Our hands actively or passively participate in our actions when we show tenderness or hate, when we eat or do some daily work, when we talk or dream. In truth, we can say for sure that both the way we manifest life and the way we express feelings have to do with the hands. As said by Pedro Bloch: “those hands would hold the most beautiful dreams, the highest principles, hands crying for prayers…”

Based on these concepts, I decided to specialize in the study of the complex anatomy and physiology of the hands to be able to offer my clients some guidance on the esthetic aspects whilst observing the chief functions of the hand.

Hands must have some esthetic care. Long ago neglected by the women the hands should be daily massaged and hydrated to keep the elasticity and health of the skin in order to keep their youth longer.

“I generally notice my patients’s wrinkled hands, full of ageing spots and swollen veins. Causes for such premature wearing are many - depend on the type of the skin, very white hands obviously are more affected because the cutis is less resistant to the weather. Excessive heat and professions that oblige people wash their hands more times than the usual lead to loss of the natural skin oiliness.

The use of detergents and the individual sensibility are also factors that account for the hands ageing. The treatment of ageing spots is simple and safe and a test is first applied to check the person’s reaction to acids. To clean the spots it is applied the glyceric acid and/or trichloroacetic acid at variable percentages depending on how deep it has to go; this is gradually done, by steps. Laser peeling is alternatively used, offering quicker results. Peelings provoke slight ardor and burns: the stain turns white initially and gets dark gradually. A crust is then formed which falls off in about 10 days, depending on the depth. The area remains reddish for approximately three months turning then to its natural colour. “At the end of treatment the hands are smooth and free of spots”.

As time goes by, the hands become flaccid and wrinkled. Ageing also promotes the decrease in skin density for the fat layer gets deficient and the skin loses elasticity and dehydrates, forming multiple deep wrinkles and redundant skin over the dorsal hand, wrist and forearm.

In cases such as this, the correct procedure is the lifting to remove off the skin. The surgical procedure dictates the resection of a certain quantity of skin from the dorsal hand, wrist and/or fingers leaving lining scars, which become almost imperceptible within months.

In very skinny hands, with apparent bones and veins it’s recommended a fat injection obtained from other parts of the body as the abdomen, buttocks and outer part of the thighs.

Surgery and fat application takes 60 to 90 minutes. Local anesthesia and light sedation is used and the patient can choose between a hospital and the day clinic unit at the practice. Patient goes home the same day. Recovering is quick and the patient should wear a splint for ten days to avoid wrist movements and to help healing. After such period, normal activities can be taken over. Hard work should be avoided during 30 days. If hand esthetics has only now start to attract women, the repair surgery of serious home and labour accidents have improved in the latest years with the introduction of tools able to detect minimum lesions in the ligaments and joints, enabling a better functional recovering. There’s today at Dr. Bloch’s practice a training center for Hand Surgery where the trainees participate in all activities related to the hand surgery and receive an Official Course arranged by the Brazilian Society for Plastic Surgery - Chapter of Hand Surgery, founded by Dr. Bloch who lectures the course. A Chapter that has been in development for some time is the congenital hand problems, one of the most complex and rare fields of the plastic surgery. Dr. Robert Bloch has been for the last four years offering his know-how acquired through 28 years or practice at the Hospital Darci Vargas in São Paulo, on work with destitute children suffering from congenital hand problems. Such pathologies are normally hereditary or happen through genetic mutation. Such happen preferentially in small cities in the countryside and within simple families in the outskirts of big towns, where there’s some frequency of consanguineous relationships or marriages, the level of malnutrition is high and there’s no pre or post birth care.

Congenital diseases are classified in seven groups in accordance with the 1967 International Classification. The pathology which most appears is the duplication of fingers reaching the fifth and first axles respectively. “I have recently finished a work about the thumb duplication where I had the opportunity to see about 30 patients; such work was presented at the International Congress of Hand Plastic Surgery in Finland”.