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    High five

    Polylactic acid, IPL impressive tandem tools in hand rejuvenation


    (Left) 70-year-old female patient prior to receiving PLA hand rejuvenation treatment. (Right) Same patient following five treatments using injections of polylactic acid. Photo credit: Alessio Redaelli, M.D.
    MILAN — Many cosmetic surgeons find that optimum hand rejuvenation is a tricky undertaking because some of the techniques used to rejuvenate the face do not work as well on the bony structures and sometimes-thin skin of the hands. Among the procedures that seem to work well, however, either alone or in conjunction, are intense pulsed light (IPL) and polylactic acid (PLA).

    PLA AS ADJUNCTIVE THERAPY Alessio Redaelli, M.D., a vascular surgeon and aesthetic medicine specialist in Milan, Italy, recently conducted a small clinical study on the effectiveness of polylactic acid for multi-site rejuvenation. He reported on 27 subjects, with an average age of nearly 60 years. The researcher injected PLA to rejuvenate the subjects' face or necks simultaneously, using 150 mg PLA diluted with 0.5 mL of 3 percent Carbocaine and water yielding injectable preparations from 5 mL to 8 mL.

    He injected the hands' intermetacarpal spaces in dosages ranging from 2 mL to 4 mL per session, using an exacting technique, in from three to six consecutive sessions (with sessions performed every 30 to 45 days).

    Only one patient reported visually unnoticeable but palpable nodules at the treatment site. In total, casuistic nodules (on the face and other areas) occurred in 1.2 percent of subjects, with less than 1 percent occurring on the hands.

    Dr. Redaelli reports that patients tend to be satisfied with the results. Using the DGS, Definitive Graduated Score — a doctor and patient rating system from one to 10 — his patients score higher than 7.1 on average. Injections to maintain the effect can be made every six months.

    NEW OPTIONS NEEDED Dr. Redaelli says that PLA is an important option in hand rejuvenation because fillers do not last in the hands. "Even if early results are good, fillers can lead to a blue transparent color in the intermetacarpal space," he tells Cosmetic Surgery Times .

    Dr. Redaelli
    But a physician's training in the PLA hand treatment technique is mandatory in order to achieve good results, he emphasizes. According to Dr. Redaelli, in Italy only those physicians who have been adequately trained in PLA can even purchase the treatment materials.

    "There are simple rules that each [practitioner] must follow. First, use a dilution of at least 6 mL of water for injectable preparations and 0.5 mL of Carbocaine 3 percent. Second, use the maximum amount of 0.05 mL PLA for each injection site [it is critical to make a lot of injections, each with a small amount]. And third, massage the area for 15 minutes following the procedure and instruct patients to massage the area for at least 10 minutes, twice each day," he says.

    HAND CANDIDATES Dr. Redaelli counsels patients to consider a more global approach to rejuvenation, including the hands, and often proposes chemical peels and other rejuvenating techniques simultaneously. He might use lasers for age spots; fractional CO2 laser or Jessner's peel for rejuvenation; PLA or some fillers for skeletization; and sclerotherapy for veins.

    Dr. Gershenbaum
    He describes the optimal candidates for PLA treatment of the hands as those patients whose tendons are visible, with skeletization of metacarpal spaces. The skin should not be too thin, however, he advises.


    Lisette Hilton
    Lisette Hilton is a writer in Boca Raton, Fla., who heads up her company, Words Come Alive.