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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SMOOTH OPERATORS 32 MARCH 2016 | Med Esthetics when patients are able to work in partnership with their physicians—undergoing in-offi ce treatments to reduce the cellulite and then maintaining those results with a good diet, regular exercise and occasional maintenance treatments as needed." Dr. Poulos adds, "You need to show pictures that are really accurate. It's easy to be proud of good results, but you also have to show modest results. I'd rather under promise and over deliver," she says. "If a patient hesitates when I ask if a 50% improvement is acceptable, I'll tell her that the procedure is probably not for her. If a patient says, 'I don't want any dimples left,' I won't treat her. But if you leave a patient with the caveat that she might need a touch-up, then usually she can accept that." Another facet to patient satisfaction is patient selection. Age, health and skin condition are all factors to consider. "If someone has laxity in her skin and she's in her 50s, then she really needs a thigh lift," says Dr. Mills. "Cellfi na isn't going to address that. It's not going to take care of the extra skin. If you're looking at treating the cellulite only, it might make it look 15% to 20% better. I use before and after pictures. If the patient thinks it's not a reasonable result, she should not have the procedure. Sometimes you need to turn patients away. Either they have unrealistic expectations, they're not good candidates or they don't need it." When treating cellulite with subcision, Dr. Kilmer considers the age of the patient when mapping out her treatment plan and explaining potential outcomes. "Because patients in their 20s, 30s and sometimes early 40s have much more collagen and elastin, the skin can rebound and they're much more likely to respond well," she says. "As you get older, skin laxity stays around more. With a younger patient, we know we can do more releases in a treatment because we know the skin will tighten up. It isn't just going to hang there looking saggy. With older patients, you're always assessing to see if they have good skin and if it has the ability to retract." Our panel of experts agrees that genetics and overall health play a big role in cellulite. "It is safe to say that maintaining a decent weight—a healthy BMI—good hydration and getting regular exercise help to keep skin tone healthy and cellulite at bay. People who bounce up and down weight-wise have more issues with tissue tone," says Dr. Poulos. "There is a genetic component you can't do anything about. But you can counsel patients to stay within a reasonable BMI and use common sense when it comes to diet, good nutrition and hydration. There is cumulative trauma to the skin when we're younger. Whatever you do shows up on your body later in life." Shelley Moench-Kelly is a Vermont-based writer and editor. Treating cellulite requires a combination of septae release, dermal remodeling, and reduction or destruction of adipose cells. "Topical creams may offer a very short- term improvement in the appearance of cellulite." © GETTY IMAGES