# High-Resolution Ultrasound Evaluation of Common Dorsal Hand Rejuvenation Techniques: A Multicenter Study

## TL;DR

This study uses high-resolution ultrasound to evaluate different hand rejuvenation techniques, showing how each filler material appears on scans and confirming safe placement.

## Contribution

The study introduces HRUD as a practical tool for verifying correct filler placement and identifying distinct sonographic patterns in hand rejuvenation.

## Key findings

- HRUD clearly identified distinct sonographic patterns for each filler material used in hand rejuvenation.
- All injected materials were safely placed superficial to the extensor tendons with no complications observed.
- Short-term aesthetic improvements were noted in most patients at two months post-procedure.

## Abstract

Background

Hand dorsum volumization is an increasingly used aesthetic procedure, but the ultrasonographic appearance of commonly injected materials has not been systematically described. High-resolution ultrasound with Doppler (HRUD) may provide an objective method to verify product placement and support safer, standardized hand rejuvenation. This descriptive study aimed to characterize the postprocedural high-resolution ultrasonographic features of dorsal hand volumization using commonly employed fillers and autologous fat grafting.

Methods

We conducted a multicenter, descriptive study at three aesthetic medicine centers in Bogotá, Colombia, and Mexico City, Mexico, between March and June 2025. Adults requesting dorsal hand volumization received hyaluronic acid, calcium hydroxylapatite (CaHA), a poly-L-lactic acid (PLLA)-hyaluronic acid mixture, a factory-prepared CaHA-hyaluronic acid hybrid filler, or autologous fat grafting. All products were injected into the subdermal plane using a standardized cannula technique. HRUD was performed at baseline, early post-procedure, and at follow-up. Baseline aging was graded using the Merz Hand Grading Scale, and outcomes were assessed at two months using the Modified Aesthetic Response Scale (MARS).

Results

Twelve patients were included (mean age, 56 years; range, 44-66 years; 11 women). HRUD enabled clear identification of dorsal hand anatomy and material-specific sonographic patterns: CaHA appeared as hyperechoic cloud-like bands, hybrid fillers as lobulated hyperechoic structures, hyaluronic acid as hypoechoic pseudocystic areas, PLLA-hyaluronic acid mixtures as diffuse echogenicity with linear bands, and fat grafts as elongated isoechoic structures. In all cases, injected material was located superficial to the extensor tendons, with transient postinjection vascularization observed on Doppler. No early or late complications were detected. At two months, most patients demonstrated favorable short-term aesthetic improvement.

Conclusion

HRUD provides a practical method for documenting dorsal hand anatomy, confirming correct subdermal placement of volumizing materials, and recognizing distinct sonographic signatures. Its use may assist experienced injectors in enhancing procedural safety and monitoring. Given the short follow-up, findings should be interpreted cautiously, and larger studies with longer follow-up are warranted.