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Cellulite treatments may lack supportive evidence of efficacy

Article-Cellulite treatments may lack supportive evidence of efficacy

National report — Few aesthetic procedures are more desperately desired than cellulite reduction, and in response to that strong demand is no shortage of supply, in the form of lasers and light, heating and cooling devices, wraps, creams and other concoctions. But do any of them work?

Some published studies show hints of improvement in treated areas and colorful histologies suggesting tissue and fat changes. However, when it comes to the bottom line — patient feedback — the efficacy of most treatments is underwhelming.

Before (left) and three months after one treatment with the Thermage Body Tip 16.0 (Solta Medical). The patient had 288 pulses from the tip applied over the entire abdomen. (ALL PHOTOS CREDIT: ROBERT WEISS, M.D.)
An ongoing survey on the patient feedback Web site perhaps says it best. The "Was it Worth It?" survey, ranking aesthetic treatments according to patient satisfaction, showed cellulite treatment to be next to last on the list of 33 procedures, with only mesotherapy ranking lower. The radiofrequency tissue-tightening device Thermage (Solta Medical) ranked only two spots higher, and fellow tissue-tightening device Accent (Alma Lasers) was also in the bottom 10. And although patients' sentiments tend to be overshadowed by heavy marketing efforts to the public, many physicians share that lack of enthusiasm. The existence of a truly reliable, consistent technology offering long-lasting improvement of cellulite remains elusive, they say, and, according to Mathew Avram, M.D., no technologies that exist even come close to offering the kind of results that could be considered significant improvement.

"At this point, I don't think there is even a leading candidate," Dr. Avram tells Cosmetic Surgery Times. "There is simply no technology that can improve cellulite in a significant and long-term manner. That doesn't mean there aren't things being developed that might come down the road in the next year or two, but at this point, there just isn't a game-changer."

The silver lining to that isn't glaring, but it does exist. Current modalities, for all of their shortcomings, still have a role for that niche of patients who would rather have something — even if it's short-lived and less than spectacular — than nothing.

"There are clearly some patients who are happy with seeing just a modest benefit for a temporary period of time, and if that is all they require and expect, then you might have a satisfied patient," says Dr. Avram, director, Dermatology, Laser and Cosmetic Center at Massachusetts General Hospital and affiliate faculty at the Harvard Medical School's Wellman Center for Photomedicine. What's essential, however, is setting those expectations from the start, he adds.

"We have to be honest with patients and tell them that the technologies that exist for cellulite treatment have only temporary and limited effectiveness."

For those patients who know the facts and choose to give it a try anyway, devices that show the strongest results include radiofrequency devices Accent and Thermage; VelaSmooth (Syneron), a combination radiofrequency and infrared light device; and Primaeva, a bipolar radiofrequency micro-needle device, according to Macrene Alexiades-Armenakas, M.D.

SKIN SURFACE TECH "Accent has been shown to be the most efficient in terms of treatment numbers for skin surface technologies," says Dr. Alexiades-Armenakas, an assistant clinical professor at Yale University School of Medicine.

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