Plastic surgeon Grant Stevens, M.D., says he has tried everything to treat his patients’ cellulite. He estimates the devices (not to mention lotions and potions) have cost him close to $1 million during his 30 years in practice. It wasn’t until the last few years, however, that his money was well spent on a technology that not only works but also offers patients long-term results.
This device that appears to represent the new wave in cellulite treatment is the Ulthera (Merz) Cellfina System. The FDA cleared the technology in early August 2015 for the long-term improvement in the appearance of cellulite on the buttocks and thighs, with no loss of benefit for up to two years. That’s the longest the FDA has cleared any cellulite treatment. Dr. Stevens, who practices in Marina del Rey, Calif., is clinical professor of surgery at the University of Southern California Keck School of Medicine division of plastic surgery and has the first commercial Cellfina installation, says he has seen results lasting nearly four years and counting.
The type of cellulite treatment and results rival everything that Dr. Stevens has had to offer his patients with cellulite, he says.
“I’ve used Endermologie (LPG), VelaShape (Syneron Medical), SmoothShapes (Biocellulase), Velashape I, II and III, and I own two Cellulazes (Cynosure),” Dr. Stevens says. “Cellulaze works, but it costs so much money to run, it’s very hot, it has risks and complications and it doesn’t have longevity. All of my Cellulaze patients came back.”
The FDA’s nod is based on a prospective, multicenter US study of 55 patients who underwent a single treatment with the Cellfina System. According to the results, Cellfina improved the appearance of cellulite in 98% of treated patients at two years. Interestingly, noticeable improvement on the Global Aesthetic Improvement Scale (GAIS) was seen in 100% of treated patients at two years, according to a Merz press release.
“I’ve never seen cellulite improve over time,” Dr. Stevens says.
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Grading System for Patient Selection
Dr. Stevens says proper patient selection for cellulite treatment with Cellfina and other devices is key to patient satisfaction, and he's created a grading system to help standardize the process.
“While using Cellfina and even prior to that with the other technologies I’ve used over the last 30 years …, it became clear to me that there were certain types of cellulite that were more amenable to Cellfina than others. With that in mind, we created a grading system of one through five,” Dr. Stevens says.
According to the plastic surgeon:
- 1 = cellulite-free
- 2 = wavy
- 3 = isolated pits, divots or depressions
- 4 = adjacent pits and depressions
- 5 = overall diffuse cottage cheese.
Patients who are not Cellfina candidates, according to Dr. Stevens, are 1s (they don’t need treatment) and 2s.
“Cellfina really does great when releasing the fibrous bands, so 3s, 4s and 5s have done the best; 3s and 4s (isolated and adjacent depressions) seem to be the absolute best,” he says.
While 5s get improvement from Cellfina, it’s a limited outcome. They might go from a 5 to a 3 or 2 so, it’s important to treat only patients with realistic expectations, Dr. Stevens says.
“I send home about a third of patients because they’re not great candidates or have unrealistic expectations,” he adds.
Cellfina is a novel approach in cellulite treatment.
“It’s a controlled subcision that has a proprietary suction applicator, which sucks the buttocks, skin and the fat into the applicator — stretching the fibrous bands and allowing the subcision blade to precisely divide those bands at either 6 mm or 10 mm,” Dr. Stevens says. The blade, itself, is the same as a 22-gauge needle — like getting a shot of penicillin. There are no stitches.”
While nonsurgeons might have a light learning curve when using Cellfina, use of the technology shouldn’t stress experienced surgeons in the slightest, according to Dr. Stevens.
The FDA clearance covers the buttocks and posterior thighs; however, Dr. Stevens says he has used the technology with success on cellulite on the lateral thighs, as well.
Procedure time ranges from 20 to 60 minutes. Patients need only one treatment. There is no pre-treatment, and post-treatment involves wearing something to compress the area, like yoga pants, according to the plastic surgeon. Dr. Stevens sends patients home with a dressing over the treated area because of potential oozing from the local anesthetic.
Dr. Stevens says he is in the process of publishing a study in which he and colleagues interviewed patients about pain and recovery post-Cellfina treatment.
“Over 90% of the people went out that night or had unrestricted activity the night of the procedure. The majority of them went to work or did their normal activity the next day. No one took narcotics. I have yet to write a prescription for pain meds,” he says.
Dr. Stevens asks patients who are on aspirin, to stop taking it two weeks prior to the procedure. He won’t do Cellfina treatment on patients who have bleeding problems.
One potential drawback is the device requires physicians use an $800 consumable with each treatment. But Dr. Stevens says that’s well covered in what women are willing to pay for a treatment that diminishes their cellulite for the long-term, as the price range is from $3500 to $6500.
The Cellfina System will be available to U.S. physicians in fall 2015.
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