Hollow hands: hyaluronic acid injections.

What does it mean to have hollow palms?

The hollow-hand phenomenon appears with age. Hands are prone to dermal elasticity loss and to a subcutaneous tissue atrophy. Several factors explain this elasticity loss. During UV exposure, hands undergo premature aging of the skin and underlying structures. UV rays generate reactive oxygen species that cause oxidative stress and damage support structures such as collagen and elastin fibers and cell membranes. This process can result from hydration loss: the skin dries, which deepens creases and fine lines.

Thinning is caused by fat loss, while the loss of skin elasticity results from a decrease in collagen and elastin. Soft tissue atrophy, in turn, is linked to a lack of hydration. This loss of hydration is due to depletion of extracellular matrix proteins such as hyaluronic acid and proteoglycans, and disruption of the hydrolipid film, leading to poor water retention.

The hollow hand phenomenon manifests as a wrinkled, aged, and sunken appearance on the back of the hand. Veins become more visible because the skin is thinner and subcutaneous tissue is reduced. Dorsal tendons become more pronounced and the skin may appear creased, less elastic, and bony. Pigment spots may appear.

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Hyaluronic acid to restore volume in hollow hands.

Hyaluronic acid is a glycosaminoglycan present in the dermis and epidermis, accounting for about 1 percent of skin’s dry weight. It is essential for binding and retaining water. This hydrating agent occurs naturally in the extracellular matrix. It accounts for about 50 percent in the dermis and is present in the eye and joints. It plays a key role in skin hydration. With its ability to hold up to 1,000 times its weight in water, it maintains skin suppleness and contributes to its proper hydration. It contributes to dermal structure by interacting with the collagen and elastin, which helps maintain skin firmness and elasticity. It supports cell renewal and has antioxidant properties, helping to combat oxidative stress.

However, its level declines with age. Experts estimate a child’s level is twice that of a 50-year-old adult. This gradual loss results in skin dehydration and reduced skin volume.

Hyaluronic acid used in injections is produced via biotechnological synthesis by fermentation by natural bacteria, such as Streptococcus equinus, Streptococcus zooepidemicus or Bacillus subtilis. When injected into the skin, it improves skin hydration and elasticity, restores volume and strengthens the skin barrier against external stressors. When administered to the back of the hands, it acts as a volumizing agent, filling depressions and restoring tissue density. By retaining water, it induces slight swelling and provides immediate, natural plumping of the skin.

A study of 16 patients with a mean age of 60 evaluated hyaluronic acid injections for hollow hand rejuvenation. Participants received a single injection of SGP-HA, a viscous gel containing 20 mg/ml of hyaluronic acid produced by bacterial fermentation (Streptococcus). The injection was administered on the dorsum of the hand, followed by a massage toward the fingers to achieve uniform gel distribution. The volume injected was 4 ml per hand, with an optional 1 ml touch-up two weeks later to optimize results. Several follow-up visits were scheduled, including a final assessment one year after the initial treatment. Two weeks after the injection, most patients showed significant improvement in hand appearance, with sustained results: 85% satisfaction at six months, although this rate declined to 50% after one year.

How is a hyaluronic acid injection performed for hollow hands?

For hyaluronic acid injection into the hands, two main techniques can be used.

Conventional multi-point injection.
Hyaluronic acid is injected at several precise points on the back of the hand using a fine needle. The procedure is usually followed by a massage to distribute the product evenly across the treated area. It is a simple, quick technique that doesn’t require any special equipment. However, it can be difficult to apply in some areas, particularly between the fingers, and may cause a slight risk of bruising.
Injection with a microcannula.
In this method, hyaluronic acid is injected with a micro-cannula about 50 mm long, introduced through a pre-puncture as a single entry point. Local anesthesia may be applied at that point for comfort. The cannula is then advanced under the skin to distribute the product in the deep layers of the hand. A massage may follow the injection. This technique improves access to interdigital spaces while reducing the risk of vascular injury.

An injection session lasts 30 to 40 minutes. The injected volume depends on factors such as skin thickness and quality (elasticity, suppleness, texture, etc.). Initial results appear within 48 hours of the session, with effects lasting 12 to 18 months.

What are the side effects and contraindications of hyaluronic acid injections?

After an injection session, the patient may experience mild swelling on the back of the hands. Moderate pain, itching, or bruising (bruises) may also appear. These side effects are mild and transient: they resolve within hours to days depending on individual sensitivity. In some cases, applying an ice pack after the procedure can help limit hematoma formation. The patient can resume daily activities after the session. However, certain precautions must be observed: it is recommended toavoid sun exposure in the weeks following injection, as well as hot, humid environments such as steam rooms or saunas.

Hyaluronic acid injections are contraindicated in pregnant or breastfeeding women. They should not be performed in individuals allergic to any excipient in the formulation or in those receiving anticoagulant therapy to prevent blood clots.