MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
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size of the area treated. Local anesthesia is administered to the treatment area. Using suction and subcision, the needle-like device administers pressure on the fi brous septae. Repeated pressure eventually releases the fi bers to smooth the skin surface. It can take as little as three days to see results, which are expected to last at least two years, and side effects—including soreness, tenderness and bruising—are minimal. Clinical trials have posted patient satisfaction rates at 94% after one year and 96% after two years. "I've been in private practice for 28 years. We've been trying to fi nd something that works on cellulite ever since. We kept being told, 'This works' and 'That works,' and each time those options failed," says Daniel Mills, MD, founder of the Aesthetic Plastic Surgical Institute in Laguna Beach, California. "With Cellfi na, there's minimal discomfort with little or no downtime, and it only takes one treatment. It is promising." Dermatologist Joel L. Cohen, MD, director of AboutSkin Dermatology and DermSurgery in Englewood and Lone Tree, Colorado, notes that the ideal Cellfi na patient is one who "maintains a stable weight, works out regularly, eats a healthy diet, but simply has some focal areas of persistent dimple-cellulite." His patients are seeing improvement in dimple-release in 10 to 14 days. "We know that some of that is likely still swelling, but patients have been happy with the improvement even weeks after treatment," he says. The key difference between the two is Cellfi na treats large focal areas of dimpling but does not address dermal remodeling, though the lack of laser energy makes Cellfi na a better choice for some patients. "With Cellulaze, the heat may trigger hyperpigmentation. But to be fair, I think it's accurate to say that less well-defi ned cellulite can benefi t more from the Cellulaze because it covers a larger area compared to Cellfi na, which treats more discrete bands," says Dr. Kilmer. Other minimally invasive energy-based options include Sciton's CelluSmooth, which uses a 1319nm laser wavelength to cut fi brous septae, emulsify fat and tighten the dermis to improve the appearance of dimpled skin, and the VASERsmooth, a device that ultilizes ultrasound rather than laser energy. NONINVASIVE OPTIONS For patients who want a truly noninvasive option, suction and manipulation treatment methods include: Real Aesthetics' Bella Contour, a body-shaping treatment method that uses non-focused ultrasound to promote fat release from cells; electric currents to help fat penetrate the cells; and vacuum therapy to help the body fl ush the fat. Patients typically undergo 10 to 15 treatment sessions. CELLULITE BASICS The top layer of fat just under the skin on the thighs, hips and buttocks is connected to the lower layers of fat by vertical collagen fi bers (fi brous septae). When estrogen levels decrease due to factors such as age, so does circulation and collagen production. As fat cells become larger, the lack of collagen allows them to protrude through the fi bers and become visible on the surface of the skin in a cottage cheese or orange rind appearance. Cellulite most commonly affects women because estrogen stimulates subcutaneous fat storage. It appears in the fat-prone areas of the body: the knees, thighs and buttocks as well as the stomach and backs of the arms. The male hormone testosterone, on the other hand, stimulates protein resulting in more dense layers of connective tissue and thicker skin layers, which help to prevent cellulite. "Ninety-eight percent of women have cellulite because it's estrogen-based. It's a female characteristic," says Suzanne Kilmer, MD, founder of the Laser & Skin Surgery Center of Northern California in Sacramento. "If you put men on estrogen therapy to treat, for example, prostate cancer, they will actually develop cellulite." MINIMALLY INVASIVE TREATMENT OPTIONS Two of the most talked-about treatments today are Cynosure's Cellulaze and Ulthera's Cellfi na. Both are FDA-approved and promise long-term improvement in the appearance of cellulite in a single treatment. Cellulaze is a 1440nm laser-based procedure that takes 60-90 minutes and delivers long-lasting (one year or more) results after one treatment. Local anesthesia is applied and tiny incisions are made in the treatment area. The proprietary laser fi ber is threaded through a cannula that's inserted through the incision(s). It levels out fatty bumps, releases fi brous septae and stimulates collagen production to increase skin thickness and elasticity. Clinical trials have noted patient satisfaction rates at 93% one year after treatment. Side effects include bruising and general soreness that can last up to a few weeks. Some patients experience hyperpigmentation. "It works. It's very effective. It's long lasting. But you have to fi nd the right patient type," says Cynthia Poulos, MD, founder of Classique Medical Spa in Northborough, Massachusetts, who was an early adopter of the procedure that debuted in 2011. "When you have someone who has reasonable tissue tone and moderate cellulite, it's a fantastic procedure." Cellfi na, launched in 2016, is a subcision-based, in-offi ce procedure that takes about one hour, depending on the "It's easy to be proud of good results, but you also have to show modest results." medestheticsmagazine.com | MARCH 2016 29