Background: Hand aesthetics have been poorly described because function is the main reason why patients consult a surgeon about their hands. Ideal proportions are based on normal anatomy, which is a prerequisite for aesthetics.
Methods: A literature review was performed.
Results: Anatomically correct proportions are, besides adequate soft tissue, the most important aspects of hands considered to be beautiful. The golden proportion may be used to identify suboptimal areas. Extrinsic and intrinsic aging must be distinguished, and therapy should be determined accordingly.
Conclusion: Hand aesthetics are based on normal anatomy. Knowing this is essential for every surgeon treating hand patients.