Hi, I’m Dr. Ellen Marmur.
I’m a board certified dermatologist in New York City
and today we’re going to do hand filler
to soften the look of the back of the hands.
What is filler?
Filler looks like hair gel.
It’s in a syringe and it’s about a teaspoon of gel
and in that gel are these little tiny molecules
called hyaluronic acid.
Hyaluronic acid is in all plants and all animals
and its only job is to hold water.
Today we’re treating Barbara.
I’ve known Barbara for many years.
The first thing I’m gonna do is evaluate Barbara’s hands.
We place our hands on a tray in a relaxed
kind of flat position and typically what works best
is if we like think about these spaces between the fingers
and we’re gonna try to soften some
of those valleys and shadows there.
[Barbara] Sound good? Yeah, definitely.
Then I’m going to hold up the skin,
evaluate the elasticity and also find a safe place
to inject the filler.
So you could pinch and pull the top of your skin.
That’s called tenting and if your skin bounces right back,
like mine you, that means I have good elasticity.
So go ahead and try that yourselves
and you can test your own elasticity.
If your skin’s kind of tents up and sort of stays
wrinkled a little bit then your elasticity is going bye bye.
You need to use more sun protection.
We can use some lasers to improve that elasticity
and also we can use some filler to improve it.
This procedure is gonna take me between 15 and 20 minutes.
The filler I’m going to use today is called Restylane Lift,
one of those hyaluronic acids that’s safe to use,
FDA cleared for the back of the hands and reversible.
When I inject the filler, I’m using a needle with lidocaine
which is numbing and makes the procedure very comfortable.
Here we go.
That’s tenting and you’ll feel a little bit
of the needle going in
and you’ll see the filler coming right into play.
Do you see that?
And then make a gentle fist
and you can see where the filler is.
Relax your hand a little bit
and then we just press it right along
and then you’ll start to see right away an improvement.
Sometimes when I’m injecting the back of the hand
you’ll see the filler bump up.
There’s so much anatomy in the back of the hands
and little compartments and what I’ll do is just massage
the hand and you’ll see the filler stream out
and look great.
The ideal candidate for filler in the hands
is somebody who has skinny hands,
prominent veins or prominent tendons on their hands.
So once you’re numb you can’t really feel right anything.
So that was one syringe
and I think you definitely need a second syringe.
The reason we’re gonna do a second syringe
is because now that we made this look really good
we still have leftover areas and I find
that people really want this particular area
to look great because that’s what they see
when they’re holding their margarita.
So we always wanna make sure we get the whole span
of the back of the hand.
As we age we lose a little volume of skin,
muscle, collagen, even bone.
We use fillers to re-sculpt the body and the face
to give some nice natural volume.
There is no cookbook way of deciding what filler
to put where and the more experienced dermatologists
are going to have like a whole pantry
full of different kinds of fillers.
We look at fillers based on how viscous they are,
meaning like if you think of honey versus water
versus jello, you would think about viscosity
in terms of how much lift or how much volume
or how much rigidity you’re getting from that filler.
So we’re really only like one to two millimeters
under the top of the skin.
Depending on where you inject, the pain is different.
In our studies, we were found that injecting
between the knuckles, inter digital space,
is what we call it, is less painful
but afterward it can feel a little bit like a bruise
’cause you can have some small bruising in that area.
This looks so good.
Yeah, so you can see here,
this is a little bit more crinkled
and this is a lot smoother.
The whiteness of the skin is part partially
from the lidocaine so that’s gonna go away
and then all of these little injection points
are gonna go away in about 20 minutes
and then we can see here also the difference.
You wanna make a gentle fist with the other hand too.
That’s nice to show too, that’s gonna stay really nicely.
Yeah, all that veininess is gone
and all those valleys are filled in.
Looks really nice.
This hand is a little different.
This hand is a little skinnier over here.
We’re going straight into the area.
Pulling up the skin, how you doing?
And then it just streams right through the skin.
So your body water will hydrate
over the next couple of days.
So when people get swelling,
it’s usually for the first three days
and then everything balances out.
So from your perspective where do you think you need it now?
Right there and there and there and there.
And I love to look at like from your perspective,
where you see it, ’cause I agree.
So we’re gonna clean you and then start on your fingers.
The next one I’m gonna use here is called Belotero Balance.
It has lidocaine in it and it is just a finer filler.
This one can hydrate a good amount
so I’m gonna under treat you on purpose, okay?
And here it’s more painful when we come closer
to the tip of the finger, so I’m gonna start back here.
Once I finish with the hands,
I always look at the knuckles and the fingers as well.
Believe it or not finger filler looks so good
in people who have hand eczema
and it might even help with hydration of the skin
from underneath upward.
Doing Barbara’s fingers in a couple spots here,
just so that it all looks so good together to have the hands
and fingers as one nice cosmetic unit looking great.
I tend not to go over the knuckle space.
Everyone’s sort of used to seeing knuckles
that have a little bit of wrinkling on them.
It would just take a lot of filler to get rid
of those wrinkles and then you’d have weird knuckles.
So what we’re doing now is trying to make this space
around the knuckles look better.
We are gonna use about a half of a syringe per hand
on your fingers compared to two syringes per hand
with the Restylane Lift hand fillers.
Don’t you see the difference in the elasticity here?
Yeah, all those little tiny things.
My hands lost 20 years.
And no one will say, did you get your hands filled?
Right, that’s great.
Thank you so much.
It looks good.
I feel better.
You know all of these little things that we can do,
they just help you feel better about yourself
and they make you feel a bit more confident
and we’re all aging and if we can do it
and look our best, it just makes a difference.
So thank you.
I’m glad you did it.
So the aftercare, we’re gonna keep you here
until all the little things stop bleeding
which is about five minutes.
Then we’re gonna wash you off and moisturize you.
Then we’re going to put some sunscreen on your hands
and then you’re on your way.
So I’d say today, I wouldn’t do any hot yoga,
anything that would increase blood flow and bruising.
I wouldn’t do any biking today.
Anything that’s like really grippy.
You shouldn’t have any pain.
You should have a little bit of swelling
especially where we have tiny bruising.
Within three days everything should be settling in
and normally I see you back in two weeks
and we see if we missed a spot
or if anything needs to be tweaked.
Barbara’s gonna see her results immediately.
Everybody’s so different in terms of duration of filler.
So this might last about a year.
Barbara can maintain the results
and optimize the duration of her results
by using sun protection and great moisturizers on her hands
for the entire year after she has filler.
I don’t think that cosmetic is vanity.
I think that taking care of yourself cosmetically
is just like eating well.
It’s all about wellness and having that holistic approach
to being really motivated to honor your body
and this life you’re leading and do it in the best way.