Cellulite is a stubborn genetic condition of connective tissue that pulls down on the skin causing dimples, as well as enlarged fat cells that herniate upwards creating the “cottage cheese appearance" all women hate. The resulting lumps and bumps are a treatment challenge for dermatologists, cosmetic, facial plastic and plastic surgeons.
“There is no single treatment that provides a quick fix of cellulite. Greater improvements are seen with surgical interventions, such as laser and mechanical subcision, and short-term improvement is seen with external heating devices,” says Beverly Hills, Calif., dermatologic surgeon Jason Emer, M.D., who presented yesterday on the topic of cellulite reduction using noninvasive technologies at the at the 11th annual Vegas Cosmetic Surgery and Aesthetic Dermatology multispecialty aesthetic symposium in Las Vegas.
Long-term maintenance treatments are needed, and it’s important that providers set patients’ expectations to get optimal satisfaction, according to Dr. Emer.
“I inform all my patients that we can get immediate improvements but will need to maintain the results with ongoing treatments forever,” he says.
For a noninvasive treatment to show maximum benefit in cellulite reduction, it must mechanically manipulate the tissue. This can be with rollers, suction or vibration.
“… the cellulitic connective tissue bands need to be ‘broken apart’ or ‘released’ to give cosmetic improvement, and this only improves it if you manipulate the tissue,” Dr. Emer says.
That’s why surgical intervention with laser subcision or needle subcision — for example, the FDA-approved Cellfina (Ulthera) and Cellulaze (Cynosure) — offers the greatest improvement, according to Dr. Emer. Cellfina and Cellulaze, albeit different procedural modalities, permanently cut connective tissue adhesions that are pulling the upper layers of skin down and creating dimples, giving more promising long-term improvements, he says.
Adding heat to the surgical intervention — radiofrequency, infrared or laser — helps to damage or shrink fat cells, smoothen the skin texture and improve bulging. However, the heat only works if the tissue is warmed for long enough during treatment, which Dr. Emer syas is at least 10 to 15 minutes at 39 to 42 degrees Celsius, and it it’s performed in a series of treatments to get sustained improvements.
Dr. Emer says that his go-to treatments are: VelaShape (Syneron-Candela) for the stomach/abdomen, flanks and anterior and posterior thighs and buttock rolls; Venus Legacy (Venus Concept) for the inner and outer thighs, neck and face, breast, arms, back/bra fat rolls and calves; and Thermage (Valeant Medical) for localized cellulite of the buttock or crepe skin of the arms, knees and stomach.