By William Payton

Our hands are often the first place we really show our age. That’s why plastic surgeons such as Chicago’s John A. Kotis, MD, are all about hand rejuvenation.

Reconstructive hand surgery specialists like Kotis treat problems such as arthritis, nerve and tendon injuries, and congenital defects. The rapid development of minimally invasive aesthetic treatments such as injectables and energy-based therapies has allowed them to extend their skills to the aesthetic side of the business.

Kotis, a clinical instructor at the University of Illinois and at Midwestern University’s Chicago School of Osteopathic Medicine in Downers Grove, Ill, and a fellow of the American College of Surgeons as well as the American College of Osteopathic Surgeons, chatted with PSP about the needs and options available to hand aesthetic rejuvenation patients.

1) How much of your practice is devoted to hand surgery?

Approximately 40% of my practice is devoted to treating hand trauma and hand deformities.

2) Why did you pursue a fellowship in hand surgery?

Hand surgery has fascinated me since being a resident and fellow in plastic surgery at the Philadelphia Hand Center with Lee Osterman, MD. Hand surgery is incredibly intricate and challenging. It is also rewarding to be able to give one the ability to use and/or increase functionality in their hands. I now teach residents in hand surgery at the Illinois Masonic Medical Center here in Chicago, where I am a clinical instructor in plastic surgery/hand surgery.

3) Tell us about your Radiesse hand lift patients.

Radiesse hand lift patients are men and women between the ages of 34 and 65 who are bothered by the appearance of their hands. They feel that their hands look significantly older than the rest of their body. In the past, physicians aspirated and injected fat into the hands, which required surgery and could ultimately result in fat necrosis and/or clumping of the fat. Injectables are far more consistent and the results are not permanent, which matters when a patient is less than satisfied.

4) Are engagement selfies driving this trend?

Engagement photos are a popular reason for some to consider Radiesse injections to their hands. However, I do not believe it is the trend.

5) What can you tell us about injecting Radiesse into the hands?

I inject over the index long and ring metacarpal ray in an equal amount over the proximal middle and distal aspects of the metacarpal. I then massage the area to even out the injected filler to improve the contour.

6) What can you offer today’s hand rejuvenation patient?

Patients are having their age spots removed from their hands and forearm. In my practice, we are combining procedures such as hand rejuvenation involving injectable fillers to improve atrophy with laser treatments to remove age spots for a more youthful appearance to the hands.

7) What other types of hand surgery do you perform?

I perform various hand surgical cases including reconstruction after trauma, repair of nerve and tendon injuries, fracture care, and reconstructive and joint-replacement surgery.

8) What is the most challenging reconstructive hand procedure you have performed?

I had a patient that was involved in a terrible accident involving a semi truck who almost lost her hand. After hours of reconstruction involving skin grafts, pinning and tendon repair, we were unable to save the thumb. I treated this patient for 3 years after the surgery and ultimately grew her a thumb by using flaps and a bone fixator.

9) What is your practice mantra?

Treat patients as you would treat your own family.

10) Where do you get your industry news?

I read industry journals in plastic surgery and hand surgery. I attend educational meetings and symposiums. Teaching helps keep me updated on the latest trends in the industry as well.

William Payton is a contributing writer for Plastic Surgery Practice magazine. He can be reached via PSPeditor@allied360.com.