PRP Hand Rejuvenation

By Claudia McGloin / 23 Jul 2017

Aesthetic nurse practitioner Claudia McGloin discusses hand ageing and the use of platelet rich plasma treatments for rejuvenation

Our hands are constantly exposed to factors like chemicals and the sun, so it’s no wonder that people often say that they give away our age more so than any other part of the body. 

After Madonna’s ageing ‘Mitts’ were heavily featured in the media,1 I found that many people became more aware of hand aesthetics and began requesting treatment for this area. In this article, I will look at platelet rich plasma (PRP) for hand rejuvenation, which is becoming popular as a natural procedure for rejuvenating ageing hands.5

Hand ageing

It is common knowledge that sun damage is a large culprit of ageing. In my experience, patients tend to look after their face and neck more, and neglect their hands, despite hands being the most visible area of the body, other than the face.2

The skin on our hands is affected by both intrinsic and extrinsic ageing factors, leading progressively to a loss of structural integrity and physiological function. Intrinsic ageing of the skin occurs as a natural consequence of physiological changes over time at variable, yet genetically-determined rates. 

Intrinsic ageing affects the deeper soft tissue, decreasing skin elasticity, volume and dermal vascularity. This can result in wrinkles, thinner and lax skin, prominent veins, joints and tendons.6 

Extrinsic factors are, to varying degrees, controllable and for the hands, include exposure to sunlight, pollution or nicotine, which damages skin by discolouring it, and miscellaneous lifestyle components such as diet and overall health.3,6 

Extrinsic ageing affects the epidermal and dermal layers following exposure to the sun, chemicals and smoking and can cause actinic keratosis, solar lentigines, hypopigmentation, and solar purpura.6

Anatomy of the hand

The hand and wrist are made up of many different bones, muscles and ligaments that enable a wide range of movements. Practitioners should have sound knowledge of the anatomy before treating the hands of patients with any injectable procedure.4 Special note must be taken to avoid tendons because I have found that if injected they can cause pain, swelling and bruising. Avoid veins and arteries, which are often prominent and easily seen on the back of the hand, because it will cause bleeding and bruising. 

Figure 1: The nerve and muscles of the wrist and hand

When should treatment be considered?

A patient should be considered for a hand rejuvenation treatment if their hands:

  • Are wrinkled and skin loses its elasticity and appears thin and crepey
  • Have prominent veins and tendons due to loss of volume
  • Have age spots

However, as we all know, prevention is better than cure, so hand rejuvenation treatments should start before the signs of ageing present with the use of moisturisers and sun protection on a daily basis.

Treatments

There are many medical aesthetic procedures available for treating ageing hands and the type of procedure selected for the patient will depend on what indication we are looking to treat. For example, loss of volume and obvious veins would be addressed using dermal filler, while for pigmentation, a chemical skin peel or a laser treatment might be considered. Some of the procedures available for hand rejuvenation include: intense pulse light (IPL), microdermabrasion, chemical peel, dermal filler, laser, skin needling, fat grafting, mesotherapy, skincare and PRP. 

My personal favourite treatment for rejuvenating the hands is PRP because it is a natural procedure and it allows for the body to heal and repair itself. 

In my experience, patient selection is key and it may be a better option for younger patients up to the age of 50. This is because sometimes with older patients, they have lost the elasticity and volume in their skin and you might need to address this using a filler or a combination of treatments; whereas younger patients might want a more hydrating and rejuvenating effect. 

PRP works especially well for the forehead, cheeks, neck, décolletage, knees, elbows and hands and is a good treatment for skin revitalisation, scars (including acne scars) and stretch marks. It is also good for promoting hair growth and for non-healing wounds.7,8,9 PRP is very actively researched; new studies are being published on an almost daily basis (I have found more than 22,000 worldwide on Pubmed and 33,000 on Wiley Online Library) and cover almost every field of medicine including dental, orthopeadic, eye laser surgery, plastic surgery, cardiac surgery and most commonly, to treat sports injuries and hair loss.

However, there seems to be limited research on PRP for hand rejuvenation – I could not find any studies online so this is an area that I believe could be studied in the future.

What does PRP do?

PRP, colloquially known as self-stimulated serum and vampire therapy, allows the body to heal faster and more efficiently. It does this by stimulating DNA repair, which can heal scars and make dry, lacklustre skin look and feel younger. 

Plasma, which comprises 55% of blood fluid, is mostly water (90% by volume), and also contains dissolved proteins, glucose, mineral ions, hormones, carbon dioxide (plasma being the main medium for excretory product transportation), platelets, and blood cells themselves.7,8,9 As it is a concentration of platelets, it is also a concentration of the seven fundamental protein growth factors actively secreted by platelets to initiate all wound healing.7,8,9

Platelets are the first responder to any trauma in the body and so, by injecting the platelets directly to the site requiring treatment, you are tricking the body into thinking a trauma has occurred and the growth factors will start to work immediately to stimulate and rejuvenate.7,8,9

PRP proticol for hands

A small amount of blood (I usually take 18mls with our kit) is drawn from the patient’s arm into a sterile tube in the same manner as a standard blood sample. The tube containing the patient’s blood is placed into a centrifuge and spun to separate the plasma and platelets from the blood cells. 

After a few minutes, the plasma and concentrated platelets are removed from the tube and re-introduced into the patient at the site of injury, which may be a scar or obvious lines or wrinkles or areas that require rejuvenation. I firstly use a topical anaesthetic to numb the patient’s hands prior to injecting. I use a 30 gauge needle for injecting and use micro droplets of PRP into the area requiring treatment. 

Lidocaine is not mixed with the PRP. I use 10ml of plasma that is injected into each hand (5ml per hand). Patients may bruise, but I advise the use of Arnica both prior to and post procedure to reduce the chance of bruising. Once the PRP has been injected, I massage the hand with a gauze soaked in some PRP. 

I find that using topical PRP helps the reduction of bruising and redness following injection. The treatment lasts 30 to 45 minutes and can be applied to any skin type or colour.

Following a PRP treatment, the results are noticeable within three to four weeks and one procedure of PRP can last up to 12 months so patients are advised to have yearly procedures. They may have a second procedure if they desire at six months.

PRP is a generally safe procedure that gives natural results and there is no risk of allergic reactions, as you cannot be allergic to your own blood and your body will not reject it. 

In addition, there is limited downtime associated with PRP treatments and it can be combined on the same day or at another time with other procedures such as fillers, microneedling, mesotherapy and chemical peels.

PRP injection technique in the hands

Knowledge of the anatomy and function, together with appropriate technique of injection, leads to confident treatment, optimal results and a lower risk of complications. Some practitioners use a cannula, while others use a needle to inject. Mesoguns are also popular for injecting. Choose whatever method works for you and makes you feel most comfortable. The injection techniques for hand volume restoration include:

  • Tenting: injecting a single bolus by pinching the skin
  • Serial puncture: injecting the filler in a series of small volumes along a line
  • Microdroplets: injecting minute amounts of filler at a large number of points
  • Tunnelling or linear retrograde threading: once the needle is at the appropriate depth, injecting the filler along a line in a retrograde fashion (i.e. while withdrawing the needle)
  • Fanning: without withdrawing the needle, several threads are injected radially. I prefer to use mainly needle, precisely injecting blebs where I need to.

Conclusion

As we know, many people look after their face and neck and may seek aesthetic treatment in these areas first, however the hands often reveal significant signs of ageing. I’m seeing more and more patients who want a natural approach to antiageing that will give them a gradual rejuvenating effect without downtime and without the risk of allergic reactions or rejection. 

Non-surgical procedures such as platelet rich plasma are a fantastic natural option for hand rejuvenation treatments. As with all hand rejuvenation treatments, the patient’s individual ageing concerns must be 

References
  1. Bianca London, ‘Women rush to banish their ‘Madonna Mitts’: Rise in anti-ageing procedures on HANDS’, Daily Mail Online, 2013, <http://www.dailymail.co.uk/femail/article-2396983/Rise-anti-ageing-procedures-HANDS-women-rush-banish-Madonna-Mitts.html>
  2. Web MD, ‘The Effects of Aging on Skin’, 2017, <www.webmd.com/beauty/cosmetic-procedures-aging-skin#1>
  3. M.A. Farage, K.W. Miller, P. Elsner & H.I. Maibach, ‘Intrinsic and extrinsic factors in skin ageing: a review’, International Journal of Cosmetic Science, 2008, <http://onlinelibrary.wiley.com/doi/10.1111/ j.1468-2494.2007.00415.x/full>
  4. Bodice SM, Hatef DA, Rohrich RJ, ‘Dorsal hand anatomy relevant to volumetric rejuvenation’, Plast Reconstr Surg, 2010;126:163-8.
  5. Ulrich Kühne and Matthias Imhof, ‘Treatment of the Ageing Hand with Dermal Fillers’, J Cutan Aesthet Surg, 2012, 5(3): 163-169.
  6. Farage MA, et al, ‘Intrinsic and extrinsic factors in skin ageing: a review,’ Int J Cosmet Sci, 2008, 30(2):87-95.
  7. Cash TF, Price VH, Savin RC, ‘Psychological effects of androgenetic alopecia on women:Comparisons with balding men and with female control subjects’, J Am Acad Dermatol, 1993;29:568–75.
  8. Lachgar S, Moukadiri H, Jonca F, et al., ‘Vascular endothelial growth factor is an autocrine growth factor for hair dermal papilla cells’, Journal of Investigative Dermatology, 1996;106(1):17–23.
  9. Cameli, Norma, Mariano, Maria, ,Cordone, Iole et al., ‘Autologous Pure Platelet-Rich Plasma Dermal Injections for Facial Skin Rejuvenation: Clinical, Instrumental, and Flow Cytometry Assessment’, Dermatologic Surgery, 2017 46:6, p 826–835. 

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