VASERsmooth

This unique technique works through the use of high frequency ultrasound at 36,000 Hertz known as VASER technology. VASERsmooth™ is a specifically designed ultrasound powered probe that has a cutting edge about 2 cm’s from the blunt tip.

This advanced instrument excises the vertically oriented fibrous bands. Additionally, the tip of the ultrasound probe delivers ultrasound energy to mobilize fat, smoothing out adjacent areas. Areas of excess bulging of fat can be smoothed out by micro-cannula liposculpting and areas of persistent indentations can be filled in by using one’s own fat, stem cells and/or platelet rich plasma (PRP). The “cobblestone” or “orange peel” appearance of cellulite, which is causing skin dimpling and contour irregularities, is more efficiently and effectively treated than ever before by VASERsmooth™.

The advantage over Laser technologies, such as Cellulaze (Cynosure), is that the procedure duration is one half shorter in duration with a much safer safety profile. The laser needs to achieve about 42° C to achieve the optimal effect, however, skin burns occur at 47° C. Thus, the range of treatment target temperature and tissue safety is narrow. The main limitation of any form of cellulite treatment is the lack of repair of the areas of indentations. Unfortunately, Laser technologies, such as Cellulaze, destroy fat cells. Thus, fat and stem cell transfer to these areas of indentations cannot be performed.

VASERsmooth™ reduces cellulite through tissue tightening, cutting those fibrous bands and by promoting your body’s creation of new collagen and alterations of the current collagen fibers. Additionally, 85% of fat cells and 87% of stem cells mobilized by VASER energy is alive and viable for fat and stem cell grafting both into the areas of indentations as well as under the entire skin areas treated.

The advantage of this layer of either fat alone or coupled with either stem and regenerative cells or platelet rich plasma (PRP), is that all these components have growth factors vital to healing and regenerating a thicker and rejuvenated skin.

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 or orange peel appearance.

The tissue changes in cellulite include: fibrous septae attachments of the skin extending into the underlying fat and even connecting to the underlying muscle, a thickened fat layer, fat lobules herniating up into the skin-fat interface as well as reduced skin blood circulation.

 

The most common areas of the woman’s body affected by cellulite are the posterior thigh and the buttock, however, cellulite may effect other areas as well:

• Buttocks
• Thighs
• Midsection
• Flanks
• Back

 

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.

When you undergo the minimally invasive VASERsmooth™ treatment, you will be given oral sedation to make you sleepy, make you relax and treat discomfort. You lie down on a comfortable procedure table after being prepared with warmed antibacterial solution and sterile drapes are applied. Monitors are placed for your safety. Some patients prefer to be more sedated and intravenous medications can be administered.

The procedure begins with the administration of a small amount of local anesthesia. Thereafter, one or more small incisions (about 1/8 inch) are made near the treatment site. A very narrow cannula will then be inserted through this incision and water with numbing medication (lidocaine) and a medication to stop bleeding (adrenalin) is infiltrated into the targeted cellulite area.

After adequate anesthesia, controlled ultrasound energy is delivered through a minute sized laser fiber to the treatment site. If needed, small amount of liposuction or addition of fat can be performed. The goal is a smooth skin contour that may be permanent.

In contrast to Laser technologies, the skin of the thigh and/or buttock affected with cellulite does not need mapping in 5 X 5 cm sections. The treatment areas is marked with areas of indentation (from fibrous septae) with one color pen and areas of fullness (fat herniation) with another, using a down lighting. This “down lighting” highlights the surface contour asymmetries and indentations to optimize the treatment strategies.

Initially, a standard VASER ultrasound probe delivers energy to the entire sub-dermal fat area. This step is performed until loss of tissue resistance is appreciated by the surgeon. Thereafter, the VASERsmooth™ probe disrupts the fibrous attachments noted by the markings until smooth unabated movement of the probe under the skin at these areas is again appreciated by the surgeon. Areas of excess fat fullness can be suctioned with a small liposuction cannula (2 – 3 mm).

If there are persistent areas of indentations in the area of cellulite, unresolved by cutting sub-dermal fibers by the VASERsmooth™ ultrasound probe, they may be treated by the following treatments to produce a smooth outcome:

1. Transfer a homogeneous, thin coat of one’s own fat immediately under the skin.
2. Transfer a homogeneous, thin coat of one’s own fat immediately under the skin and place fat into the areas of indentations
3. Transfer a homogeneous, thin coat of one’s own combination of fat mixed with stem cells in a homogeneous thin layer under the skin
4. Transfer a homogeneous, thin coat of one’s own combination of fat mixed with platelet rich plasma (PRP) in a homogeneous thin layer under the skin.

 

The preparation and sedation for the procedure on the day of treatment takes about one and a half hours, the procedure itself takes about one hour per area (thigh). If the above additions area performed, the length of the procedure may be prolonged by amount 30 minutes. Patients immediately stand up and can walk to their car to an awaiting driver to take you home.

There are currently numerous medical technologies, both minimally invasive and non-invasive, marketed for the treatment of cellulite. Dr. Troell has organized and is performing the first scientific study designed to compare the safety and efficacy of both minimally invasive and non-surgical technologies for the treatment of cellulite.

Additionally, a study investigating the optimal technique to harvest and process fat as well as stem and regenerative cells is ongoing. The study will be performed with the association of the Associate Dean of Research, Dr Mahboob Qureshi, MD, PhD through Touro University Nevada, Osteopathic School of Medicine.

Patients usually have on or two small incisions that should be dressed with a bandaid. Fluid may leak from the incisions for the first 18-24 hours post-treatment. Mild swelling peaks at two days after the procedure and 90% is resolved by one week. Mild, and rarely moderate bruising is experienced, which is resolved in most patients by 10 days. The pain needing oral narcotics is from one to three days, although the area is sore for about 10-14 days.

Light exercise can resume at one week and regular exercise at two weeks post-treatment. A compression garment is recommended to wear fro a three week duration.

Non-invasive treatments after the VASERsmooth™ procedure
may facilitate a smooth outcome:

1. Immediate manual massage
2. Non-invasive, non-focused ultrasound delivery, known as VASERshape, which can be delivered up to five days post-treatment
3. Mechanical massage in the form of a device known as Endermologie, which can begin about two weeks after the procedure