Dallas — While treating fat noninvasively through the skin rather than using liposuction is the next target of investigation, which modalities will be effective — whether laser, infrared, radiofrequency, or ultrasound — is not yet known, according to Sharyn A. Laughlin, M.D., assistant professor at the University of Ottawa, dermatologist and medical director of Laserderm, Ottawa, Ontario, Canada. Her investigative group tested whether deep infrared heating combined with contact cooling to spare the skin surface had a therapeutic effect on cellulite. She reported the findings at the American Society for Laser Medicine and Surgery meeting.
Dr. Laughlin and her assistants were testing the basic theory that if vascular flow is increased, it will improve the overall look of cellulite.
"The etiology of cellulite is controversial," Dr. Laughlin says. One theory is that it is an abnormality of the capillary, venous and lymphatic microcirculation. This leads to stasis and retention of metabolites and toxins that ultimately leads to formation of fat nodules and interstitial fibrosis, which further compounds the problem."The working hypothesis is that by applying heat to strategic areas, there is a metamorphosis and remodeling of the fat globules, interstial fibrous bands with smoothing of the dermal/hypodermal junction. The feasibility of the infrared approach has been established in vitro and in animal studies. This current clinical study piloted the use of the technique for treating cellulite in humans.
Fourteen female patients with skin types I to IV were divided into two groups. In both groups, one thigh was treated while the other served as control. Group A received light and a topical OTC Retinol cream. Group B received light alone. Energy from the infrared source was applied twice weekly for a total of eight treatments. Patients were followed for one month. The investigators used a prototype device called Cellulux by Palomar, which consisted of a power source that emitted a broad band of infrared heat that was focused deep in the dermis/subcutaneous fat through a water cooled chiller and sapphire window. The skin was chilled to 20 - 32 degrees centigrade to keep the patient comfortable.
The patients were not given any specific diet or exercise regimen. Benefits of the study were determined using qualitative assessments by patients, blinded and unblinded experts. Quantitative assessment was accomplished through clinical photographs and thermal imaging prior to treatment, at the end of the treatment and four weeks follow-up.
In group B, the infrared-only group, there was a statistically significant change in the non-uniformity of thermal scans (skin temperature which correlates to the severity of cellulite) at the one-month follow-up. The addition of the Retinol cream in patients in group A seem to have had a deleterious effect for unknown reasons.
Dr. Laughlin believes there was a mild to moderate improvement in the clinical appearance and texture of the skin in both groups compared to the controls graded by both patients and experts. The difference between the two groups was not significant. However, "I think the follow-up period in the study should have been extended, to assess whether or not the improvement that was demonstrated at one month follow-up in thermal imaging would be reflected in clinical outcome and its long-term effect. Future studies could be designed with a longer follow-up.
This preliminary clinical trial shows that applying heat to deep dermis/subcutaneous fat with a novel infrared device, with parallel contact cooling, a practitioner can be effective in improving the clinical appearance of the cellulite, Dr. Laughlin says.