1. From: Minimal-Scar Handlift: A New Surgical Approach
Figure 1. A manual pinch test is administered in the dorsal carpal region, with the wrist in functional position, to evaluate skin excess.
From: Minimal-Scar Handlift: A New Surgical Approach
Aesthet Surg J. 2011;31(8): doi: / X
Aesthet Surg J | © 2011 The American Society for Aesthetic Plastic Surgery, Inc.

2. From: Minimal-Scar Handlift: A New Surgical Approach
Figure 2. The S-shaped incision line curves around the distal border of the caput ulnae, ending in a horizontal direction in the relaxed skin tension lines in the ulnar as well as radial direction. Distal drift of forearm skin is compensated by about 5 mm in a proximal direction. The original incision line is shown light blue.
From: Minimal-Scar Handlift: A New Surgical Approach
Aesthet Surg J. 2011;31(8): doi: / X
Aesthet Surg J | © 2011 The American Society for Aesthetic Plastic Surgery, Inc.

3. From: Minimal-Scar Handlift: A New Surgical Approach
Figure 3. Distal distraction of the horizontal lines occurs on the forearm mostly in the ulnar segment (marked with blue dye), demonstrating the change in tension after suturing. The original position is marked in light blue.
From: Minimal-Scar Handlift: A New Surgical Approach
Aesthet Surg J. 2011;31(8): doi: / X
Aesthet Surg J | © 2011 The American Society for Aesthetic Plastic Surgery, Inc.

4. From: Minimal-Scar Handlift: A New Surgical Approach
Figure 4. The subcutaneous plane between the superficial and intermediate fatty layer is shown, with undermining guided by fascia structure. The limits and Point A are marked with blue ink on the dorsal skin surface.
From: Minimal-Scar Handlift: A New Surgical Approach
Aesthet Surg J. 2011;31(8): doi: / X
Aesthet Surg J | © 2011 The American Society for Aesthetic Plastic Surgery, Inc.

5. From: Minimal-Scar Handlift: A New Surgical Approach
Figure 5. The dorsal venous plexus is preserved completely. This is primarily to avoid bleeding and preserve the accompanying microvascular and lymphatic vessels, thereby preventing complications.
From: Minimal-Scar Handlift: A New Surgical Approach
Aesthet Surg J. 2011;31(8): doi: / X
Aesthet Surg J | © 2011 The American Society for Aesthetic Plastic Surgery, Inc.

6. From: Minimal-Scar Handlift: A New Surgical Approach
Figure 6. Movement of the advancement rotation flap is shown, with its main vector (blue arrow) from the center of the second metacarpophalangeal joint to the center of the caput ulnae.
From: Minimal-Scar Handlift: A New Surgical Approach
Aesthet Surg J. 2011;31(8): doi: / X
Aesthet Surg J | © 2011 The American Society for Aesthetic Plastic Surgery, Inc.

7. From: Minimal-Scar Handlift: A New Surgical Approach
Figure 7. After making the key stitch, the skin in the radial and ulnar extensions is compensated with new vector setting and positioning of the suture line in the relaxed skin tension lines.
From: Minimal-Scar Handlift: A New Surgical Approach
Aesthet Surg J. 2011;31(8): doi: / X
Aesthet Surg J | © 2011 The American Society for Aesthetic Plastic Surgery, Inc.

8. From: Minimal-Scar Handlift: A New Surgical Approach
Figure 8. The final suture line is shown. Note the vasoconstrictive side effect of epinephrine (white discoloration).
From: Minimal-Scar Handlift: A New Surgical Approach
Aesthet Surg J. 2011;31(8): doi: / X
Aesthet Surg J | © 2011 The American Society for Aesthetic Plastic Surgery, Inc.

9. From: Minimal-Scar Handlift: A New Surgical Approach
Figure 9. (A, C) This 53-year-old woman with Fitzpatrick type III skin presented for hand rejuvenation. (B, D) 17 months after minimal-scar handlift procedure, the overall hand appearance is more elegant. There is improved definition in several of the interdigital folds; the hand appearance is more slender; scar visibility is low. Note that the patient had significant sun exposure in Figure 9C and 9D. This patient experienced partial suture dehiscence on the right wrist due to noncompliance and premature splint removal. She was treated conservatively with compression dressing for two months. Her outcome was good, and she requested no revisionary or supplemental treatments.
From: Minimal-Scar Handlift: A New Surgical Approach
Aesthet Surg J. 2011;31(8): doi: / X
Aesthet Surg J | © 2011 The American Society for Aesthetic Plastic Surgery, Inc.

10. From: Minimal-Scar Handlift: A New Surgical Approach
Figure 10. (A, C) This 62-year-old woman presented with skin excess, advanced decline of skin tonicity, preexisting age marks, prominent veins, and visible subcutaneous tissue loss. (B, D) 20 months after minimal-scar handlift, this patient’s results demonstrate scar quality and its near invisibility in the hand’s regular position. She experienced delayed wound healing, characterized by a slowed bleaching effect, likely because she was a smoker without consequences on the final results. The patient also demonstrates postoperative wrinkle reduction over the proximal two-thirds of the dorsum with tightening of the skin; the wrinkles in the forehand have also changed to a more vertical direction. The caput ulnae is more prominent and the anatomical structures are more visible. (E, F) Close-up demonstration of the patient’s left and right hands at 20 months postoperatively.
From: Minimal-Scar Handlift: A New Surgical Approach
Aesthet Surg J. 2011;31(8): doi: / X
Aesthet Surg J | © 2011 The American Society for Aesthetic Plastic Surgery, Inc.

11. From: Minimal-Scar Handlift: A New Surgical Approach
Figure 11. (A, C) This 69-year-old woman presented with very thin hands with prominent veins, age marks, and a significant loss of subcutaneous soft tissue, which had resulted in prominent extensor tendons and intermetacarpal hollowing. The patient’s skin excess was very significant; tonicity was minimal; and deep horizontal wrinkles predominated on the wrist and proximal dorsum of her hand. (B, D) 19 months after minimal-scar handlift, in which the skin flap was advanced by 3.3 cm. This patient’s postoperative course was unremarkable and her satisfaction high. She would benefit from supplementary treatments, such as a combination of autologous fat tissue transfer to correct tissue loss and trichloracid peeling or laser rejuvenation. (E) Close-up at 19 months postoperatively shows good scar quality with good positioning distal to the caput ulnae.
From: Minimal-Scar Handlift: A New Surgical Approach
Aesthet Surg J. 2011;31(8): doi: / X
Aesthet Surg J | © 2011 The American Society for Aesthetic Plastic Surgery, Inc.

12. From: Minimal-Scar Handlift: A New Surgical Approach
Figure 12. (A, C) This 44-year-old woman presented with advanced loss of skin tensile force comparable with what is seen in aged women as a result of massive weight loss. (B, D) 15 months after minimal-scar handlift, in which the skin flap was advanced by 3.4 cm. Even in this relatively-young patient, the rejuvenating effect was visible, and the patient was satisfied. As a positive side effect, tissue tightening compressed the veins and reduced their appearance. The postoperative appearance of the dorsum of the hand was tighter with fewer wrinkles.
From: Minimal-Scar Handlift: A New Surgical Approach
Aesthet Surg J. 2011;31(8): doi: / X
Aesthet Surg J | © 2011 The American Society for Aesthetic Plastic Surgery, Inc.

13. From: Minimal-Scar Handlift: A New Surgical Approach
Figure 13. (A) This 53-year-old patient presented with Fitzpatrick Type 3 skin and is shown at 17 months follow up. (B) This 62-year-old patient presented with Fitzpatrick Type 4 skin and is shown at 11 months follow up. (C) This 44-year-old patient presented with Fitzpatrick Type 2-3 skin nine months follow up. (D) This 69-year-old patient presented with Fitzpatrick Type 2 skin and is shown at 19 months follow up. Various scar maturation states demonstrating differences in visibility depending on the advanced bleaching effect and among between scar, skin type, and color. Scar maturation of more than six months must be taken into consideration before making a decision on supplementary treatment. Dyspigmentations were more likely to be seen in darker skin, thus increasing scar visibility even more. Palpably thinner scar tissue is formed in Fitzpatrick Type 2 and 3 skin.
From: Minimal-Scar Handlift: A New Surgical Approach
Aesthet Surg J. 2011;31(8): doi: / X
Aesthet Surg J | © 2011 The American Society for Aesthetic Plastic Surgery, Inc.