Biomedical Engineering Reference
In-Depth Information
cellulite reduction. The Tri-Active laser energy is emitted
through six 808-nm diode lasers to target the endothelial cells
in order to enhance arterial, venous, and lymphatic fl ow and
promote neovascularization. The contact cooling system can
manually be adjusted from 10°C to 25°C and aids in decreas-
ing edema by causing an initial vasoconstriction followed by a
compensatory vasodilatation allowing for pooled fl uid to
remobilize. The rhythmic massage, which can either be
selected as either single or dual phase, counteracts circulatory
stasis, thereby mobilizing fl uids by stimulating lymphatic
drainage. In addition, the massage stretches the connective tis-
sue smoothing the interface between the dermis and the
epidermis.
The parameters of the Tri-Active system can be manipulated
to optimize patient results. The depth and intensity of the rhyth-
mic massage can be controlled by the frequency (0.1-5 Hz) and
duty cycle (20-80%). The frequency (Hz) measures the number
of aspirations per second. At higher frequencies, a superfi cial
mechanical action is achieved, whereas lower repetition rates
stimulate deeper tissue. The duty cycle is the percentage of time
the aspiration is active between one aspiration and the next. For
example, a duty cycle of 70% indicates that the aspiration is
active 70% of the time between the two aspirations. The higher
the value, the stronger the action. Thus by manipulating the
duty cycle and frequency, one can increase or decrease the inten-
sity and depth of the message.
For Fitzpatrick skin types I-III, it is recommend to start at
30 W and adjusting for patient discomfort and erythema. The
frequency should initially be set at 3 Hz with duty cycle of
60%, and the operator may increase it to 4 or 5 Hz but would
need to decrease the duty cycle to 50%. The dual mode is
advised for the massage setting. When treating darker skin
types, Fitzpatrick skin types IV-VI, the energy should be
adjusted down to an initial fl uence of 20 W. The fl uence should
be adjusted based on patient discomfort and the level of ery-
thema. The same repetition rates (Hz) and duty cycles as listed
above for skin types I-III can be utilized. No matter which skin
type, the contact cooling function should be on and set at
coolest level (10°C) and can be adjusted during the
treatment.
A seal of the applicator should be always chambered to the
skin—if the air is heard to be sucked into the chamber, this
indicates that the applicator is not positioned properly for
ideal vacuum suction on the skin. Five minutes should be
spent on each major surface, that is, posterior thigh, outer
thigh and hip, inner thigh, anterior thigh, and buttocks. Each
treatment should last approximately for 30 minutes, and each
zone should be treated with three to fi ve passes, with the end
point being signifi cant erythema and warmth radiating from
the treated skin. The Tri-Active device has also been used
before, during, and after other surgical procedures, including
liposuction and abdominoplasty. We have noted a marked
improvement in irregularities when Tri-Active is performed
after liposculpture. This improvement may be due to the redis-
tribution of dystrophic adipose cells (12).
The experimental studies in Europe regarding the effi cacy of
Tri-Active were conducted by Nicola Zerbinati, MD, assistant
professor of dermatology, University of Insubria, Milan, Italy.
Ten patients were enrolled and each treated with 20-minute
sessions three times a week. To evaluate the effi cacy of the
technique, all patients were requested not to change habits
such as diet, physical activity, and lifestyle in general. Clinical
observation, circumference of the thighs and hips, plicometry,
skin elasticity, and thermography were recorded. All patients
noted an increase in skin tone and a reduction in the circum-
ference of the areas treated (13).
A similar study to those presented above to evaluate the effi -
cacy of the Tri-Active without the lymphatic drainage protocol
confi rmed the importance of lymphatic drainage. Thirteen
healthy females from 19- to 51-year old group with a mean age
of 36.6 years and a mean body mass index of 22.26 kg/m
2
(19.2-29.3 kg/m
2
) were included in the study. The mean starting
body fat percentage of the subjects was 22.18% (16.46-31.02%).
Subjects underwent biweekly treatments for 6 weeks for a total of
12 treatments. Treatments were administered locally only on the
hips and thighs. Effi cacy was measured via waist, hip, and thigh
circumference, elasticity, and thermography. Analysis of results
included a subjective evaluation of pre- and posttreatment
photos by fi ve blinded evaluators. An overall improvement of
21% was noted among the treated patients. The most notable
improvement was in the appearance of cellulite (23%), skin tex-
ture (16%), size (15%), and skin tone (14%). The results of
thermography evaluated in this study show neither changes of
mean temperature nor variations in uniformity of tempera-
ture distribution in the treated areas. The results revealed a
trend toward modest but steady improvements in hip and
thigh circumferences. A comparison with the pretreatment
photos also suggests modest improvements in the appearance
of cellulite and overall appearance, with those subjects starting
with the least symptoms showing the greatest degree of
improvement. Comparing these results with those of the pre-
vious studies suggests the importance of considering the entire
system and method as a whole concept to be diligently per-
formed for maximizing results (14).
Gold evaluated the Tri-Active on 10 females with cellulite
treated with 15 biweekly sessions. Nine of the 10 subjects com-
pleted the study and the 1-month follow-up period. There
were no signifi cant changes in the subject's weight. An approx-
imate 50% improvement in the visual grading scale was noted
in 80% of the subjects (15).
Nootheti and Goldman performed the fi rst comparative
study to determine the relative effi cacy of treatment of cellulite
using two novel modalities, Tri-Active versus VelaSmooth. The
VelaSmooth is based on a combination of two different ranges
of electromagnetic energy, which produce heat: infrared (IR)
light (700-2000 nm) and bipolar RF combined with mechani-
cal manipulation of the skin and has also been demonstrated
to improve the appearance of cellulite (see below). Patients
were treated twice a week for 6 weeks with the randomization
of Tri-Active on one side and VelaSmooth on the other side.
There were a total of 12 treatments per leg. Cellulite grading
was determined utilizing the four-stage Nurnberger-Muller
scale; measurements of thigh circumference were taken before
treatment and after the fi nal treatment. Visual inspection and
photographic grading were quantifi ed and statistically
examined.
In comparing effi cacy between VelaSmooth treatment and
Tri-Active treatment, they calculated a 28% versus a 30%
improvement, respectively, in the upper thigh circumference
measurements, whereas a 56% versus a 37% improvement was
