Percutaneous Collagen Induction Therapy for Hand Rejuvenation

Abstract

Sir: Hand rejuvenation has recently gained increased popularity in plastic surgery. Although wrinkles, veins, prominent joints, thin skin, deformity, and spots characterize old hands, fullness, lack of veins, and lack of wrinkles characterize younger hands.1 To date, autologous fat grafting, filler injection, laser and chemical peeling techniques, and vein and skin resection surgery have been commonly used for hand rejuvenation.2 Both men and women show a distinct progression of the wrinkling pattern in hand aging.3 Dorsal veins and age spots increase with age, whereas the wrinkle-to-wrinkle distance decreases. It has recently been shown in experimental and clinical studies that percutaneous collagen induction therapy, also known as medical needling, is an innovative method for treating wrinkles and scars.4,5 Percutaneous collagen induction therapy has achieved smoothening of the skin by thickening the epidermal layers and expression of genes and proteins relevant for dermal regeneration without the risk of dyspigmentation in, above all, the face and abdomen. Given the observation that hand aging is associated with a loss of collagen-elastin matrix, and that percutaneous collagen induction therapy is able to improve these aging effects of skin, we decided to evaluate this method for hand rejuvenation (Fig. 1).Fig. 1.: Percutaneous collagen induction therapy for hand rejuvenation.As an initial feasibility study, we treated three patients aged 52 to 61 years with percutaneous collagen induction therapy. All patients were treated in an outpatient setting using regional anesthesia with lidocaine. The dorsum of the hand was treated by rolling vertically, horizontally, and diagonally to create thousands of closely neighboring microwounds. This results in a confluent zone of rather superficial dermal inflammation, triggering the release of growth factors, such as epidermal growth factor, fibroblast growth factor, and transforming growth factor-β3, which ultimately results in improved collagen in the patient. All patients were treated once. The duration of the procedure was 20 to 30 minutes. Assessment of the results revealed improved skin texture, skin tightening, dermal neovascularization, and no change of pigmentation. We encountered no adverse effects of percutaneous collagen induction therapy in this initial case series. Given this preliminary observation of the feasibility of percutaneous collagen induction therapy for hand rejuvenation, we strongly believe that further large-scale, randomized, controlled trials are mandatory to elucidate the value of this promising technique. Matthias Aust, M.D. Karsten Knobloch, M.D., Ph.D. Andreas Gohritz, M.D. Peter M. Vogt, M.D., Ph.D. Plastic, Hand, and Reconstructive Surgery Hannover Medical School Hannover, Germany Desmond Fernandes, M.D. Department of Plastic and Reconstructive Surgery Grooteschuur Hospital Renaissance Body Science Institute Cape Town, South Africa