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Treatments of the non-invasive and invasive varieties abound for cellulite

Article-Treatments of the non-invasive and invasive varieties abound for cellulite

Key iconKey Points

  • Skin tightening and smoothing is the main goal in skin rejuvenation procedures.
  • BodyTite is a new device in the treatment of cellulite.
  • The radiofrequency-assisted liposuction device works by internal application of RF energy.

24-year-old woman with Curri grade IV cellulite before and 13 months following a single treatment combining deep and subdermal Nd:YAG laser lipolysis and autologous fat transplantation. (PHOTO CREDIT: ROBERT GOTKIN, M.D., F.A.C.S. )
Occurring predominantly in women, cellulite is characterized by lumpy and dimpling skin typically seen over the thighs, hips and buttocks. In predisposed individuals, the bulging out of the fat between the tight bands of fibrous tissue that connect the muscle to the skin causes the skin to dimple and have an orange peel-like effect. Although therapeutic approaches are geared to smooth out and correct the irregularities of skin contour, the various invasive and noninvasive techniques used often result in only temporary cosmetic results, says one surgeon expert.

SEARCHING FOR A SOLUTION "There is no cure for cellulite," states Robert Gotkin, M.D., F.A.C.S., at Cosmetique Dermatology, Laser & Plastic Surgery, LLP, in New York, N.Y. "What we can do as aesthetic surgeons is try to improve the orange peel-like skin seen in cellulite. However, these improvements will be only temporary as skin laxity worsens with age. In my experience though, more invasive surgical procedures and devices can achieve longer lasting cosmetic results."

Dr. Gotkin co-authored a recent study in which a combination treatment of laser energy and fat transplantation was used to improve the signs of cellulite. In the trial, 52 female patients with grades 3 and 4 cellulite were treated with a 1064 nm Nd:YAG laser, followed by autologous fat transplantation in fat-depleted target areas. The laser technique was first used in the deep fat layers for actual lipolysis, and then superficially to break the fibrous bands causing cellulite. The autologous fat was selectively transplanted to the areas with the most severe concave contour deformities to try to fill those areas out and give a smoother, more even contour to the target skin's surface.

Results showed that nearly 85 percent of patients rated their improvements as "good" or "excellent" in the patient self-assessment questionnaires. According to Dr. Gotkin, the results using this technique are lasting — with the caveat that the aging process will continue, making the results less evident over time.

Dr. Gotkin explains that the laser device not only breaks the fibrous bands, but also treats the undersurface of the skin by contracting existing collagen and spurring neocollagenesis, subsequently leading to skin tightening. In the early post-operative period, patients were started on a physiotherapeutic routine with the TriActive device, a non-invasive laser treatment designed to improve cellulite and body contour, on a once-a-week regimen for a series of approximately 10 to 15 treatments. The TriActive device, which applies a rolling and suction massage, is also equipped with a cooling apparatus and multiple diode lasers in the handpiece that stimulate the microcirculation.

According to Dr. Gotkin, the technique allows the surgeon to work very superficially because the cannula carrying the laser fiber has a very small external diameter that essentially does not leave a footprint. This is different from traditional liposuction in which larger cannulas, used superficially at the dermal-fat junction, may contribute to a worsening of the appearance of cellulite by causing tunneling and dimpling. In addition, traditional liposuction also uses higher vacuum pressures (one atmosphere) to aspirate the fat, whereas this technique uses very low negative pressures for lipid aspiration.

"As a woman gets older and continues to develop skin laxity, cellulite will likely return," Dr. Gotkin says. "However, in the 12- to 30-month follow-up that we had in our study patients, we could significantly improve the cellulite long-term. Most of the approaches currently used in aesthetic surgery are noninvasive and therefore also achieve minimal results. Our goal was to give some permanent improvement in the appearance of cellulite and we were able to achieve that using this surgical technique."

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