Commentary on: Minimal-scar handlift: a new surgical approach.

We enjoyed reading the article by Handle et al entitled “Minimal-Scar Handlift: A New Surgical Approach.” Their technique is certainly a worthwhile addition to the plastic surgery literature and a procedure that we may elect to utilize in select patients. The basic idea behind their approach—namely, excising skin and leaving the scar hidden—is an essential tenet of plastic surgery. It is what many of us aim for in our aesthetic surgery practices on a daily basis for many anatomical areas. However, as the authors note, excisional procedures solve only some of the problems of the aging body, leaving unaddressed losses of skin elasticity, bone, muscle, and fat, as well as changes in position of these structures. Plastic surgeons have made great strides in the last 10 years in terms of nonsurgical rejuvenation with lasers and other energy devices, as well as fillers and toxins. The ultimate goal of any rejuvenation procedure is to restore elasticity and multiple-level volume loss with no scars—we think of this as the “holy grail” of cosmetic surgery. However, we are currently unable to currently achieve complete rejuvenation with nonsurgical procedures alone, regardless of anatomical area. Studying the “state of the science” in terms of a nonsurgical approach to the aging hand is indicative of where technology is today in regard to aesthetic restoration, and it gives us a good idea of where we might go in the future. Features of the aging hand include color …