Hollow hands: hyaluronic acid injections.

What does it mean to have hollow hands?

The phenomenon of hollow hands appears with age. Hands are prone to a loss of dermal elasticity and to a atrophy of subcutaneous tissue. Several factors explain this loss of elasticity. During UV exposure, the hands undergo premature ageing of the skin and deeper structures. UV generates reactive oxygen species, causing oxidative stress that alters support structures such as collagen and elastin fibres and cell membranes. This process may result from reduced hydration: the skin dries, accentuating folds and fine lines.

Thinning is caused by fat loss, while reduced skin elasticity results from a decrease in collagen and elastin. Soft tissue atrophy is linked to reduced hydration. This hydration loss is due to depletion of extracellular matrix proteins, such as hyaluronic acid and proteoglycans. It also results from disruption of the hydrolipidic film and leads to poor water retention.

The phenomenon of hollow hands appears as a wrinkled, aged and sunken appearance on the back of the hand. Veins become more visible as the skin thins and subcutaneous tissue diminishes. Dorsal tendons become more pronounced and the skin may appear creased, less elastic and bony. Pigment spots may appear.

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Hyaluronic acid to restore volume to sunken hands.

The hyaluronic acid is a glycosaminoglycan in the dermis and epidermis, accounting for about 1 percent of the skin’s dry weight. It binds and retains water. This humectant occurs naturally in the extracellular matrix, in high concentrations in the dermis (around 50 percent) and in the eye and joints. It plays a key role in skin hydration. With the capacity to hold up to 1,000 times its weight in water, it maintains skin suppleness and supports proper hydration. It contributes to dermal structure by interacting with the collagen and elastin, which helps preserve skin firmness and elasticity. It promotes cell regeneration and has antioxidant properties that help counter oxidative stress.

However, its level declines with age. Specialists estimate a child’s level is twice a 50-year-old adult’s. This loss leads to skin dehydration and reduced volume.

The hyaluronic acid used in injections is derived from a biotechnological synthesis via fermentation of natural bacteria, such as Streptococcus equinus, Streptococcus zooepidemicus, or Bacillus subtilis. When injected into the skin, it improves skin hydration and elasticity, restores volume and strengthens the skin barrier against external stressors. When administered to the backs of the hands, it acts as a volumising agent by filling depressions and restoring tissue density. It causes a slight swelling for natural skin plumping.

A study of 16 patients with an average age of 60 years assessed the efficacy of hyaluronic acid injections for the rejuvenation of hollow hands. Participants received a single injection of SGP-HA, a viscous gel containing 20 mg/ml of hyaluronic acid obtained by bacterial fermentation (Streptococcus). The injection was administered on the back of the hand, followed by a massage towards the fingers for uniform distribution. The volume injected was 4 ml per hand, with an optional top-up of 1 ml two weeks later to optimise results. Several follow-up visits were scheduled, the last one occurring one year after the initial treatment. Two weeks after injection, a marked improvement in hand appearance was observed in most patients, with sustained outcomes over time: 85% satisfaction at six months, although this rate fell to 50% after one year.

How is a hyaluronic acid injection performed for hollow hands?

Injection of hyaluronic acid into the hands can be performed using two main techniques.

Standard injection at multiple sites.
Hyaluronic acid is injected at precise points on the back of the hand using a fine needle. The procedure is followed by a massage that ensures uniform distribution of the product across the treated area. It is a simple and quick technique that does not require special equipment. However, it can be difficult to apply in some areas, in particular between the fingers, and may carry a slight risk of bruising.
Micro-cannula injection.
In this method, hyaluronic acid is injected using a micro-cannula measuring about 50 mm, introduced through a pilot hole—that is, a single entry point. Local anaesthesia may be applied at this site for comfort. The cannula is then advanced beneath the skin to achieve homogeneous, deep distribution across the hand. A massage may also be performed after injection. This technique offers improved access to the interdigital spaces (between the fingers) while reducing the risk of vascular injury.

An injection session lasts between 30 and 40 minutes. The amount injected depends on factors such as skin thickness and quality (elasticity, suppleness, and texture). Initial results appear 48 hours after the session, with effects lasting between 12 and 18 months.

What are the side effects and contraindications of hyaluronic acid injections?

After an injection session, the patient may experience a mild swelling on the back of the hands. Some moderate pain, itching or ecchymoses (bruises) may occur. These side effects are mild and temporary. They resolve within hours to a few days depending on individual sensitivity. Applying an ice pack after the procedure may limit haematoma formation. The patient may resume daily activities at the end of the session. However, some precautions apply: it is advised toavoid sun exposure in the weeks following injection, as well as hot, humid environments such as steam rooms or saunas.

Hyaluronic acid injections are contraindicated in pregnant or breastfeeding women. They should not be administered to individuals with an allergy to any excipient in the formulation, or to those on anticoagulant therapy to prevent blood clots.