Dr. Robert Troell - Las Vegas, NV
Cosmetic and Facial Plastic Surgeon
Medical Director of The Institute of Advanced Body Sculpting (*)
Here is a list of current treatment modalities for Cellulite. Dr Troell is performing the first world-wide study objectively analyzing the cellulite treatment options:
What is CELLULITE?
Cellulite affects an estimated 85% of post-pubescent women. The association with woman is linked to the effect of estrogen hormone on the skin and soft tissues, which we do not fully understand. The cellulite results in dimpled, uneven skin with a cobblestone appearance or orange peel effect.
The soft tissue alterations in cellulite include:
- Fibrous septae attachments of the skin extending into the underlying fat and even connecting to the underlying muscle
- Thickened fat layer
- Fat lobule herniation up into the skin-fat interface
- Reduced blood circulation of the skin
The most common areas of the woman’s body affected by cellulite are the thigh and the buttock, however, cellulite may effect other areas as well:
A Universal Cellulite Grading System was developed in 1972, known as the Nurenberger-Muller Grading Scale. There are four grades of cellulite ranging from grade 0-3:
How severe is your Cellulite?
Grade 0: “No cellulite”. There is no visible cellulite while standing. With pinching the skin, there is no appearance of cellulite. This grade of cellulite is rare and very desirable.
Grade 1: “Tight cellulite”. There is no cellulite when standing, however, when one pinches the skin of the thigh/buttock or when the thigh/buttock muscles are contracted, one will see the appearance of orange peel or mattress appearance of the skin. The pinch test should be painless and the skin-fold small.
Grade 2: “Loose cellulite”. There is visible cellulite while standing, but it is not visible when lying. The cellulite is visible when the subject contracts the buttocks or when the skin is pinched. The skin is generally loose and has a painless skin pinch.
Grade 3: There is visible cellulite while standing and in the supine position. Some refer to this as “painful cellulite”, any type of cellulite, which is characterized by significant tenderness during the pinch test.
What are the available Non-Invasive Cellulite Treatment Options?
The reason it is important to grade the severity of your cellulite is to predict the best treatment option for you with the following the non-invasive technologies:
Those with less severe cellulite can achieve a 25-50% improvement with non-invasive (no surgery) procedures. Some of these offer a temporary benefit, such as Endermologie or VelaShape, however, if continued treatments are performed regularly, then one can maintain these benefits. VASER Shape has been shown to have a long-term benefit (as long as two years) using a non-invasive non-focused ultrasound bimodal diathermy device.
Dr Troell and the Institute of Advanced Body Sculpting Study
As described above, there are numerous medical technologies, both minimally invasive and non-invasive, marketed for the treatment of cellulite. However, if one current technology was superior to all others, a scientific study comparing their safety and efficacy would be unnecessary. Dr. Robert Troell’s study is the first IRB approved comprehensive study designed to compare both minimally invasive and non-surgical technologies in the treatment of cellulite. The non-invasive modalities being studied are: non-focused ultrasound (1 mega Hz) or VASER Shape (Sound Surgical Technologies, Louisville, Colorado), mechanical massage or Endermologie (LPG Systems, Valence, France) and a combination of infrared light (700 nm), mechanical massage and bipolar radiofrequency or Velashape II (Syneron Medical Inc., Irvine, California).
Endermologie – The first Cellulite Treatment device
The first modality for the treatment of cellulite was developed in the 1970’s known as Endermologie (LPG Systems, Valence, France). This is a non-invasive motorized mechanical roller that mobilizes subcutaneous fat, temporarily improves arterial microcirculation up to four fold for up to 6 hours post-treatment, increases blood flow in the subcutaneous veins within the adipose tissue, and improves lymphatic drainage by three fold for up to 3 hours post-treatment, although fat redistribution was not observed.6
Does one see weight loss & a decrease in body circumference with Endermologie?
One study revealed patient’s lost a mean weight of 1.35 pounds and a mean body circumference of 0.54 inches undergoing 7 sessions.9 Another study confirmed these findings with a mean weight reduction of 0.45 pounds and body circumference of 0.45 inches after undergoing 20 sessions of treatment.10
How much improvement occurs using Endermologie for Cellulite?
Endermologie demonstrated softening of superficial skin surface irregularities and cellulite with a 50% improvement by objective blind photographic grading and a 92% patient satisfaction rate.10 Endermologie is approved by the Food and Drug Administration for the temporary improvement in the appearance of cellulite.
What about a radiofrequency device for Cellulite Treatment?
Technology using a mechanical roller, infrared light (700 nm wavelength) and bipolar radiofrequency was developed and underwent two alterations, known as Velasmooth, Velashape I and the newest model, Velashape II (Syneron Medical Inc., Irvine, California).
How does Velashape II work?
Heat generated by both the infrared light and radiofrequency is theorized to increase the delivery of oxygen into fat (adipose tissue). The depth of penetration of both infrared light and radiofrequency is not more than 3 millimeters. As with Endermologie, the mechanical massage improves circulation and may stretch the fibrous bands in the fat layer.11 Velashape II is approved by the Food and Drug Administration for the temporary improvement in the appearance of cellulite.
What is VASER Shape?
A non-focused ultrasound device, VASER Shape, manufactured by General Projects (Florence, Italy) and distributed in the United States by Sound Surgical Technologies (Louisville, Colorado) was FDA approved as a non-invasive device for the temporary treatment of cellulite in 2010. The author has observed up to a 50% improvement in cellulite with long-term results (up to two years) without further treatments.
What Awards has VASER Shape won?
This was voted at the annual “Aesthetic Show” in Las Vegas NV as the “Best Non-invasive Body Contouring Device”. Dr Troell won the best Non-invasive Body Enhancing Patient Award in 2011 using this technology.
How does VASER Shape work?
The VASER Shape system delivers a non-invasive treatment that uses therapeutic massage and external ultrasound using the combined action of two low-frequency ultrasound heads. This advanced ultrasound hand piece is placed over the skin so that the deep penetrating action of the ultrasound, up to 5 cm, is concentrated onto the affected tissue only, offering a treatment has been shown to be both safe and effective.12
The action of the low-frequency ultrasound (ultrasound diathermy) is followed with lymphatic drainage. This is performed through the use of the suction-massage hand piece with a special elastomeric membrane, which applies movement to the tissue. This membrane operates in an undulating motion, which gently lifts, folds and compresses the tissue following a sequence of movements specific to each area being treated. This manipulation improves lymphatic, arterial and venous circulation. With the same hand piece, the lymph nodes are opened prior to drainage, thus allowing the elimination of potential toxins and lipids caused by the action of the ultrasound.
What did the first published study on VASER Shape reveal?
In the first published series using VASER Shape in the US, the multi-center study revealed reductions of 2.1 inches in the abdomen and 1.0 inch in the thighs over 5 treatments performed once per week, and reductions of 0.8 in and 0.5 in, respectively, were achieved after the first treatment. These results were achieved with no adverse events and no patient discomfort.13
What are the Minimally Invasive Cellulite Treatment Devices?
Due to the less than optimal outcomes for cellulite treatment using any of the non-invasive medical technologies, minimally invasive techniques used for the treatment of cellulite have been brought to market:
- Palomar Medical Technology Cellulite Laser Device
Dr Troell and the Institute of Advanced Body Sculpting Study
Dr. Robert Troell’s study is the first IRB approved comprehensive study designed to compare both minimally invasive and non-surgical technologies with regard to comparing their safety and efficacy in the treatment of cellulite. The minimally-invasive modalities studies were Cellulaze, Palomar’s Cellulite Device and VASERsmooth.
One of the minimally invasive medical technologies studied is the side firing 1440 nm (YAG) laser technology known as Cellulaze (Cyanosure, Westford, Massachusetts). To date five patients underwent this technology on one thigh and they received minimally invasive ultrasound at 36 kiloHertz on the opposite thigh known as VASERsmooth (Sound Surgical Technologies, Louisville, Colorado).
Laser technologies kill fat cells, however, ultrasound does not with about 85% of fat cells and 87% of stem cells viable after ultrasound is delivered to the area of treatment. Variants of treatment using the VASERsmooth device include the addition of autologous fat grafting, autologous stem cell grafting and a combination of the fat and stem cell grafting methods.
The Slim Lipo Cellulite device (Palomar Medical Technologies, Burlington, Massachusetts) light fiber at 924 nm is still under investigation and internal studies by the manufacturer.
Here is a list of current treatment modalities for Cellulite. Dr Troell is performing the first world-wide study objectively analyzing all the cellulite treatment options available:
- Non-invasive (Non-Surgical) Technologies
- Endermologie vs VASER Shape followed by Endermologie
- VASER Shape vs VASER Shape followed by Endermologie
- VASER Shape vs VelaShape II
- Minimally Invasive Technologies
- VASERsmooth vs Cellulaze
- VASERsmooth vs Slim Lipo cellulite device
- VASERsmooth vs VASERsmooth adding autologous stem cells
- VASERsmooth vs VASERsmooth adding autologous fat transfer
- VASERsmooth vs VASERsmooth adding stem cells & fat transfer
- VASERsmooth vs VASERsmooth adding Platelet Rich Plasma (PRP) & fat transfer
The published objective study of the efficacy of Cellulaze
Dr. B. DiBernardo completed an excellent objective scientific study evaluating the efficacy, safety and duration of the clinical benefit in ten patients using Cellulaze (Cyanosure, Westford, Massachusetts), a pulsed laser that delivers energy at 1440 nm using a side firing light fiber.13 The study revealed with a single treatment observed for at least one year produced a “good” rating by survey. The results showed a patient survey of 3.2 and a physician survey of 3.4 (5 point scale) with a patient satisfaction rate of 93%.
Objective measures revealed improved skin elasticity of 29%, by elastometry, and increased skin thickness of 25%, by diagnostic ultrasound. The author concluded the following: 1) uneven dermal-hypodermal interface by melting the hypodermal fat to prevent its expansion into the hypodermis, 2) the connective tissue septae were thermally subcized and 3) the dermal layer due to heat production to increase skin thickness, producing skin tightening and stimulate collagen synthesis.13
- Draelos Z, Marenus KD. Cellulite: etiology and purported treatment. Dermatol Surg 1997;23:1177-1181.
- Rosenbaum M, Prieto V, Hellmer J, et al. An exploratory investigation of the morphology and biochemistry of cellulite. Plast Reconst Surg 1998; 101:1934-1939.
- Avram MM. Cellulite: areview of its physiology and treatment. J Cosmet Laser Ther 2004;6:181-185.
- Draelos Z. The disease of cellulite. J Cosmet Dermatol 2005;4:221-222.
- Querlox B. Cellulite characterization by high-frequency ultrasound and high-resolution magnetic resonance imaging. In: Goldman MP, Bacci PA, Leischof G, Haxel D, Angelini F, editors. Cellulite: Pathophysiology and Treatment, New York, NY: Taylor & Francis;2006:105-114.
- Watson J, Fodor PB, Cutcliffe B, et al. Physiological effects of Endermologie: A preliminary report. Aesthetic Surg J 1999;19(1):39-45.
- Revuz J, Adhoute H, Cesarini JP, et al. Clinical and histological effects of the Lift6 device used on facial skin ageing. Les Nouvelles Dermatologiques, 2002;21:335-342
- Adcock D, Paulsen S, Davis S, et al. Analysis of the cutaneous and systemic effects of Endermologie in the porcine model. Aesthetic Surg J 1998;19:414-420.
- Ersek RA, Mann GE, Salisbury S, et al. Noninvasive mechanical body contouring: a preliminary clinical outcome study. Aesthetic Plast Surg 1997;21:61-67.
- La Trenta, G. Endermologie versus liposuction with external ultrasound assist. Aesthetic
- Sadick NS, Mulholland RS. 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 2005;7:81-85.
- Atluri P, Barone F, Cervone J. Clinical Effects of Noninvasive Ultrasound Therapy for Circumferential Reduction Am Journal Cosmet Surg 2012; 29(2):114-120.
- DiBernardo BE. Treatment of cellulite using a 1440-nm pulsed laser with one-year follow-up. Aesthetic Surg J 2011;31:328-341.
Contact Dr. Troell’s Office for Your Free Consultation:
Dr. Troell and his staff are happy to discuss Reconstructive Plastic Surgery procedures with you and answer your questions. Please feel free to call our offices in Las Vegas, Nevada (702) 242-6488.
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