gms | German Medical Science

Objective: To retrospectively evaluate the rate of adverse events after hand volumizing procedures using a calcium hydroxyl-apatite product and to investigate the relationship between injector used (needle vs. cannula) and technique applied (bolus, tenting, proximal-to-distal fanning, distal-to-proximal single line).

Material and methods: 220 individuals (214 females (97.3%); 52.3 years ± 11.4) treated bilaterally for hand rejuvenation were investigated between the years 2006 and 2017. Cadaveric dissections (n=12), fluoroscopic (n=4), ultrasound (n=22) and computed tomographic imaging (n=4) were additionally performed to guide conclusions.

Results: 32 hands (out of 440; 7.3%) developed adverse events within the first 15 days, with swelling 11 (5%), pain 4 (1.8%), erythema 3 (1.4%) and discoloration 1 (0.5%). Using a needle (vs. cannula) was significantly related to the occurrence of adverse events OR 7.57 (95% CI 3.76–15.24) (p<0.001). The proximal-to-distal fanning technique with access to the dorsal superficial lamina was identified as a safer application technique with each of the other techniques having an significantly increased odds ratio for adverse events: bolus technique (OR 26.9 (95% CI 6.87–105.2)), tenting technique (OR 24.73 (95% CI 7.48–81.76)) and single line technique (OR 26.68 (95% CI 7.45–95.48)); (all p<0.001).

Conclusion: The results of this study support the use of cannula vs. needle and the proximal-to-distal fanning technique. The underlying anatomy supports the positioning of the material into the subdermal space which can be identified less than 1 mm deep to the skin surface and is termed the dorsal superficial lamina.