Changes in Sonographic Thickness with Identification of Nine Layers, Roughness, and Hydration in the Dorsal Hand after Injectables

BACKGROUND: With the use of sonography, soft-tissue thickness can be measured accurately to assess the volumizing effects of fillers. METHODS: In this prospective study, monophasic stabilized hyaluronic acid filler (1 cc) was injected into the dorsal superficial and intermediate laminae of 20 patients using a subdermal scraping fanning injection technique. Sonograms and topographic computer analyses were used to measure soft-tissue thickness, skin roughness, and stratum corneum hydration (SCH) at 1 week and 1, 2, 3, and 6 months. RESULTS: Hand appearance and skin roughness improved in all patients. Sonography showed that soft-tissue thickness was increased by 4.52 mm (immediately after treatment), 5.52 mm (1 week), 4.89 mm (1 month), 4.25 mm (2 months), 4.08 mm (3 months), and 3.86 mm (6 months) from the pretreatment baseline of 3.20 mm. Roughness was reduced by 15.39 au (16.17%) at 1 month, 21.5 (18.12%) at 2 months, 22.7 (23.91%) at 3 months, and 27.16 (38.12%) at 6 months, indicating improvements in fine wrinkles. SCH also improved during follow-up. CONCLUSIONS: Detailed subdivision of nine layers of hand dorsum was established in this sonography study for the first time. Soft-tissue thickness was increased more than 207% during follow-up, and placement of hyaluronic acid materials was confirmed in the dorsal superficial and dorsal intermediate laminae. Hand appearance and skin roughness improved in all patients. Veins and tendons became less apparent, with volumizing effects. All patients stated that their skin became more moisturized, youthful, and smooth during the follow-up period after only one session of the subdermal scraping, fanning injection technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.