Endermologie

At the onset of treatment, the patient puts on a body suit. The Endermologie machine is turned on and spontaneously undergoes the calibration process. The treatment personnel validates the parameters on the LCD display to include: time in minutes, which for the thigh is 9 minutes each, and the suction settings can be changed from 1- 6, starting at level 3.

The device is then placed on the treatment area; suction is tested to be “on” by the treatment personnel. The rollers are placed on the patient’s skin and the patient is asked if they are experiencing discomfort.

 

If they are tolerating the treatment, suction is steadily increased until the setting where discomfort is elicited. If there is discomfort at the start of treatment the setting is decreased from 3 to 2. The treatment continues at the tolerated level for one minute. If tolerated, the treatment personnel will then increase the suction setting one unit level.

 

This process is repeated every minute with changes in setting related to the presence of discomfort. The movement of the rollers on the thigh occurs in all directions.

 

In order to optimize the treatment result, it is important to grade the severity of cellulite prior to commencing treatment. The Universal Cellulite Grading System developed in 1972, the Nurenberger-Muller Grading Scale, was chosen to ensure uniformity in cellulite assessment. There are four grades of cellulite ranging from grade 0-3:

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.

 

For optimal results when treating different types of cellulite, LPG has specified Pre-Set Program Parameters for each type of cellulite. Cellulite is mainly present on the posterior thigh area, other thigh areas, and the buttocks. Rarely, is cellulite located elsewhere. The recommended parameters included: Duty cycle %, Frequency (Hz), time for each treatment, and roller speed.

A diagrammatic representation of the skin and subcutaneous tissue changes is noted.

Cellulite is present in about 85% of post-pubescent women, which usually affects the thighs and buttocks. The pathogenesis of cellulite includes fibrous septae attachments of the skin extending into the subcutaneous fat connecting to the underlying muscle, a thickened hypodermal fat layer, hypodermal fat lobules herniating into the dermal-hypodermal interface and reduced microcirculation. Ultrasound imaging has been used to view both the skin thickness and the dermis-hypodermis interface.

This is a non-invasive motorized mechanical roller that mobilizes subcutaneous fat, temporarily improves microcirculation up to four fold up to 6 hours post-treatment, increases flow velocities in the subcutaneous veins within the adipose tissue, and improves lymphatic drainage by three fold up to 3 hours post-treatment, however, in vivo redistribution of fat was not demonstrated.

Biopsies reveal that Endermologie increases elastin or oxytalan fiber diameter and density. Collagen fibers show a more compact appearance with increased density in the papillary and upper reticular dermis (although the collagen effect is weaker than the elastic fiber effect). Despite these histological changes, there was no change in skin elasticity as measured by a Cutometer. There is no evidence to document if this is a temporary or permanent effect.

With Endermologie, there was a subjective observed reduction in adipose volume, however, this observation lasted only two weeks after treatment. A porcine study revealed accumulation of dense, longitudinal collagen bands in the mid and deep sub-dermis with distortion and disruption of adipocyte cell membranes. No inflammatory response, skin or muscle injury was observed. The skin and subcutaneous tissue thickness remained constant.

In one study, patients lost a mean weight of 1.35 pounds and a mean body circumference of 0.54 inches undergoing 7 sessions. 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, although no long term follow-up was performed.

Additionally, 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. However, objective measures of body contouring were minimal and proportional to weight loss. Thus, Endermologie alone should not be considered an effective body contouring method.

Clinical outcomes can be observed as shown below. However, patients require continued treatments between once a week to once a month to keep the results long term.

 

In an attempt to achieve permanent results as well as an improved outcome, Dr. Robert J Troell, FACS, FAAFPRS, FAACS, FAAOHNS, FAASM has under taken an Investigation Review Board (IRB) approved scientific study combining VASERshape with Endermologie for non-invasive cellulite treatment.

When performed after VASERshape, the Endermologie treatment is begun immediately after VASERshape treatment is completed. The hypothesis is that the increased tissue temperature and mobilization of fat by “cavitation” from the ultrasound, should be more easily molded using the mechanical rollers of Endermologie. Additionally, Since the VASERshape produces permanent results by itself, combining with Endermologie may bring improved as well as permanent outcomes.