Elsevier

Dermatologic Clinics

Volume 32, Issue 1, January 2014, Pages 51-59
Dermatologic Clinics

A Modern Approach to the Treatment of Cellulite

https://doi.org/10.1016/j.det.2013.09.005Get rights and content

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Key points

  • Cellulite is a well-documented condition and, although many treatment options have been purported, few have lasting clinical results.

  • The use of laser and light-based devices, in both a noninvasive and a minimally invasive fashion, has augmented the understanding and approach to the treatment of cellulite.

  • Understanding the structural components that underpin cellulite anatomy allows for a more specific targeting approach.

Cellulite anatomy and grading

The topographic appearance of cellulite is multifactorial in nature. The overall contour deformity is that of skin depression admixed with lax inelastic epidermis. The area of cellulite can comprise isolated depressions or a cluster of such that leads to an overall rippled appearance. The depressed areas can be either ovoid or linear in shape. Ovoid areas of cellulite tend to be more prominent on the buttocks or posterior thigh regions. Cellulite can be broken down into 3 main structural

Grading

There are multiple scales of cellulite grading based on the clinical severity. Nurnberger and Muller described a scale of 3 grades:

  • Grade I: Skin is smooth when standing.

  • Grade II, mild, moderate, severe: Grade II is defined as orange peel or mattress appearance when standing.

  • Grade III, mild, moderate, severe: Grade III is defined as grade II cellulite plus raised and depressed areas and nodules when standing (Fig. 1).

Curri also described a cellulite grading scale, ranging from grade 0 (absence

Baseline photography

Appropriate imaging pretreatment is important to gauge any improvement after treatment. Cellulite photography and imaging can be quite altered by lighting and shadowing due to the undulating and rippling topographic nature of the condition. Therefore proper lighting and positioning of the patient is key. Overhead or tangential illumination of the areas should be used to visualize the surface area better. Photographs should be taken with the patient standing and muscles relaxed. A total body

Pharmacologic treatment options

The treatment armamentarium targeted toward cellulite includes weight loss, topical pharmacologic agents, and physical mechanisms. The main pharmacologic treatment options include methylxanthines (caffeine, aminophylline, and theophylline) and retinol.

Nonpharmacologic treatment options

A myriad of noninvasive devices has been produced for the treatment of cellulite, all with varying results (Box 2). Some combine suction and massage, whereas others use laser and light sources to target adipose cells. Anderson and colleagues6 purported that the 1210-nm and 1720-nm wavelengths are selectively absorbed by adipose cells and from this concluded that wavelengths in the infrared spectrum can be used for selective photothermolysis of fat. Although laser platforms in combination with

Surgical treatment options

Surgical treatment options for cellulite consist of mechanical destruction of dermal septae via either subcision or laser-assisted devices.17

Subcision uses a 16- or 18-gauge needle or a blade inserted into the subcutaneous adipose layer, parallel to the epidermis, to break the septae separating the fat lobules. By cutting the septae, it is hypothesized that the structure of the subcutaneous fat producing the cellulite is altered, thus leading to less tethering of the underlying connective

Treatment resistance/complications

Depending on the grade and severity, some cellulite patients may see a lesser degree of improvement. It is important in the consultation to frame patient expectations. Noninvasive treatments require multiple treatments as well as possible interval maintenance treatments. Resistant cases could be due to severity of the case or undertreatment of the area. When using laser, radiofrequency, or ultrasound devices, it is important not to deliver excessive fluences as this could lead to unwarranted

Evaluation of outcome and long-term recommendations

It is important to see all patients in follow-up. Measurements to be taken include dimple severity, circumference, and overall laxity. Patient satisfaction should also be assessed. For surgical patients follow-up at 3 and 6 months can provide enough healing time and remodeling to assess improvement. The use of traditional 2D imaging as well as 3D imaging can augment follow-up visits and patient satisfaction as well as give an objective comparison from baseline.

Summary

Cellulite is a well-documented condition and, although many treatment options have been purported, few have lasting clinical results. This historically notorious problem now has a modern resurgence of treatment technology. The use of laser- and light-based devices, in both a noninvasive and a minimally invasive fashion, has augmented the understanding and approach to the treatment of cellulite. Understanding the structural components that underpin cellulite anatomy allows for a more specific

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References (22)

  • R. Neira et al.

    Low-level laser-assisted liposuction: the Neira 4 L technique

    Clin Plast Surg

    (2006)
  • M.M. Avram

    Cellulite: a review of its physiology and treatment

    J Cosmet Laser Ther

    (2004)
  • A.B. Rossi et al.

    Cellulite: a review

    J Eur Acad Dermatol Venereol

    (2000)
  • F. Nurnberger et al.

    So-called cellulite: an invented disease

    J Dermatol Surg Oncol

    (1978)
  • N. Collis et al.

    Cellulite treatment: a myth or reality: a prospective randomized, controlled trial of two therapies, endermologie and aminophylline cream

    Plast Reconstr Surg

    (1999)
  • A. Am Kligman et al.

    Topical retinol improves cellulite

    J Dermatolog Treat

    (1999)
  • R.R. Anderson et al.

    Selective photothermolysis of lipid-rich tissues: a free electron laser study

    Lasers Surg Med

    (2006)
  • P.K. Nootheti 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)
  • Z.D. Draelos et al.

    Cellulite. Etiology and purported treatment

    Dermatol Surg

    (1997)
  • T.S. Alster et al.

    Cellulite treatment using a novel combination radiofrequency, infrared light, and mechanical tissue manipulation device

    J Cosmet Laser Ther

    (2005)
  • N. Sadick et al.

    A study evaluating the safety and efficacy of the VelaSmooth system in the treatment of cellulite

    J Cosmet Laser Ther

    (2007)
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    Anthony M. Rossi MD has nothing to disclose.

    Bruce E. Katz, MD has the following disclosures: Alma, Clinical Advisory Board; Life Biosciences, Consultant; Merz Pharmaceuticals, Clinical Advisory Board; El-En Engineering, Consultant; Cynosure, Stockholder; Valeant Pharm, Clinical Advisory Board; Allergan, Clinical Advisory Board.

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