A new laser achieves promising long-term results against cellulite by addressing the three factors that cause it, according to Barry DiBernardo, M.D.
"Many women are obsessed over cellulite," which gives the skin a dimpled appearance somewhat like an orange peel, says Dr. DiBernardo, a Montclair, N.J., plastic surgeon in private practice. And paradoxically, he says, "It seems that the smaller the cellulite on the body, the more distraught they are over it."
Regarding the pathology of cellulite, he says that preliminary research using ultrasound revealed thinning of the dermis and herniations of subcutaneous fat compartments that extend into the thinned dermis (Querleux B. Cellulite characterization by high-frequency ultrasound and high-resolution magnetic resonance imaging. In: Goldman MP, Bacci PA, Leischoff G, Hexsel D, Angelini F, editors. Cellulite: Pathophysiology and Treatment. New York: Taylor & Francis; 2006:105-114. Lucassen GW, van der Sluys WLN, van Herk JJ, et al. Skin Res Technol. 1997;3(3):154-160).
"Also," Dr. DiBernardo says, "we know that there are fibrous vertical septae that extend from the dermal layer, through the hypodermal fat layer, and connect to the underlying muscle. With cellulite, we find these septae are fibrosed, and they get thicker and contract down to form those dimples."
As such, he says that he and his colleagues concluded based on preliminary research that cellulite includes three distinct components that are important to understand in order to devise an effective treatment. "These include expansion of the subcutaneous fat, the fibrotic septae and the dermal laxity and atrophy, which cause herniation," he says.
CELLULAZE SUCCESS A new 1,440 nm laser (CelluLaze, Cynosure, pending regulatory approval) addresses all three components, Dr. DiBernardo says. The laser's heating addresses the fat herniation and uneven fat distribution; cutting or thermal subcision treats the uneven septae.
A feasibility study of the device began with 10 female patients (DiBernardo BE. Aesthet Surg J. 2011;31(3):328-341). Ultimately, Dr. DiBernardo says, this study included more than 100 patients in a total of six centers. "Under an IRB-approved protocol, patients had to have moderate-to-severe cellulite on their thighs," he says. Investigators excluded subjects who had undergone previous surgical and nonsurgical treatments for cellulite.
Tools used to objectively measure cellulite before and after treatment included two-dimensional photography, three-dimensional photography and Vectra (Canfield) 3-D analysis, plus high-frequency ultrasound and skin elasticity measurements. "Even if you're very well-versed in photography and lighting, cellulite is one of the hardest things to light" consistently in clinical photos, Dr. DiBernardo says. "I've been a professional photographer for 40 years, and it was challenging for me. But I believe we achieved that."
3-D BENEFITS Three-dimensional photography provides an important advance for cellulite imaging, Dr. DiBernardo says. "It doesn't use light — it uses a calculated surface, so it eliminates light from the equation."
Using the three-dimensional images, Dr. DiBernardo says he devised a marking system that's "really about hills and valleys and zones of heating." Specifically, investigators marked the entire treatment area while patients were in a standing position with a grid of sectors measuring 5 cm by 5 cm, using red for depressed areas and green for elevated areas. Three-dimensional imaging also enabled investigators to calculate the volume of fat pockets before and after treatment.
Before treatment, Dr. DiBernardo cleaned the treatment area with povidone-iodine antiseptic then infused tumescent lidocaine solution (50 mL to 80 mL). He also applied topical lidocaine to incision areas if patients requested it.
Through two to four small incisions, Dr. DiBernardo gave subjects one treatment subcutaneously (1 cm to 2 cm beneath the skin) using the device, using a power setting of 8 W to 10 W and a pulse frequency of 40 Hz. During treatment, he says, ultrasound imaging enabled him to visualize uneven fat distribution beneath a spot of cellulite.
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