Biomedical Engineering Reference
In-Depth Information
subject evaluations on cellulite reduction, skin texture, and
satisfaction at 1 year were roughly equal to those, if not greater,
than at 3 and 6 months.
clearance is presently pending on the device and is only avail-
able in the USA through investigational studies. The RF Cel-
luTite applicator (Invasix, Inc., Yokneam, Israel) is specifi cally
designed to target cellulite by treating in the immediate hypo-
dermal space, which results in an enhanced collagen barrier in
the deep hypodermis, improving the appearance of cellulite,
both clinically and histologically (55). Presently only anecdotal
reports exist, and randomized clinical trials are lacking (55).
The incidence of thermal injury reported with the Invasix
internal and external device is less than 1%; however, the tech-
nique is very user sensitive (55).
Laser-Assisted Lipolysis for the Treatment of Cellulite
Laser-assisted lipolysis (LAL) is indicated for body contouring
(45). While some physicians use exclusively LAL without lipo-
suction, others feel that it is best served as an adjunct to lipo-
suction (46,47). With traditional liposuction, the improvement
in appearance of cellulite is modest to say the least and in cer-
tain instances may exacerbate cellulite (48). Due to the simul-
taneous capabilities of LAL to emulsify fat and stimulate
neocollagenesis, resulting in skin shrinkage and tightening
(45,46,49-51), it was extrapolated that this technology may
have a role in the treatment of cellulite.
Goldman and colleagues investigated a combination app-
roach of laser lipolysis using a pulsed 1064-nm neodymium-
doped:yttrium-aluminum-garnet (SmartLipo, Deka, Calenzo,
Italy) and autologous fat transplantation in 52 females with
moderate-to-severe cellulite of the hips, buttocks, thighs,
fl anks, and/or abdomen. Fat was manually harvested via
syringe aspiration from a site distant to the areas treated with
LAL. An average volume of 240 mL of centrifuged adipose tis-
sue was then transferred to the depressed areas with a 10-15%
overcorrection. Ecchymoses and edema were common, but no
burns or infections occurred. At 1 year postoperatively, patient
evaluation of improvement was greater than 75% in 30.8% of
patients and 51-75% in 53.8% of patients. Although patient
satisfaction was high, the isolated effect of the laser was
unknown (48).
In a small study by Palm and Goldman, nine patients (11
sites) received treatment with either LAL (CoolLipo,
CoolTouch, Inc., Roseville, California, USA) or mechanical
disruption with a liposuction microcannula. At the conclusion
of the study, there was no difference in the effi cacy between
the two treatment regimens with both groups improving by
1 point on a 4-point investigator-evaluated scale. Patient eval-
uated improvement did not differ between the two regimens
(52). Furthermore, larger studies will be needed to investigate
the effects of LAL alone in the management of cellulite.
conclusion
In short, cellulite is a normal female sexual characteristic that
cannot be “cured.” It has only been brought to the attention of
the female population as a condition to be treated by the mass
media. However, as cosmetic dermatologists, we have devel-
oped a variety of methods to improve the appearance of cel-
lulite. While this improvement is temporary, it may last for
several months. Thus, patients who wish to have smoother
skin with less visible cellulite can have a series of treatments
and then return for additional treatments as necessary. Future
research will try and extend both treatment effi cacy and dura-
tion. The extent of research will be stimulated by the public's
demand for treatment.
references
1. Draelos ZD, Marenus KD. Cellulite—etiology and purported treatment.
Dermatol Surg 1997; 23: 1177-81.
2. Avram MM. Cellulite: a review of its physiology and treatment. J Cosmet
Laser Ther 2004; 6: 181-5.
3. Goldman MP. Cellulite: a review of current treatments. Cosmet Dermatol
2002; 15: 17-20.
4. Querleux B, Cornillon C, Jolivet O, et al. Anatomy and physiology of
subcutaneous adipose tissue by in vivo magnetic resonance imaging and
spectroscopy: relationships with sex and presence of cellulite. Skin Res
Technol 2002; 8: 118-24.
5. Rossi ABR, Vergnanini AL. Cellulite: a review. J Eur Acad Dermatol
Venerol 2000; 14: 251-62.
6. Nurnberger F, Muller G. So-called cellulite: an invented disease.
J Dermatol Surg Oncol 1978; 4: 221-9.
7. Pierard GE, Nizet JL, Pierard-Franchimont C. Cellulite: from standing fat
herniation to hypodermal stretch marks. Am J Dermatopathol 2000; 22:
34-47.
8. Pellicier F, Andre P, Schnebert S. The adipocyte in the history of slimming
agents. Pathol Biol 2003; 51: 244-7.
9. Salter DC, Hanley M, Tynan A, et al. In-vivo high-defi nition ultrasound
studies of subdermal fat lobules associated with cellulite. J Invest Dermatol
1990; 29: 272-4.
10. Sainio EL, Rantanen T, Kanerva L. Ingredients and safety of cellulite
creams. Eur J Dermatol 2000; 10: 596-603.
11. Rao J, Goldman MP. A double-blinded randomized trial testing the
tolerability and effi cacy of a novel topical agent with and without
occlusion for the treatment of cellulite: A study and review of the
literature. J Drugs Dermatol 2004; 3: 417-27.
12. Goldman MP. The use of Tri-Active in the treatment of cellulite. In:
Goldman MP, Hexsel D, eds. Cellulite: Pathophysiology and Treatment,
2nd edn. New York, NY: Informa Healthcare, 2010: 99.
13. Zerbinati N, Vergani R, Beltrami B, et al. The TriActive system; a simple
and effective way of combating cellulite. Internal study conducted by
Deka 2002.
14. Boyce S, Pabby A, Chuchaltkaren P, et al. Clinical evaluation of a device for
the treatment of cellulite: triactive. Am J Cosmetic Surg 2005; 22: 233-7.
15. Gold M. The use of rhythmic suction massage, low level laser irradiation,
and superfi cial cooling to effect changes in adipose tissue/cellulite. Laser
Surg Med (Sup) 2006; 18: 65.
Radiofrequency-Assisted Lipolysis
for the Treatment of Cellulite
BodyTite (Invasix, Inc., Yokneam, Israel) uses a bipolar RF
device with one electrode on the skin and one RF electrode
under the skin immediately in the subdermal and hypodermal
area. The internal cannula is coated with dielectric material and
has a conductive tip that emits RF energy into the adipose tissue
toward the skin surface, while the external electrode moves
along the surface of the skin delivering RF energy (53). Areas to
be contoured are divided into 10 cm × 15 cm sections and up to
50 W of RF power is applied between the two electrodes. The
RF energy coagulates the adipose, connective, and vascular tis-
sues in the vicinity of the internal cannula tip and gently heats
the dermis below the external electrode. The internal electrode
also serves as an internal suction cannula, aspirating the coagu-
lated adipose, vascular, and fi brous tissues. Real-time epidermal
temperatures are continuously provided by a builtin thermal
sensor in the external electrode. Target temperatures are set
at 38-42°C, and maintained for 1-3 minutes (53,54). FDA
