustain extension.
The soft tissues of the MP joint can be reconstructed alone or the entire joint can be replaced in arthroplasties. Soft-tissue arthroplasty commonly includes a synovectomy component with MP joint stability, such as radial collateral ligament restoration or tendon realignment. When discomfort is uncontrollable or function is hindered, joint replacement is recommended for MP joint deformity or subluxation. Joint replacement can be done with a variety of MP joint implants.
A transverse incision across the entire dorsum of the hand at the MP level or discrete longitudinal incisions over each MP joint are used in the MP joint replacement surgery. Individual longitudinal incisions have a lower risk of interfering with lymphatic and venous outflow, but the transverse incision is the most common for convenience of access.
The dissection continues down to the level of the paratenon. On the ulnar aspect of the extensor tendon, an incision is created, and the tendon is radially reflected. At this time, great care is taken not to compromise the capsule's integrity. A longitudinal incision is made in the capsule of the MP joint. The metacarpal head is liberated of any soft-tissue attachments to the metaphyseal flare using a periosteal elevator.
A genuine cut is made with an oscillating saw, preserving a 90° angle in line with a lengthy access to the metacarpal and in the coronal plane. After that, the metacarpal head is discarded. The medullary canal can be reammed with an electrical burr or a Christmas-tree kind of rasp.
A burr hole on the articular surface of the base of the phalanx is used to identify the medullary canal of the proximal phalanx. A rongeur is used to remove osteophytes from the proximal phalanx at this time. The proximal phalanx's intramedullary canal is reamed. Both the metacarpal and the proximal phalanx have rectangular openings that are square in line with the axial direction of the metacarpal and phalanx. The medullary canals are then filled with appropriate diameters.
Plastic Surgery for Hand Infections
Elevation, heat, rest, antibiotics, incision and drainage when pus is present, and tetanus prophylaxis for open wounds are the main concepts of treating any hand infection. Elevation helps with venous and lymphatic drainage as well as patient comfort. Rest improves the patient's comfort while also limiting the transmission of infection across tissue planes. Heat helps the affected area's circulation and leukocyte count. Dry heat is less effective than moist heat.
If possible, cultures should be acquired before to starting antibiotic therapy. While culture and sensitivity testing are being performed, antibiotic medication should be started. The empiric antibiotic decision is based on the organism(s) most likely to be cultured, as well as the history of the injury or other causative variables, and should most likely include coverage for MRSA in those who are susceptible to the pathogen.
Evaluating Hand Aesthetics
The use of hand aesthetics as a patient-reported outcome in clinical research has impacted the indications for surgical procedures in hand surgery and proved their usefulness. Although assessing aesthetic improvement may affect treatment decisions, gathering this information requires the use of proper outcome evaluation tools.
In hand surgery research, there are several outcome instruments, although hand aesthetics is rarely expressly included. The Disabilities of the Arm, Shoulder, and Hand instrument, for example, evaluates the construct of "function," but only indirectly considers hand appearance.
Understanding and communicating the burden of disease or the success of health-care interventions requires measuring and reporting "what matters" to patients. A globally acknowledged, standardized aesthetic assessment instrument would theoretically allow for accurate comparison of results across literature.
More study is needed to demonstrate the quality of currently available aesthetic assessment instruments, as demonstrating the validity (and responsiveness), reliability, interpretability, practicality, and minimal clinically meaningful difference of the tool is more crucial. Alternatively, efforts could be focused on developing a universal hand aesthetics assessment tool.
Furthermore, social views may have a negative impact on a patient's perception of their hand appearance. As a result, hand aesthetics is best understood as a dynamic and sensitive self-concept to biopsychosocial variables.
The impact of hand pathology and the efficacy of therapeutic therapies can be demonstrated by evaluating hand appearance. Although functionality is still the most important factor in evaluating the effectiveness of surgical procedures in the hand, aesthetics should be considered a relevant result that should be examined and monitored.
Currently, there are no extensive, precise assessments of aesthetic discomfort available. As a result, ad hoc questioning is a typical approach of judging appearance, making cross-literature comparison problematic. More research is needed to determine how to effectively and comprehensively analyze hand aesthetics.