Soft Tissue Augmentation (Temporary Injectable Fillers) on the Trunk and Extremities (Hands, Feet, Trunk)

  • Alyx Rosen
  • Shino Bay Aguilera
  • Drew Taylor
  • Eduardo Weiss


In 2015, over 2.4 million patients had treatments with soft tissue fillers, with the largest population between 40 and 54 years of age and ranging in age from teenagers to nonagenarians (ASPS, Plastic Surgery Statistics Report 2015, 2015) (4). This data is also representative of the patient population seeking treatment with temporary fillers of the trunk and extremities where the average age is around 60 years, with females significantly outweighing males. All skin types are represented in this demographic, but skin types II–IV are far more common than V–VI.


Dorsal hands Temporary fillers Volume loss Extremities Trunk Soft tissue 


  1. 1.
    ASPS. 2015 Plastic surgery statistics report 2015.Google Scholar
  2. 2.
    Merz. Radiesse dermal filler for the treatment of volume loss in hands: panel pack for the advisory committee for general and plastic surgery devices panel. February 27, 2015.Google Scholar
  3. 3.
    Palm MD, Goldman MP. Patient satisfaction and duration of effect with PLLA: a review of the literature. J Drugs Dermatol. 2009;8(10 Suppl):s15–20.PubMedGoogle Scholar
  4. 4.
    Vleggaar D, Fitzgerald R, Lorenc ZP, et al. Consensus recommendations on the use of injectable poly-L-lactic acid for facial and nonfacial volumization. J Drugs Dermatol. 2014;13(4 Suppl):s44–51.PubMedGoogle Scholar
  5. 5.
    Moyle GJ, Lysakova L, Brown S, et al. A randomized open-label study of immediate versus delayed polylactic acid injections for the cosmetic management of facial lipoatrophy in persons with HIV infection. HIV Med. 2004;5(2):82–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Bass LS, Smith S, Busso M, McClaren M. Calcium hydroxylapatite (Radiesse) for treatment of nasolabial folds: long-term safety and efficacy results. Aesthet Surg J. 2010;30(2):235–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Busso M, Moers-Carpi M, Storck R, Ogilvie P, Ogilvie A. Multicenter, randomized trial assessing the effectiveness and safety of calcium hydroxylapatite for hand rejuvenation. Dermatol Surg. 2010;36:790–7.CrossRefGoogle Scholar
  8. 8.
    Carruthers A, Carruthers J, Hardas B, et al. A validated hand grading scale. Dermatol Surg. 2008;34(Suppl 2):S179–83.PubMedGoogle Scholar
  9. 9.
    Cohen JL, Carruthers A, Jones DH, et al. A randomized, blinded study to validate the Merz Hand Grading Scale for use in live assessments. Dermatol Surg. 2015;41(Suppl 1):S384–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Marmur ES, Al Quran H, De Sa Earp AP, Yoo JY. A five-patient satisfaction pilot study of calcium hydroxylapatite injection for treatment of aging hands. Dermatol Surg. 2009;35(12):1978–84.PubMedCrossRefGoogle Scholar
  11. 11.
    Sadick NS, Anderson D, Werschler WP. Addressing volume loss in hand rejuvenation: a report of clinical experience. J Cosmet Laser Ther. 2008;10(4):237–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Redaelli A. Cosmetic use of polylactic acid for hand rejuvenation: report on 27 patients. J Cosmet Dermatol. 2006;5(3):233–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Redaelli A, Forte R. Cosmetic use of polylactic acid: report of 568 patients. J Cosmet Dermatol. 2009;8(4):239–48.PubMedCrossRefGoogle Scholar
  14. 14.
    Palm MD, Woodhall KE, Butterwick KJ, Goldman MP. Cosmetic use of poly-l-lactic acid: a retrospective study of 130 patients. Dermatol Surg. 2010;36(2):161–70.PubMedCrossRefGoogle Scholar
  15. 15.
    Williams S, Tamburic S, Stensvik H, Weber M. Changes in skin physiology and clinical appearance after microdroplet placement of hyaluronic acid in aging hands. J Cosmet Dermatol. 2009;8(3):216–25.PubMedCrossRefGoogle Scholar
  16. 16.
    Man J, Rao J, Goldman M. A double-blind, comparative study of nonanimal-stabilized hyaluronic acid versus human collagen for tissue augmentation of the dorsal hands. Dermatol Surg. 2008;34(8):1026–31.PubMedGoogle Scholar
  17. 17.
    Gubanova EI, Starovatova PA, Rodina MY. 12-month effects of stabilized hyaluronic acid gel compared with saline for rejuvenation of aging hands. J Drugs Dermatol. 2015;14(3):288–98.PubMedGoogle Scholar
  18. 18.
    Mazzuco R, Sadick NS. The use of poly-L-lactic acid in the gluteal area. Dermatol Surg. 2016;42(3):441–3.PubMedCrossRefGoogle Scholar
  19. 19.
    Bolton J, Fabi S, Peterson JD, Goldman MP. Poly-L-lactic acid for chest rejuvenation: a retrospective study of 28 cases using a 5-point chest wrinkle scale. Cosmet Dermatol. 2011;24(6):278–84.Google Scholar
  20. 20.
    Fabi S, Bolton J, Goldman MP, Guiha I. The Fabi-Bolton chest wrinkle scale: a pilot validation study. J Cosmet Dermatol. 2012;11(3):229–34.PubMedCrossRefGoogle Scholar
  21. 21.
    Streker M, Reuther T, Krueger N, Kerscher M. Stabilized hyaluronic acid-based gel of non-animal origin for skin rejuvenation: face, hand, and decolletage. J Drugs Dermatol. 2013;12(9):990–4.PubMedGoogle Scholar
  22. 22.
    Narins RS, Brandt F, Leyden J, Lorenc ZP, Rubin M, Smith S. A randomized, double-blind, multicenter comparison of the efficacy and tolerability of Restylane versus Zyplast for the correction of nasolabial folds. Dermatol Surg. 2003;29(6):588–95.PubMedGoogle Scholar
  23. 23.
    Fabi SG, Burgess C, Carruthers A, et al. Consensus recommendations for combined aesthetic interventions using botulinum toxin, fillers, and microfocused ultrasound in the neck, decolletage, hands, and other areas of the body. Dermatol Surg. 2016;42(10):1199–208.PubMedCrossRefGoogle Scholar
  24. 24.
    Peterson JD, Goldman MP. Rejuvenation of the aging chest: a review and our experience. Dermatol Surg. 2011;37(5):555–71.PubMedCrossRefGoogle Scholar
  25. 25.
    Vanaman M, Fabi SG. Decolletage: regional approaches with injectable fillers. Plast Reconstr Surg. 2015;136(5 Suppl):276S–81S.PubMedCrossRefGoogle Scholar
  26. 26.
    El Khatib HA. Classification of brachial ptosis: strategy for treatment. Plast Reconstr Surg. 2007;119(4):1337–42.PubMedCrossRefGoogle Scholar
  27. 27.
    Distante F, Pagani V, Bonfigli A. Stabilized hyaluronic acid of non-animal origin for rejuvenating the skin of the upper arm. Dermatol Surg. 2009;35(Suppl 1):389–93. discussion 394.PubMedCrossRefGoogle Scholar
  28. 28.
    Amselem M. Radiesse((R)): a novel rejuvenation treatment for the upper arms. Clin Cosmet Investig Dermatol. 2016;9:9–14.PubMedGoogle Scholar
  29. 29.
    Cogorno Wasylkowski V. Body vectoring technique with Radiesse((R)) for tightening of the abdomen, thighs, and brachial zone. Clin Cosmet Investig Dermatol. 2015;8:267–73.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Lorenc ZP. Techniques for the optimization of facial and nonfacial volumization with injectable poly-l-lactic acid. Aesthet Plast Surg. 2012;36(5):1222–9.CrossRefGoogle Scholar
  31. 31.
    Coleman KM, Pozner J. Combination therapy for rejuvenation of the outer thigh and buttock: a review and our experience. Dermatol Surg. 2016;42(Suppl 2):S124–30.PubMedCrossRefGoogle Scholar
  32. 32.
    Lam SM, Azizzadeh B, Graivier M. Injectable poly-L-lactic acid (Sculptra): technical considerations in soft-tissue contouring. Plast Reconstr Surg. 2006;118(3 Suppl):55S–63S.PubMedCrossRefGoogle Scholar
  33. 33.
    Ralston JP, Blume JE, Zeitouni NC. Treatment of postoperative soft tissue loss with injectable poly-L-lactic acid. J Drugs Dermatol. 2006;5(10):1000–1.PubMedGoogle Scholar
  34. 34.
    Vleggaar D. Soft-tissue augmentation and the role of poly-L-lactic acid. Plast Reconstr Surg. 2006;118(3 Suppl):46S–54S.PubMedCrossRefGoogle Scholar
  35. 35.
    Alam M, Gladstone H, Kramer EM, et al. ASDS guidelines of care: injectable fillers. Dermatol Surg. 2008;34(Suppl 1):S115–48.PubMedGoogle Scholar
  36. 36.
    Werschler WP, Busso M. Prepackaged injectable soft-tissue rejuvenation of the hand and other nonfacial areas. In: Alam M, Pongprutthipan M, editors. Body rejuvenation. New York: Springer; 2010. p. 221–5.CrossRefGoogle Scholar
  37. 37.
    Heath CR, Taylor SC. Fillers in the skin of color population. J Drugs Dermatol. 2011;10(5):494–8.PubMedGoogle Scholar
  38. 38.
    Edelson KL. Hand recontouring with calcium hydroxylapatite (Radiesse). J Cosmet Dermatol. 2009;8(1):44–51.PubMedCrossRefGoogle Scholar
  39. 39.
    Fabi SG, Goldman MP. Hand rejuvenation: a review and our experience. Dermatol Surg. 2012;38(7 Pt 2):1112–27.PubMedCrossRefGoogle Scholar
  40. 40.
    Lefebvre-Vilardebo M, Trevidic P, Moradi A, Busso M, Sutton AB, Bucay VW. Hand: clinical anatomy and regional approaches with injectable fillers. Plast Reconstr Surg. 2015;136(5 Suppl):258S–75S.PubMedCrossRefGoogle Scholar
  41. 41.
    Rivkin AZ. Volume correction in the aging hand: role of dermal fillers. Clin Cosmet Investig Dermatol. 2016;9:225–32.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Coimbra D. Poly-L-lactic acid in the rejuvenation of the medial and anterior arms. Surg Cosmet Dermatol. 2012;4(2):182–5.Google Scholar
  43. 43.
    Narins RS. Minimizing adverse events associated with poly-L-lactic acid injection. Dermatol Surg. 2008;34(Suppl 1):S100–4.PubMedGoogle Scholar
  44. 44.
    Valantin MA, Aubron-Olivier C, Ghosn J, et al. Polylactic acid implants (New-Fill) to correct facial lipoatrophy in HIV-infected patients: results of the open-label study VEGA. AIDS. 2003;17(17):2471–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Mazzuco R, Hexsel D. Poly-L-lactic acid for neck and chest rejuvenation. Dermatol Surg. 2009;35(8):1228–37.PubMedCrossRefGoogle Scholar
  46. 46.
    Aguilera SB, Aristizabal M, Reed A. Successful treatment of calcium hydroxylapatite nodules with intralesional 5-fluorouracil, dexamethasone, and triamcinolone. J Drugs Dermatol. 2016;15(9):1142–3.PubMedGoogle Scholar
  47. 47.
    Fathi R, Cohen JL. Challenges, considerations, and strategies in hand rejuvenation. J Drugs Dermatol. 2016;15(7):809–15.PubMedGoogle Scholar
  48. 48.
    Butterwick KJ, Nootheti PK, Hsu JW, Goldman MP. Autologous fat transfer: an in-depth look at varying concepts and techniques. Facial Plast Surg Clin North Am. 2007;15(1):99–111. viii.PubMedCrossRefGoogle Scholar
  49. 49.
    Coleman SR. Hand rejuvenation with structural fat grafting. Plast Reconstr Surg. 2002;110(7):1731–44. discussion 1745–1737.PubMedCrossRefGoogle Scholar
  50. 50.
    Goldman A, Prati C, Rossato F. Hand rejuvenation using intense pulsed light. J Cutan Med Surg. 2008;12(3):107–13.PubMedCrossRefGoogle Scholar
  51. 51.
    Stebbins WG, Hanke CW. Ablative fractional CO2 resurfacing for photoaging of the hands: pilot study of 10 patients. Dermatol Ther. 2011;24(1):62–70.PubMedCrossRefGoogle Scholar
  52. 52.
    Swinehart JM. Salicylic acid ointment peeling of the hands and forearms. Effective nonsurgical removal of pigmented lesions and actinic damage. J Dermatol Surg Oncol. 1992;18(6):495–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Fabi SG, Goldman MP, Dayan SH, Gold MH, Kilmer SL, Hornfeldt CS. A prospective multicenter pilot study of the safety and efficacy of microfocused ultrasound with visualization for improving lines and wrinkles of the decollete. Dermatol Surg. 2015;41(3):327–35.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Fabi SG, Massaki A, Eimpunth S, Pogoda J, Goldman MP. Evaluation of microfocused ultrasound with visualization for lifting, tightening, and wrinkle reduction of the decolletage. J Am Acad Dermatol. 2013;69(6):965–71.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Torres O, Kirkland CR, Rogachefsky A. Fractionated C02 laser treatment for photoaging of the arms and legs. Dermatologist. 2013;21(7).
  56. 56.
    Alster TS, Tanzi EL. Noninvasive lifting of arm, thigh, and knee skin with transcutaneous intense focused ultrasound. Dermatol Surg. 2012;38(5):754–9.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Willemsen JC, Lindenblatt N, Stevens HP. Results and long-term patient satisfaction after gluteal augmentation with platelet-rich plasma-enriched autologous fat. Eur J Plast Surg. 2013;36:777–82.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Mofid MM, Gonzalez R, de la Pena JA, Mendieta CG, Senderoff DM, Jorjani S. Buttock augmentation with silicone implants: a multicenter survey review of 2226 patients. Plast Reconstr Surg. 2013;131(4):897–901.PubMedCrossRefGoogle Scholar
  59. 59.
    Serra MS, Goncalves LZ, Ramos-e-Silva M. Soft tissue augmentation with PMMA-microspheres for the treatment of HIV-associated buttock lipodystrophy. Int J STD AIDS. 2015;26(4):279–84.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alyx Rosen
    • 1
  • Shino Bay Aguilera
    • 2
  • Drew Taylor
    • 3
    • 4
    • 5
  • Eduardo Weiss
    • 6
    • 7
    • 8
  1. 1.University of Miami Miller School of MedicineDr. Philip Frost Department of Dermatology and Cutaneous SurgeryMiamiUSA
  2. 2.SHINO BAY Cosmetic Dermatology, Plastic Surgery & Laser InstituteFt. LauderdaleUSA
  3. 3.Skin Institute of South FloridaMohs Micrographic Surgery and Dermatologic Oncology FellowshipCoral GablesUSA
  4. 4.Hollywood Dermatology and Cosmetic Surgery SpecialistsCosmetic Dermatologic Surgery FellowshipHollywoodUSA
  5. 5.Mohs Micrographic Surgery/Dermatologic Oncology and Cosmetic Dermatologic SurgeryVail DermatologyEdwardsUSA
  6. 6.University of MiamiDepartment of Dermatology & Cutaneous SurgeryMiamiUSA
  7. 7.Florida International University Herbert Wertheim College of MedicineDermatologyMiamiUSA
  8. 8.Hollywood Dermatology & Cosmetic SpecialistsDermatologyHollywoodUSA

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