Abstract
The dorsum of the hand has emerged as a defining site in aesthetic medicine, frequently exposing age-related changes that contrast sharply with treated facial features. As dorsal hand rejuvenation becomes more mainstream, it brings with it anatomical complexity that demands more than superficial knowledge. This article reviews current anatomical understanding of the dorsal hand, identifies the ideal injection plane for volumising agents, and underscores the clinical value of visual mapping. Special attention is given to procedural safety, consistency, and the application of sterile, skin-compatible marking tools—such as SKRYBE—to optimise planning and outcomes.
Introduction
Dorsal hand ageing manifests visibly as volume loss, tendon prominence, and venous dilation, contributing to the perception of senescence even in patients with otherwise rejuvenated facial features. As non-surgical treatment options for the hands grow in popularity, anatomical precision and procedural planning have become critical to avoid complications and produce harmonious outcomes [1,2].
Unlike the face, the dorsal hand presents a thin soft tissue envelope, highly mobile structures, and considerable patient-to-patient variation. These features make the hand particularly unforgiving in poorly planned procedures. Marking and mapping—long standard in facial toxin and filler treatments—are now indispensable in dorsal rejuvenation protocols. Sterile, high-contrast markers such as SKRYBE FMD preserve visual clarity through skin prep and support aseptic technique, turning anatomical awareness into procedural accuracy [3].
Updated Anatomical Understanding
Recent literature divides the dorsal hand into three fascial laminae [2,4]:
- Superficial lamina: A fatty layer directly beneath the dermis. It is largely avascular and free of critical tendinous structures, making it the optimal injection plane for aesthetic procedures.
- Intermediate lamina: Contains the dorsal venous network and extensor tendons. Injections into this layer risk vascular trauma, visible filler, and functional interference.
- Deep lamina: Houses the interosseous muscles and deeper neurovascular bundles, including dorsal metacarpal arteries. This layer should be strictly avoided.
Delivering product within the superficial lamina enables uniform distribution and reduces the risks of bruising, nodularity, or tendon involvement [2].
The Role of Visual Mapping
While pre-procedure planning is well established in facial aesthetics, the case for visual mapping in dorsal hand rejuvenation is even more compelling [3,5]. The hand’s anatomy is dynamic, with visible veins shifting with temperature, position, or stress, and tendons moving with contraction.
Using a sterile white marker like SKRYBE FMD, clinicians can:
- Identify veins and trace them clearly to avoid intravascular injury
- Map metacarpal corridors (2nd to 4th rays) for optimal product placement
- Mark lateral boundaries to prevent filler migration or asymmetry
- Define safe entry points away from dominant vessels
Markings also facilitate photographic documentation, standardised re-treatment, and help educate patients or junior staff on planning protocols [6].
Assessment and Procedural Planning
Comprehensive pre-treatment evaluation should include:
- Visual assessment for dermal thinning, bony prominence, and vein pattern
- Palpation of tendons and troughs
- Dynamic assessment, including clenching or extension to enhance structure visibility
- Optional ultrasound imaging in anatomically ambiguous or high-risk cases [2]
After antiseptic cleansing, re-marking should be avoided to maintain sterility. Instead, sterile markers like SKRYBE FMD should be used post-cleanse to preserve visual clarity during injection.
Recommended markings include:
- One or two proximal entry points on the radial or ulnar side, 1–2 cm above the wrist crease
- Three linear injection paths along the 2nd, 3rd, and 4th metacarpals
- Outlined venous structures using visual inspection and/or transillumination
- Lateral boundaries to preserve symmetry
Injection Technique
- Cannula: 25G blunt-tip
- Plane: Superficial lamina
- Entry: Through a lateral proximal mark
- Technique: Retrograde fanning along mapped corridors
- Volume: 0.5–1.5 mL per hand depending on product and tissue quality
Tactile feedback and skin tenting aid in confirming superficial placement. Injectors should avoid bolus deposits and remain vigilant against vascular resistance or patient discomfort. If resistance occurs, withdraw and redirect rather than increasing pressure [4].
Filler Modalities and Product Considerations
Injection plane consistency is critical regardless of filler type [1,7]:
- Hyaluronic acid (HA): Ideal for immediate volume restoration. Rheologically appropriate, smooth formulations reduce risk of visibility or lumpiness.
- Collagen stimulators (e.g., Radiesse, Lanluma, Sculptra): Promote structural enhancement over time. Require uniform subdermal spread and post-treatment massage.
- Skin boosters: Low-viscosity HA suitable for early ageing or combination therapies.
- Polynucleotides: Non-volumising injectables used to enhance dermal quality and support regeneration [7].
All agents must be confined to the superficial lamina to minimise complications and enhance tissue integration [2].
Avoiding Common Complications
Without proper mapping, injectors are more likely to encounter:
- Bruising or haematoma: Often from inadvertent venous traversal
- Lumpiness or irregularity: From product deposited into the intermediate lamina
- Functional interference: Rare but possible if tendons are impacted
- Asymmetry or overfilling: Due to inconsistent entry points or injection planes [2,5]
These complications are largely preventable through accurate anatomical mapping and disciplined technique.
Clinical Summary and Recommendations
| Aspect | Recommendation |
| Injection plane | Superficial lamina |
| Entry points | 1–2 lateral, ~1–2 cm proximal to wrist |
| Cannula | 25G blunt, retrograde fanning |
| Mapping | Sterile SKRYBE FMD white marker |
| Ultrasound | Optional for ambiguous vascular anatomy |
| Volume | 0.5–1.5 mL per hand |
| Product types | HA, collagen stimulators, boosters, polynucleotides |
Conclusion
Rejuvenation of the dorsal hand is no longer a fringe procedure. It is a core part of full-spectrum aesthetic practice—and one that requires structure, planning, and anatomical precision. Pre-injection mapping, once considered optional, now stands as a hallmark of competent, safe aesthetic practice.
SKRYBE’s sterile white markers play a vital role in this transition—supporting aseptic technique while allowing critical landmarks to remain visible throughout the procedure. The result is not only a better aesthetic outcome but also a higher standard of safety and practitioner confidence.
In a treatment zone as unforgiving as the hand, visual planning is no longer a bonus. It is the baseline.
References
- Wollina U. Rejuvenation of the Aging Hand. J Cosmet Dermatol. 2020;19(1):27–32.
- Loesch M, et al. Updates in Hand Anatomy Relevant to Dermal Filler Placement. Aesthetic Plast Surg.2023;47:312–321. PMC10063163
- Gülhüslü B, et al. Clinical Utility of Visual Marking in Minimally Invasive Aesthetic Medicine. Clin Cosmet Investig Dermatol. 2023;16:215–223.
- Coleman SR, Grover R. The Anatomy of Hand Rejuvenation. Plast Reconstr Surg. 2006;118(3 Suppl):73S–80S.
- Chikhalkar S, Aglow H. The Use of Pre-injection Mapping in Hand and Forearm Aesthetics. J Clin Aesthet Dermatol. 2021;14(2):45–50.
- Yang SH, Lee SH. A Prospective Study on the Clinical Impact of Skin Markers in Aesthetic Injection Planning. Dermatol Surg. 2022;48(10):890–897.
- Sparavigna A, et al. Safety and Efficacy of Polynucleotide-Based Skin Regenerative Injections. J Drugs Dermatol.2021;20(10):1074–1079.
