A new generation of technology for noninvasive reduction of the appearance of cellulite is proving to be more effective than earlier options. However, there remains room for further advances, considering treatment with these modalities involves multiple sessions that are associated with local adverse reactions and results that are still variable, according to Neil Sadick, M.D.
Speaking at the 27th annual meeting of the American Academy of Cosmetic Surgery in January, Dr. Sadick provided an overview of recent advances in noninvasive platforms for the treatment of cellulite.VELASHAPE II Introduced in 2010, Velashape II (Syneron) represents the third generation of a system that combines bipolar radiofrequency and infrared light energy with vacuum and mechanical massage to reduce the appearance of cellulite. It is also approved for circumferential reduction. Relative to its predecessor, the VelaShape II features a 20 percent increase in radiofrequency power to 75 W that results in a faster temperature rise and reduced treatment time.
Published studies investigating the earlier version of this technology demonstrated its efficacy for reducing subcutaneous fat deposits in the abdomen and flanks (Brightman L, Weiss E, Chapas AM, et al. Lasers Surg Med. 2009;41(10):791-798). Another study showed improvement in cellulite appearance in the buttocks with benefit noted as early as after the first of multiple sessions (Romero C, Caballero N, Herrero M, et al. J Cosmet Laser Ther. 2008;10(4):193-201).
SMOOTHSHAPES XV Also in 2010, Eleme Medical introduced a second generation of its technology for cellulite reduction (Smoothshapes XV) that uses dual laser (915 nm) and light (650 nm) energy with massage and suction. Compared with the previous model, this platform has been upgraded with a 50 percent increase in power along with user enhancements that include audible and visual treatment guidance and customized treatment settings, Dr. Sadick says.
In a study of 20 women with mild to moderate cellulite of the lateral thighs, 94 percent of patients were satisfied with their outcome after a series of eight treatments, and there were no adverse events (Kulick MI. Plast Reconstr Surg. 2010;125(6):1788-1796), Dr. Sadick says.
ACCENT XL In 2009, with the introduction of a new handpiece (UniForm), Alma Lasers received clearance from the Food and Drug Administration to use its Accent XL unipolar radiofrequency device for temporary reduction in the appearance of cellulite. The handpiece features the UniLarge radiofrequency tip in the center and surrounds it with a 50 mm massager ring that rotates 150 turns per minute to increase microcirculation and fluid drainage.
A study investigating radiofrequency treatment of cellulite on the buttocks and thighs using the Accent system without the dual-component handpiece showed that volumetric contraction was achieved in about two-thirds of patients based on ultrasound imaging (Rosado RH, del Pino ME, Azuela A, et al. J Drugs Dermatol. 2006;5(8):714-722). Measurements made of the distance between the stratum corneum and Camper's fascia and from the stratum corneum to the muscle showed 68 percent of patients achieved a volume contraction of about 20 percent.
REACTION SYSTEM Recognizing that abnormal skin changes associated with cellulite involve multiple depths, the Reaction bipolar radiofrequency system (Viora) combines three RF frequencies (0.8 MHz, 1.7 MHz and 2.4 MHz) in proprietary technology (CORE, Channeled Optimum RF Energy) to target the mid dermis, deep dermis and the subcutaneous layer. This technology became available in 2009, and Dr. Sadick reports he is involved in a study evaluating the system in 30 patients who are undergoing three to six sessions at four- to five-week intervals.
CELLUPULSE Extracorporeal pulse activation therapy (Cellupulse, Storz Medical) is noninvasive technology for cellulite reduction that targets the subcutaneous tissue with oscillating acoustic pulses. Performed with application of a coupling gel onto the skin, the cavitation-like effect produced by the acoustic waves decreases fibrosis of subcutaneous connective tissue, enhances blood circulation and increases collagen production.
In a randomized study using the untreated contralateral side as a control, Adatto et al. reported statistically significant benefit for improving depressions, elevations, roughness and elasticity (Adatto M, Adatto-Neilson R, Servant JJ, et al. J Cosmet Laser Ther. 2010;12(4):176-182). Other investigators reported improvements in skin elasticity after three and six months of 95 percent and 105 percent, respectively, along with increased compactness of the skin structure on ultrasound imaging following extracorporeal pulse activation therapy (Christ C, Brenke R, Sattler G, et al. Aesthet Surg J. 2008;28(5):538-544).
"We evaluated this system in 30 patients who were treated twice a week for four weeks for cellulite on the thighs, gluteal region and upper arms. The initial results are encouraging," Dr. Sadick says.
Disclosures: Dr. Sadick has received research support from Osyris and Storz Medical. He is on the advisory board for Storz and on the speakers bureau for Eleme Medical and Medicis.