Hollowing Of Hands (Wrinkled Hands)

The hands are a highly visible part of our anatomy and a record of our life history. The aesthetic hand is one that has smooth, wrinkle-free skin with an appropriate amount of subcutaneous fat that camouflages the underlying veins, tendons and bony contours. Aged hands are often disharmonious with the rest of the rejuvenated individual and are known to be a telltale sign of age. Balanced and harmonious rejuvenation of the individual often requires treatment of the hands in addition to the face.

How Does It Manifest?

With advancing age, the skin becomes thin and crepe-like and has multiple wrinkles. The subcutaneous fat thins out, causing the veins to become prominent. The spaces between the individual digits become concave and gutter-like causing a skeletal, hollowed-out appearance. This constellation of changes creates an unaesthetic hand appearance.


Following fat grafting, the hands of a man and a woman tying their small fingers together display smooth, wrinkle-free hands.

How does it arise?

Skin undergoes atrophy and thinning starting after the third decade of life. The skin elongates and loses elastic recoil due to reduced production of elastin and collagen fibers. The subcutaneous fat that normally exists beneath the skin and in between the hand bones (metacarpals) undergoes reduction in volume and thickness causing the underlying structures to become more prominent. The bony contours become prominent and the hand becomes progressively more skeletal in appearance.

Structural fat grafting

Structural fat grafting involves harvesting fat from areas of excess, purifying it, then grafting it in volume-deficient areas. A high proportional survival of fat cells may be attained with the use of specialized fat grafting cannulas available at Picasso Plastic Surgery. Structural fat grafting delivers elegant and long-lasting results. Structural fat grafting restores the soft tissue thickness overlying the tendons and bony prominences, fills the concave areas and produces an elegant and sustained result. Structural fat grafting of the hands is a simple ambulatory procedure that is performed under local anesthesia, with optional intravenous sedation if desired.

Individuals with any hand hollowing and seeking long-term improvement may consider structural fat grafting. Structural fat grafting may be simultaneously performed in other areas of hollowing and volume loss such as the face and neck and deliver benefit in multiple sites in one single procedure. Individuals with severe hollowing will benefit from significant cost saving in the long term as compared with recurrent treatment using large volume filler injection.

Individuals are advised to stop herbal supplements and traditional medicine 7 days prior to surgery to minimize bruising and swelling. Smoking cessation for at least 2 to 4 weeks prior to surgery improves the success of fat graft survival.

Preoperative marking is performed to delineate the areas in the hand that require the fat grafting. Common sites for fat harvest include the inner thighs, hips, flanks and lower abdomen. Small incisions are made near the areas of intended liposuction, and local anesthetic is infused for optimal intra- and post- operative pain relief. The fat is broken up and aspirated under negative pressure. It is purified before being grafted into the hand using purpose-made fat grafting cannulas for optimal survival. Grafting is performed through 1-mm incisions that are inconspicuous when healed.

Most individuals are able to resume normal activities on the same day as the surgery. Minor swelling and bruising is expected, which will mostly resolve by the 7th postoperative day. Stitch removal is usually performed on the 10th postoperative day.

Normal physical activities may resume 1 week after surgery. Individuals are advised to avoid putting pressure on the grafted areas for 1 month to optimize survival of the fat grafts.

After structural fat grafting is performed, blood vessels grow into the grafted area (neovascularization). The degree of neovascularization determines the proportion of fat graft survival. In general, 60 to 80% of the grafted fat will survive, and the appearance at 2 months postoperatively is normally representative of the long-term result. The non-surviving fat is absorbed by the body during the first two months. The fat grafts that survive persist for many years.

Wrinkled hands

The Picasso Advantage

Dr Yeo is experienced with liposuction and structural fat grafting and incorporates proprietary techniques to deliver exquisite and sustained results while minimizing the postoperative recovery time. Our clinic has an en suite operating facility that has MOH certification as an Ambulatory Surgical Center (ASC). This assures your maximal privacy and convenience while keeping facility and equipment costs contained. Our operating room carries a full range of liposuction equipment tailored for liposuction and structural fat grafting aimed at delivering optimal results.