Defining Key Features in Patient Perspectives of Hand Aesthetics

Goals/Purpose: The hand, like the face, is highly visible and contributes significantly to an individual’s overall aesthetic image and perceived age [1]. Hand rejuvenation is becoming an increasingly popular cosmetic procedure. Numerous interventions such as fat grafting, injectable filler, light/laser therapy and others have been studied with overall excellent patient satisfaction [2]. Current perspectives on hand aesthetics are primarily based on expert opinion rather than on lay population perspectives, which are less understood [3]. Hand aesthetic grading scales group multiple hand characteristics into a single evaluation, limiting the ability to assess the relative importance of individual factors [4-6]. The purpose of this study is to explore general population perceptions of the features that contribute most to an aesthetically pleasing hand, and to compare the relative import of wrinkles, sun damage, prominent veins, volume loss and pigmentation in overall appearance. This study aims to augment clinical practice in cosmetic hand surgery through an assessment of patient perspectives.

Methods/Technique: A diverse group of participants was recruited from the general population to take a 15-minute survey. Participants met inclusion criteria if they were over the age of 18, had no history of prior hand surgery, and were fluent in English. The survey includes photos of twenty standardized Caucasian hands, representing patients of both genders and ranging in age from 24 to 68. Survey participants rated the attractiveness of each hand based on a 10-point Likert scale, and then rated the appearance based on each characteristic: freckles, hair presence, skin tone, wrinkles, vein appearance, and hand volume. They were also asked to estimate the age and gender of each hand. Demographic information on participants gender, race/ethnicity, marital status, education, and household income was collected. The relative importance of each feature (freckles, hair presence, skin tone, wrinkles, veins, and volume) was assessed by comparison with overall attractiveness scores through Pearson’s correlation analysis.

Results/Complications: One hundred participants completed the survey resulting in 2000 individual hand assessments. Participants were 61% female (mean age 43.7, range 20-92) and 33% male (mean age 42.5, range 18-74) (Table 1). The feature assessed that was most strongly correlated with overall attractiveness score was soft tissue volume (r=0.75)(Figure 1) followed by wrinkles (r=0.73), veins (r=0.70), and skin tone (r=0.69). The least predictive factors for attractiveness were freckles (r=0.55) and hair (r=0.45). A comparison of the most and least attractive hands in the series is shown (Figure 2). The more attractive hands were 70% female, with an average rating of female hands of 4.7 (SD 2.16). The hands that scored lowest for attractiveness were 70% male, with an average attractiveness rating of male hands of 4.4 (SD 1.78). This difference between genders was statistically significant (p<0.001). Participants were able to correctly identify the gender of 92% of male hands but only 74% of female hands. There was no significant difference in how male and female evaluators graded hand attractiveness. Age was strongly inversely correlated with attractiveness (r=-0.73)(Figure 3). The most attractive hands were all under age 30, and the least attractive were all over age 50.

Conclusion: In this survey study of lay perceptions of hand attractiveness, the feature most strongly correlated with attractiveness was soft tissue volume. Perception of wrinkles, veins, and skin tone were all correlated with attractiveness as well, but to a lesser extent. Unsurprisingly, younger hands were viewed as most attractive. Female hands were perceived to be on average more attractive than male hands, and male and female evaluators had similar evaluations of attractiveness. These data suggest that hand rejuvenation may be optimized by addressing soft tissue volume deficiency first with filler or fat grafting, with secondary priority placed on skin resurfacing to address skin tone and wrinkling. Interest in hand rejuvenation will likely continue to grow, and an understanding of the factors most important to patients in aesthetic appearance is critical to achieving a pleasing result.

References

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