Original Research

A Noninvasive Mechanical Treatment to Reduce the Visible Appearance of Cellulite

Cutis. 2016 December;98(6):393-398

References

Scherwitz C, Braun-Falco O. So-called cellulite. J Dermatol Surg Oncol. 1978;4:230-234.
Khan MH, Victor F, Rao B, et al. Treatment of cellulite: part I. pathophysiology. J Am Acad Dermatol. 2010;62:361-370, quiz 371-372.
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;8:118-124.
Rawlings A. Cellulite and its treatment. Int J Cos Sci. 2006;28:175-190.
Rosenbaum M, Prieto V, Hellmer J, et al. An exploratory investigation of the morphology and biochemistry of cellulite. Plast Reconstr Surg. 1998;101:1934-1939.
Rossi AB, Vergnanini AL. Cellulite: a review. J Eur Acad Dermatol Venereol. 2000;14:251-262.
Smalls LK, Hicks M, Passeretti D, et al. Effect of weight loss on cellulite: gynoid lypodystrophy. Plast Reconstr Surg. 2006;118:510-516.
Nürnberger F, Müller G. So-called cellulite: an invented disease. J Dermatol Surg Oncol. 1978;4:221-229.
Mirrashed F, Sharp JC, Krause V, et al. Pilot study of dermal and subcutaneous fat structures by MRI in individuals who differ in gender, BMI, and cellulite grading. Skin Res Technol. 2004;10:161-168.
Khan M, Victor F, Rao B, et al. Treatment of cellulite, part II. advances and controversies. J Am Acad Dermatol. 2010;62:373-384.
Collis N, Elliot L, Sharp C, et al. Cellulite treatment: a myth or reality: a prospective randomized, controlled trial of two therapies, endermologie and aminophylline cream. Plast Reconstr Surg. 1999;104:1110-1114.
Adcock D, Paulsen S, Jabour K, et al. Analysis of the effects of deep mechanical massage in the porcine model. Plast Reconstr Surg. 2000;108:233-240.
Güleç AT. Treatment of cellulite with LPG endermologie. Int J Dermatol. 2009;48:265-270.
Piérard-Franchimont C, Piérard GE, Henry F, et al. A randomized, placebo-controlled trial of tropical retinol in the treatment of cellulite. Am J Clin Dermatol. 2000;1:369-374.
Coleman WP. Liposuction. In: Coleman WP, Hanke CW, Alt TH, eds. Cosmetic Surgery of the Skin: Principles and Practice. Philadelphia, PA: BC Decker; 1991:213-238.
ASPS guiding principles for mesotherapy/injection lipolysis. American Society of Plastic Surgeons website. http://www.plasticsurgery.org/Documents/medical-professionals/health-policy/guiding-principles/ASPS-Guiding-Principles-for-Mesotherapy-Injection-Lipolysis-7-08.pdf. Published July 2008. Accessed February 17, 2016.
Kulick MI. Evaluation of a noninvasive, dual-wavelength laser-suction and massage device for the regional treatment of cellulite. Plast Reconstr Surg. 2010;125:1788-1796.
Nootheti PK, Magpantay A, Yosowitz G, et al. A single center, randomized, comparative, prospective clinical study to determine the efficacy of the VelaSmooth system versus the TriActive system for the treatment of cellulite. Lasers Surg Med. 2006;38:908-912.
DiBernardo BE. Treatment of cellulite using a 1440-nm pulsed laser with one-year follow up. Aesthet Surg J. 2011;31:328-341.
Johannes L. New laser aims to zap cellulite at the source. Wall Street Journal. July 3, 2012. http://www.wsj.com/articles/SB10001424052702303649504577496981754619546. Accessed November 21, 2016.
Burns AJ. Commentary on: treatment of cellulite using a 1440-nm pulsed laser with one-year follow up: preliminary report. Aesthet Surg J. 2011;31:342-343.
Teitelbaum SA, Burns JL, Kubota J, et al. Noninvasive body contouring by focused ultrasound: safety efficacy of the contour I device in a multicenter, controlled, clinical study. Plast Reconstr Surg. 2007;120:779-789.
Brown SA, Greenbaum L, Shtukmaster S, et al. Characterization of nonthermal focused ultrasound for noninvasive selective fat cell disruption (lysis): technical and preclinical assessment. Plast Reconstr Surg. 2009;124:92-101.
Angehrn F, Kuhn C, Voss A. Can cellulite be treated with low energy extracorporeal shock wave therapy? Clin Interv Aging. 2007;2:623-630.
Christ C, Brenke R, Sattler G, et al. Improvement in skin elasticity in the treatment of cellulite and connective tissue weakness by means of extracorporeal pulse activation therapy. Aesthet Surg J. 2008;28:538-544.
Bosco C, Colli R, Introini E, et al. Adaptive responses of human skeletal muscle to vibration exposure. Clin Physiol. 1999;19:183-187.
Luo J, McNamara B, Moran K. The use of vibration training to enhance muscle strength and power. Sports Med. 2005;35:23-41.
Annino G, Padua E, Castagna C, et al. Effect of whole body vibration training on lower limb performance in selected high-level ballet students. J Strength Cond Res. 2007;21:1072-1076.
Verschueren SM, Roelants M, Delecluse C, et al. Effect of 6-month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study [published online December 22, 2003]. J Bone Miner Res. 2004;19:352-359.

Comment

Although there are a large number of treatment protocols that have been introduced and studied for the reduction of the appearance of cellulite,^4,9,11-18 many have not shown promising long-term results. Some treatments have shown improvement in the firmness of collagen and the dermis but not in the appearance of cellulite.^22-25 One of the only treatments that has shown some promise is an expensive invasive treatment.²⁰

The system used in this study was shown to be safe in all study participants. No significant adverse reactions were noted, and each participant successfully completed the protocol. Figures 2 and 3 show the strong correlation between the treatment and the reduction in the visible appearance of cellulite in this study population, which was supported by statistical analysis, particularly the participant self-reported ratings. The participants and the blinded physicians were not in agreement on the improvement of cellulite. Although the participants knew the changes that occurred to their bodies, the physicians only had photographs from which to make their decisions. The participants clearly observed noticeable differences to their bodies, while the physicians either saw no change or some improvement.

The physicians were asked to evaluate only the cellulite, but the process we employed changed more than the cellulite. The first step in the process was a toning of the legs and buttocks, which was readily observable by the patients but was outside the scope of the physicians’ assessment. After the body toning, the cellulite began to improve. It is possible that the participants were responding to the entire process, which clearly was positive, while the physicians were responding only to the cellulite end point.

Our treatment regimen accomplished reduction of the visible appearance of cellulite by breaking down connective tissue septa as well as increasing the thickness of the dermis and its elasticity. It also helped reduce subcutaneous fat, improve circulation, and reduce general lymphatic congestion. The parallel motions of the unit could be adjusted, but we kept them at a mid-level range of motion. The motion at this frequency would have a tendency to not only heat the epidermis and dermal layer that we were attempting to affect but would also help accomplish breaking down the septa and improving the elasticity of the dermis. Also, the rapid motion over a period of time of pulling the dermis parallel to the subdermal tissue and fascia most likely helped improve the circulation and lymphatic flow in treated areas as well as possibly broke down the subcutaneous fat. All of these factors appear to have led to an improvement in the appearance of cellulite in our study participants.

A maintenance-type program, if continued, would likely demonstrate improved results by further breaking down the septa and improving the other factors that reduce the appearance of cellulite. We believe that the participants would eventually be able to discontinue the use of the unit or reduce its use substantially once the desired results were obtained.

When utilizing the device, the participants were in a standing posture and leaning into the belt with a moderate force, which seemed to secondarily improve the tone of the gluteal and thigh musculature that was being treated. It may be that the oscillatory motion and the standing posture caused the muscles to isometrically co-contract, adding a secondary exerciselike effect.^26-29

Proving our suggested mechanisms of action would require tissue biopsies and/or magnetic resonance imaging studies that were beyond the scope of this study. However, regardless of the mechanism of action, we do believe that this treatment has been shown to be effective, convenient, and most importantly safe.

Conclusion

The unique device that was utilized in our study is a safe and cost-effective method of reducing the appearance of cellulite for home use and would allow for a noninvasive, low-risk procedure.

References

Scherwitz C, Braun-Falco O. So-called cellulite. J Dermatol Surg Oncol. 1978;4:230-234.
Khan MH, Victor F, Rao B, et al. Treatment of cellulite: part I. pathophysiology. J Am Acad Dermatol. 2010;62:361-370, quiz 371-372.
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;8:118-124.
Rawlings A. Cellulite and its treatment. Int J Cos Sci. 2006;28:175-190.
Rosenbaum M, Prieto V, Hellmer J, et al. An exploratory investigation of the morphology and biochemistry of cellulite. Plast Reconstr Surg. 1998;101:1934-1939.
Rossi AB, Vergnanini AL. Cellulite: a review. J Eur Acad Dermatol Venereol. 2000;14:251-262.
Smalls LK, Hicks M, Passeretti D, et al. Effect of weight loss on cellulite: gynoid lypodystrophy. Plast Reconstr Surg. 2006;118:510-516.
Nürnberger F, Müller G. So-called cellulite: an invented disease. J Dermatol Surg Oncol. 1978;4:221-229.
Mirrashed F, Sharp JC, Krause V, et al. Pilot study of dermal and subcutaneous fat structures by MRI in individuals who differ in gender, BMI, and cellulite grading. Skin Res Technol. 2004;10:161-168.
Khan M, Victor F, Rao B, et al. Treatment of cellulite, part II. advances and controversies. J Am Acad Dermatol. 2010;62:373-384.
Collis N, Elliot L, Sharp C, et al. Cellulite treatment: a myth or reality: a prospective randomized, controlled trial of two therapies, endermologie and aminophylline cream. Plast Reconstr Surg. 1999;104:1110-1114.
Adcock D, Paulsen S, Jabour K, et al. Analysis of the effects of deep mechanical massage in the porcine model. Plast Reconstr Surg. 2000;108:233-240.
Güleç AT. Treatment of cellulite with LPG endermologie. Int J Dermatol. 2009;48:265-270.
Piérard-Franchimont C, Piérard GE, Henry F, et al. A randomized, placebo-controlled trial of tropical retinol in the treatment of cellulite. Am J Clin Dermatol. 2000;1:369-374.
Coleman WP. Liposuction. In: Coleman WP, Hanke CW, Alt TH, eds. Cosmetic Surgery of the Skin: Principles and Practice. Philadelphia, PA: BC Decker; 1991:213-238.
ASPS guiding principles for mesotherapy/injection lipolysis. American Society of Plastic Surgeons website. http://www.plasticsurgery.org/Documents/medical-professionals/health-policy/guiding-principles/ASPS-Guiding-Principles-for-Mesotherapy-Injection-Lipolysis-7-08.pdf. Published July 2008. Accessed February 17, 2016.
Kulick MI. Evaluation of a noninvasive, dual-wavelength laser-suction and massage device for the regional treatment of cellulite. Plast Reconstr Surg. 2010;125:1788-1796.
Nootheti PK, Magpantay A, Yosowitz G, et al. A single center, randomized, comparative, prospective clinical study to determine the efficacy of the VelaSmooth system versus the TriActive system for the treatment of cellulite. Lasers Surg Med. 2006;38:908-912.
DiBernardo BE. Treatment of cellulite using a 1440-nm pulsed laser with one-year follow up. Aesthet Surg J. 2011;31:328-341.
Johannes L. New laser aims to zap cellulite at the source. Wall Street Journal. July 3, 2012. http://www.wsj.com/articles/SB10001424052702303649504577496981754619546. Accessed November 21, 2016.
Burns AJ. Commentary on: treatment of cellulite using a 1440-nm pulsed laser with one-year follow up: preliminary report. Aesthet Surg J. 2011;31:342-343.
Teitelbaum SA, Burns JL, Kubota J, et al. Noninvasive body contouring by focused ultrasound: safety efficacy of the contour I device in a multicenter, controlled, clinical study. Plast Reconstr Surg. 2007;120:779-789.
Brown SA, Greenbaum L, Shtukmaster S, et al. Characterization of nonthermal focused ultrasound for noninvasive selective fat cell disruption (lysis): technical and preclinical assessment. Plast Reconstr Surg. 2009;124:92-101.
Angehrn F, Kuhn C, Voss A. Can cellulite be treated with low energy extracorporeal shock wave therapy? Clin Interv Aging. 2007;2:623-630.
Christ C, Brenke R, Sattler G, et al. Improvement in skin elasticity in the treatment of cellulite and connective tissue weakness by means of extracorporeal pulse activation therapy. Aesthet Surg J. 2008;28:538-544.
Bosco C, Colli R, Introini E, et al. Adaptive responses of human skeletal muscle to vibration exposure. Clin Physiol. 1999;19:183-187.
Luo J, McNamara B, Moran K. The use of vibration training to enhance muscle strength and power. Sports Med. 2005;35:23-41.
Annino G, Padua E, Castagna C, et al. Effect of whole body vibration training on lower limb performance in selected high-level ballet students. J Strength Cond Res. 2007;21:1072-1076.
Verschueren SM, Roelants M, Delecluse C, et al. Effect of 6-month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study [published online December 22, 2003]. J Bone Miner Res. 2004;19:352-359.

A Noninvasive Mechanical Treatment to Reduce the Visible Appearance of Cellulite

References

Comment

Conclusion

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