Smooth Operators

How to manage expectations and identify the best candidates for minimally invasive and noninvasive cellulite treatment options.
Smooth Operators

Cellulite. The very word makes women—and some men—cringe. It’s a condition that affects people of all ages and body types. For decades, treatment options have been numerous and sometimes downright medieval, ranging from machines that vibrate wide canvas belts surrounding the hips and buttocks electrical muscle stimulators, mechanical massage, and a host of creams, serums and injectables. The problem: Until recently, no treatment modality has offered long-term results. The introduction of minimally invasive systems that promise results of two years or more—including the laser-based Cynosure Cellulaze and Sciton CelluSmooth; and Ulthera’s Cellfina, which does not rely on heat or energy—have spurred renewed interest in cellulite treatment. We asked physicians who have worked with these systems to share their experiences in patient selection, degree of improvement and longevity of results.

Cellulite Basics

The top layer of fat just under the skin on the thighs, hips and buttocks is connected to the lower layers of fat by vertical collagen fibers (fibrous septae). When estrogen levels decrease due to factors such as age, so does circulation and collagen production. As fat cells become larger, the lack of collagen allows them to protrude through the fibers and become visible on the surface of the skin in a cottage cheese or orange rind appearance.

Cellulite most commonly affects women because estrogen stimulates subcutaneous fat storage. It appears in the fat-prone areas of the body: the knees, thighs and buttocks as well as the stomach and backs of the arms. The male hormone testosterone, on the other hand, stimulates protein resulting in more dense layers of connective tissue and thicker skin layers, which help to prevent cellulite. “Ninety-eight percent of women have cellulite because it’s estrogen-based. It’s a female characteristic,” says Suzanne Kilmer, MD, founder of the Laser & Skin Surgery Center of Northern California in Sacramento. “If you put men on estrogen therapy to treat, for example, prostate cancer, they will actually develop cellulite.”

Minimally Invasive Treatment Options

Two of the most talked-about treatments today are Cynosure’s Cellulaze and Ulthera’s Cellfina. Both are FDA-approved and promise long-term improvement in the appearance of cellulite in a single treatment.

Cellulaze is a 1440nm laser-based procedure that takes 60–90 minutes and delivers long-lasting (one year or more) results after one treatment. Local anesthesia is applied and tiny incisions are made in the treatment area. The proprietary laser fiber is threaded through a cannula that’s inserted through the incision(s). It levels out fatty bumps, releases fibrous septae and stimulates collagen production to increase skin thickness and elasticity.

Clinical trials have noted patient satisfaction rates at 93% one year after treatment. Side effects include bruising and general soreness that can last up to a few weeks. Some patients experience hyperpigmentation. “It works. It’s very effective. It’s long lasting. But you have to find the right patient type,” says Cynthia Poulos, MD, founder of Classique Medical Spa in Northborough, Massachusetts, who was an early adopter of the procedure that debuted in 2011. “When you have someone who has reasonable tissue tone and moderate cellulite, it’s a fantastic procedure.”

Cellfina, launched in 2016, is a subcision-based, in-office procedure that takes about one hour, depending on the size of the area treated. Local anesthesia is administered to the treatment area. Using suction and subcision, the needle-like device administers pressure on the fibrous septae. Repeated pressure eventually releases the fibers to smooth the skin surface. It can take as little as three days to see results, which are expected to last at least two years, and side effects—including soreness, tenderness and bruising—are minimal.

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