Abstract
Background
Cellulite represents one of the common topographic alterations to the skin surface and one of the structural changes to the subdermal fat and septal band of the posterolateral thighs. Currently, no treatment exists to address this entity with a multifactorial genesis that produces long-term beneficial outcomes. This clinical study evaluated the safety and efficacy of the 1,440-nm laser and the duration of the clinical benefits during 2 years.
Methods
Initially, 25 healthy women with thigh cellulite were enrolled in this prospective institutional review board (IRB)-approved study. For grade II cellulite, the laser fiber delivered up to 1,000 J of energy to the undersurface of the entire involved skin. For grade III cellulite, the laser fiber distributed 1,300 to 1,500 J of energy to melt the subdermal fat, subcise the taut septal bands, and heat the reticular dermis. Baseline and posttreatment analyses included standardized high-resolution photography, skin elasticity measurements, ultrasound scanning for dermal thickness, histology, investigator global assessment scores, and recording of adverse events.
Results
Of the 24 subjects who underwent treatment, only 20 were available for the 6-month follow-up assessment. Objective measurements at 2 years demonstrated an increase over the baseline mean skin elasticity (34 %) and mean dermal thickness (11 %), as well as an increase in the average percentage of dermal thickening determined by ultrasound imaging. Independent investigator global assessments were rated higher for grade II subjects than for grade III subjects throughout the 2-year follow-up period. Mild adverse events disappeared by the third month.
Conclusions
This IRB-conducted clinical trial, as part of a multicenter study for Food and Drug Administration approval, demonstrated the safety and efficacy of a single minimally invasive treatment for grades II and III thigh cellulite during a 2-year follow-up period.
Level of Evidence II
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Similar content being viewed by others
References
Scherwitz C, Braun-Falco O (1978) So-called cellulite. J Dermatol Surg Oncol 4(2):23–30
Draelos ZD (1997) Cellulite etiology and purported treatment. Dermatol Surg 23:1177–1181
Nurnberger F, Muller G (1978) So-called cellulite: an invented disease. J Dermatol Surg Oncol 4:222–229
Rosenbaum M, Prieto V, Hellmer J et al (1998) An exploratory investigation of the morphology and biochemistry of cellulite. Plast Reconstr Surg 101:1934–1939
Pierard GE, Nizet JL, Pierard-Franchimont C (2000) Cellulite: from standing fat herniation to hypodermal stretch marks. Am J Dermatopathol 22:34–37
Mirrashed F, Sharp JC, Krause V et al (2004) Pilot study of dermal and subcutaneous fat structures by MRI in individuals who differ in gender, BMI, and cellulite grading. Skin Res Technol 10:161–168
Avram MM (2004) Cellulite: a review of its physiology and treatment. J Cosmet Laser Ther 6:181–185
Pierard GE (2005) Commentary on cellulite: skin mechanobiology and the waist-to-hip ratio. J Cosmet Dermatol 4:151–152
Curri SB, Bombardelli E (1994) Local lipodystrophy and districtual microcirculation. Cosmet Toilet 109:52–65
Quatresooz P, Xhauflaire-Uhoda E, Pierard-Franchimont C et al (2006) Cellulite histopathology and related mechanobiology. Int J Cosmet Sci 28:207–210
Dahl PR, Salla MJ, Winkelmann RK (1996) Localized involution allipoatrophy: a clinicopathologic study of 16 patients. J Am Acad Dermatol 35(4):523–528
Murphy GF (1997) Histopathology of the skin. In: Elder DE, Elenitsas R, Jaworsky C, Johnson BL Jr (eds) Lever’s histopathology of the skin. Lippincott-Raven, Philadelphia, pp 5–50
Franchi J, Pellicur F et al (2003) The adipocyte in the history of slimming agents. Pathol Biol 51:244–247
Bacci PA (2010) Anatomy of cellulite and the interstitial matrix. In: Goldman MP, Hexsel D (eds) Cellulite: pathophysiology and treatment, 2nd edn. Informa Healthcare, London, pp 8–12
Smalls LK, Lee CY, Whitestone J et al (2005) Quantitative model of cellulite: three-dimensional skin surface topography, biophysical characterization, and relationship to human perception. J Cosmet Sci 56:105–120
Perin F, Perrier C, Pittet JC et al (2001) Assessment of skin improvement treatment efficacy using the photograding of mechanically accentuated macrorelief of thigh skin. Int J Cosmet Sci 22:147–156
Bielfeldt S, Buttgereit P, Brandt M et al (2008) Noninvasive evaluation techniques to quantify the efficacy of cosmetic anticellulite products. Skin Res Technol 14(3):336–344
Ortonne JP, Zartarian Z, Verschoore M et al (2008) Cellulite and skin ageing: is there any interaction? J Eur Acad Dermatol Venereol 22:827–834
Querleux B, Cornillow C, Jolivet O et al (2002) 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 8:112–124
Gensanne D, Josse G, Theunis J et al (2009) Quantitative magnetic resonance imaging of subcutaneous adipose tissue. Skin Res Technol 13:45–50
Dobke MK, DiBernardo B, Thompson C et al (2002) Assessment of biomechanical properties: is cellulitic skin different? Aesthet Surg J 22:260–266
Lucassen GW, van der Sluys WLN, van Herk JJ et al (1997) The effectiveness of massage treatment on cellulite as monitored by ultrasound imaging. Skin Res Technol 3:154–160
Rossi ABR, Vergnanini AI (2000) Cellulite: a review. J Eur Acad Dermatol Venereol 14:251–262
Hu W, Siegfried EC, Siegel DM (2002) Product-related emphasis of skin disease information online. Arch Dermatol 138:775–780
Hexsel D, Zechneister do Prado D, Goldman MP (2010) Topical management of cellulite. In: Goldman MP, Hexsel D (eds) Cellulite: pathophysiology and treatment, 2nd edn. Informa Healthcare, London, pp 62–68
Sasaki GH, Oberg K, Tucker B et al (2007) The effectiveness and safety of topical PhotoActif phosphatidylcholine-based anti-cellulite gel and LED (red and near-infrared) light on grade II-III thigh cellulite: a randomized, double-blinded study. J Cosmet Laser Ther 9:87–96
Kinney BM (1999) Cellulite treatment: a myth or reality: a prospective randomized, controlled trial of two therapies, endermologie and aminophylline cream. Plast Reconstr Surg 104:1115–1117
Hamilton EC, Greenway FL, Bray GA (1999) Regional fat loss from the thigh in women using 2 % aminophylline cream. Plast Reconstr Surg 104(1 Suppl 2):95S
Artz JS, Dinner MI (1995) Treatment of cellulite deformities of the thighs with topical aminophylline gel. Can J Plast Surg 3:190–192
Collis N, Elliot LA, Sharpe C et al (1999) Cellulite treatment: a myth or reality: a prospective randomized, controlled trial of two therapies, endermologie and aminophylline cream. Plast Reconstr Surg 104:1110–1114
Kligman AM, Pagnoni A, Stoudemayer T (1999) Topical retinol improves cellulite. J Dermatol Treat 10:119–125
Pierard-Franchimont C, Pierard GE, Henry F et al (2000) A randomized, placebo-controlled trial of topical retinal in the treatment of cellulite. Am J Clin Dermatol 1:369–374
Braun M (2010) Injection lipolysis for body sculpting and cellulite reduction. In: Goldman MP, Hexsel D (eds) Cellulite: pathophysiology and treatment, 2nd edn. Informa Healthcare, London
Palmer M, Curran J, Bowler P (2006) Clinical experience and safety using phosphatidylcholine injections for the localized reduction of subcutaneous fat: a multicentre, retrospective UK study. J Cosmet Dermatol 5:218–226
Rotunda AM, Suzuki H, Moy RI et al (2004) Detergent effects of sodium deoxycholate are a major feature of an injectable phosphatidylcholine formulation used for localized fat dissolution. Dermatol Surg 30:1001–1007
Bacci PA (2010) Endermologie-LPD systems after 15 years. In: Goldman MP, Hexsel D (eds) Cellulite: pathophysiology and treatment, 2nd edn. Informa Healthcare, London, pp 91–98
Sadick NS (2010) VelaSmooth and VelaShape. In: Goldman MP, Hexsel D (eds) Cellulite: pathophysiology and treatment, 2nd edn. Informa Healthcare, London, pp 108–114
Sadick NS, Mulholland RS (2004) A prospective clinical study to evaluate the efficacy and safety of cellulite treatment using the combination of optical and RF energies for subcutaneous tissue heating. J Cosmet Laser Ther 6:187–190
Alster TS, Tanzi EL (2005) Cellulite treatment using a novel combination radiofrequency, infrared light, and mechanical tissue manipulation device. J Cosmet Laser Ther 7:81–85
Sadick N, Magro C (2007) A study evaluating the safety and efficacy of the VelaSmooth system in the treatment of cellulite. J Cosmet Laser Ther 9:15–20
Kulick M (2006) Evaluation of the combination of radiofrequency, infrared energy, and mechanical rollers with suction to improve skin surface irregularities (cellulite) in a limited treatment area. J Cosmet Laser Ther 8:185–190
Goldman MP (2010) The use of the Tri-active™ in the treatment of cellulite. In: Goldman MP, Hexsel D (eds) Cellulite: pathophysiology and treatment, 2nd edn. Informa Healthcare, London, pp 99–107
Pabby A, Goldman MP (2006) The use of TriActive in the treatment of cellulite. In: Goldman MP, Bacci PA, Leischoff G, Hexsel D, Angelini F (eds) Cellulite: pathophysiology and treatment. Taylor & Francis, New York, pp 189–195
Wanner M, Avarm M (2008) An evidence-based assessment of treatments for cellulite. J Drugs Dermatol 7:341–345
Kulick MI (2010) Evaluation of a noninvasive, dual-wavelength laser-suction and massage device for the regional treatment of cellulite. Plast Reconstr Surg 125:1788–1796
Unaeze J (2010) Goldberg: Accent® unipolar radiofrequency. In: Goldman MP, Hexsel D (eds) Cellulite: pathophysiology and treatment, 2nd edn. Informa Healthcare, London, p 11
Manuskiatti W (2010) Tripollar™ radiofrequency. In: Goldman MP, Hexsel D (eds) Cellulite: pathophysiology and treatment, 2nd edn. Informa Healthcare, London, pp 158–167
Emilia del Pino M, Rosado RH, Azuela A et al (2006) Effect of controlled volumetric tissue heating with radiofrequency on cellulite and the subcutaneous tissue of the buttocks and thighs. J Drugs Dermatol 5:714–722
Teitelbaum SA, Burns JL, Kobota J et al (2007) Noninvasive body contouring by focused ultrasound: safety and efficacy of contour I device in a multicenter, controlled, clinical study. Plast Reconstr Surg 120:779–789
Hexsel D, Mazzuco R, Soriefmann M (2010) Subcision. In: Goldman MP, Hexsel D (eds) Cellulite: pathophysiology and treatment, 2nd edn. Informa Healthcare, London, pp 174–179
Orentreich DS, Orentreich N (1995) Subcutaneous incisionless (subcision) surgery for the correction of depressed scars and wrinkles. Dermatol Surg 21:543–549
Gasparotti M (1992) Superficial liposuction: a new application of the technique for aged and flaccid skin. Aesthet Plast Surg 16:141–153
Coleman WP, Hanke CW, Alt TH et al (1991) Liposuction cosmetic surgery of the skin: principles and practice. BC Decker Inc, Philadelphia, pp 231–238
Pribanich S, Simpson FG, Jeld B et al (1994) Low-dose tretinoin does not improve striaedistensae: a double-blind, placebo-controlled study. Cutis 54:121–124
Paul M, Mulholland RS (2009) A new approach for adipose tissue treatment and body contouring using radiofrequency-assisted liposuction. Aesthet Plast Surg 33:687–694
Blugerman G, Schavelzon D, Paul MD (2010) A safety and feasibility study of a novel radiofrequency-assisted liposuction technique. Plast Reconstr Surg 125:998–1006
Hurwitz D, Smith D (2012) Treatment of overweight patients by radiofrequency-assisted liposuction (RFAL) for aesthetic reshaping and skin tightening. Aesthet Plast Surg 36:62–71
Theodorou SJ, Paresi RK, Chia CT (2012) Radiofrequency-assisted liposuction device for body contouring: 97 patients under local anesthesia. Aesthet Plast Surg 36:767–779
Goldman A, Schavelon DE, Blugerman GS (2002) Laser lipolysis: liposuction using Nd:YAG laser. Rev Soc Pa Bras Cir Plast 17:17–26
Badin AZ, Moraes LM, Gondek L et al (2002) Laser lipolysis: flaccidity under control. Aesthet Plast Surg 26:335–339
Goldman A, Schavelon DE, Blugerman G (2003) Liposuction using neodimium:yttrium-aluminum-garnet laser (abstract). Plast Reconstr Surg 111:2497
Goldman A (2006) Submental Nd:YAG laser-assisted liposuction. Laser Surg Med 38:181–184
Prado A, Andrades P, Danilla S et al (2006) A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plast Reconstr Surg 118:1032–1045
Kim K, Geronemus RG (2006) Laser lipolysis using a novel 1,064-nm Nd:YAG laser. Dermatol Surg 32:241–248
Goldman A, Gotkin RH, Sarnoff D et al (2008) Cellulite: a new treatment approach combining subdermal Nd:YAG laser lipolysis and autologous fat transplantation. Aesthet Surg J 28:656–662
DiBernardo BE, Reyes J, Chen B (2009) Evaluation of tissue thermal effects from 1,064/1,320-nm laser-assisted lipolysis and its clinical implications. J Cosmet Laser Ther 11:62–69
Sasaki GH, Tevez A (2009) Laser-assisted liposuction for facial and body contouring and tissue tightening: A 2-year experience with 75 consecutive patients. Semin Cutan Med Surg 28:226–235
Sasaki GH (2010) Quantification of human abdominal skin tightening and contraction after component treatments with 1,064-nm/1,320-nm laser-assisted lipolysis: clinical implications. Aesthet Surg J 30:239–248
DiBernardo BE (2011) Treatment of cellulite using a 1,440-nm pulsed laser with one-year follow-up. Aesthet Surg J 31:328–341
Sasaki GH, Tevez A, Ha C et al (2012) Treatment of grade II-III cellulite using a minimally invasive 1,440-nm pulsed Nd:YAG laser with eighteen-month follow-up. White paper. Cynosure, Inc., Westford
DiBernardo BE (2010) Randomized blinded split-abdomen study evaluation skin shrinkage and skin tightening in laser-assisted liposuction vs liposuction control. Aesthet Surg J 30:593–602
Grove GL, Damia J, Grove MJ et al (2006) Suction chamber method for measurement of skin mechanics: the DermaLab. In: Serup J, Jemec GBE, Grove GL (eds) Handbook of noninvasive methods and the skin, 2nd edn. CRC Press, Boca Raton, pp 593–599
Pedersen L, Hansen B, Jemec GBE (2003) Mechanical properties of the skin: a comparison between two suction cup methods. Skin Res Technol 9:111–115
Sasaki GH (2010) Histological changes after 1,440-nm, 1,320-nm, and 1,064-nm wavelength exposures in the deep and superficial layers of human abdominal tissue: acute and delayed findings. Cynosure White Paper, Westford
Goldman A, Gotkin RH, Sarnoff DS et al (2008) Cellulite: a new treatment approach combining subdermal Nd:YAG laser lipolysis and autologous fat transplantation. Aesthet Surg J 28:656–662
Bousquet-Rouaud R, Bazan M, Chaintreuil J et al (2010) High-frequency ultrasound evaluation of cellulite treated with the 1,064-nm Nd:YAG laser. In: Goldman MP, Hexsel D (eds) Cellulite: pathophysiology and treatment, 2nd edn. Informa Healthcare, London, pp 136–144
Pratt WK (2001) Digital image processing: PIKS inside, 3rd edn. Wiley, New York, pp 433–436
Lach E (2008) Reduction of subcutaneous fat and improvement in cellulite by dual-wavelength, low-level lease energy combined with vacuum and massage. J Cosmet Laser Ther 10:d202–d209
Disclosure
The author is a consultant for Cynosure, the manufacturer of the device discussed in this study, and declared no conflicts of interest with respect to the authorship and publication of this article. The author received an unrestricted study grant from Cynosure to support this clinical research as part of an IRB-approved and sponsored clinical study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sasaki, G.H. Single Treatment of Grades II and III Cellulite Using a Minimally Invasive 1,440-nm Pulsed Nd:YAG Laser and Side-Firing Fiber: An Institutional Review Board-Approved Study with a 24-Month Follow-Up Period. Aesth Plast Surg 37, 1073–1089 (2013). https://doi.org/10.1007/s00266-013-0219-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-013-0219-9