Hand Rejuvenation with Coleman Fat Grafting

A simple technique of injecting fat under the skin of an aging hand can achieve long-lasting hand rejuvenation. This specific technique was first described by Sydney Coleman in 1996. He eventually published the technique in 2002 in the journal Plastic and Reconstructive Surgery with an extensive discussion in his book Structural Fat Grafting. Aging of the hand occurs in several ways, one of them is a subtle loss of fullness under the skin (atrophy) and another involves deterioration of the skin itself. Coleman fat grafting appears to affect both of these problems.

How does a hand age?

Over the back of an aging hand, fullness gradually disappears allowing the veins to become prominent and their blue color deepens. The white color and anatomic details of the tendons in the back of the hand become more visible through the thinning skin. In addition, the skin looses elasticity assuming a texture more like crêpe paper and wrinkling becomes more prevalent. The spaces between the bones of the hand deepen, especially between the thumb and the index finger; and this wasting can be further complicated by loss of muscle volume with aging or disease. This loss of fullness of the hand and fingers makes the joints appear enlarged and arthritic.

How does injected fat rejuvenate an aging hand?

Fat injected in a specific structured fashion to position many tiny parcels of fat over the dorsal hand creates a system of support as well as an expansion of the skin. The physical presence of a thin layer of tissue will not only decrease the blue of the dorsal hand veins and the white of the extensor tendons but will also soften the shape of veins and tendons. The overall effect is to create an apparent thickening of the aging skin of the dorsal hand with an underlying youthful-appearing subcutaneous fullness. However, a second method of rejuvenation has just recently become apparent. Fat has the highest concentration of repair (stem) cells of any tissue in the body. Placing fat full of stem cells under the skin of the hand where there is usually little fat may have a repair effect on the skin. Such a repair effect can reverse the damage to the skin caused by aging and sun exposure. However, more about that in later posts on hand rejuvenation.

The hand of following patient demonstrates the effect of Coleman fat grafting to the back of the hand with an eight-year follow-up: