Dr. Patrick Treacy discusses the "Treatment of Cellulite"

Oct. 29, 2009 - PRLog -- The first cellulite device started its life in France as a deep tissue massage for horses until a company called LPG systems decided to try its effect on cellulite. The company called the procedure, Endermologie® and claimed it could increase circulation by 200%, by expelling toxins and water build up while the underlying connective fibres were stretched. The product was again heavily marketed in magazines and on the TC networks. Despite many clinical trials, the clinical evidence of the procedural effect remains ambiguous. One study performed in 1998, showed a mean index reduction in body circumference of between 1.34 and 1.83cms. Despite this evidence, another clinically controlled trial by Collins and others, Cellulite Treatment, A Myth Or Reality. A controlled trial of two therapies Endomologie and Aminophylline cream' was published in Plastic and Reconstructive Surgery 104:1110-1114, 1999. This study found no objective difference in the thigh girth or thigh fat depth of 52 women who were measured by ultrasound. It further showed that only 3 of 35 patients with aminophylline-treated legs and 10 of 35 patients with Endermologie® treated legs actually felt that their cellulite appearance had actually improved. The authors concluded that neither of the two treatments was effective in improving the appearance of cellulite. Despite these findings, the Endomologie® procedure continues to be widely marketed and the process has gained popularity in some quarters. My own impression from the experience of many colleagues is that the procedure does work. However, it usually takes 10 to 20 treatments to see any results and the patient has to do one or two maintenance treatments per month to maintain any beneficial effect.

       In 2003, the Lipodissolve® procedure was introduced to the UK and Irish market. During this procedure, phosphotidyl choline is injected directly into subcutaneous fat in an effort to dissolve it. It is not surprising that this method would be evaluated in an effort to see its effect on cellulite. In 2004, Network Lipolysis invited me to become European Group Leader for the evaluation of this pharmaceutical in the treatment of cellulite. The injections are quite painful and in my experience not always successful in treating the resilient condition. It takes multiple treatments to see any reduction in size and the dimpling effect often remains. By 2009, Ailesbury had treated nearly 700 patients with this compound in differing areas to date and our results will soon undergo scientific evaluation as part of a European trial.

      Carboxytherapy® entered the cellulite marketplace in 2006. This technique claimed to improve the appearance of cellulite by improving local tissue metabolism and perfusion. Treatments were rapid, but uncomfortable. Carboxytherapy® was technically a non-surgical method where carbon dioxide (CO2) was infiltrated into the subcutaneous tissue through a tiny needle (0.3mm in diameter). From the injection point, the carbon dioxide diffuses easily into adjacent tissues. The patient felt the parts being treated balloon as the gas being flowed in by puncture holes made by needles.  The device claimed to work in two complimentary ways. Firstly, and quite simply carbon dioxide mechanically kills fat cells but supposedly bursting them. Secondly, it causes dilation of blood vessels on the capillaries in the area. Wider vessels mean bigger and stronger blood flow to the area, which means more oxygen. The increase in oxygen is important because it eliminates the built up fluid from between the cells. The end result is fewer fat cells and firmer subcutaneous tissue.
The treatment was not comfortable. The areas surrounding the injection sites will be inflated for 10 to 20 minutes as CO2 is being infiltrated. The level of comfort will decrease during the procedure. Between 10 and 20 sessions are necessary to eliminate cellulite. Ideally they should be carried out every other day, although sometimes two or even one session per week will be sufficient due to the level of pain. This will depend on the extent of your cellulite. Each session lasts between 10 to 15 minutes. After the 5th session you will see that your skin looks noticeably healthier. Around the 8-10 session mark, you will appreciate that your subcutaneous tissue is firmer. Before the treatment program ends you will have firmer, cellulite free skin.

            In 2007, Ailesbury ran the European trials for a new medical device, which promises to be the most interesting development to date in the battle against cellulite. This product was called the VelaSmooth® and the machine had already undergone rigorous medical testing in the United States. The products works by using a combination of bipolar Radio Frequency, Infrared light, and suction in an effort to safely and effectively re-contour the skin surface. In clinical trials in both Israel and the United States, it appears to be the most effective treatment available to date. The device apparently works by allowing radiofrequency to heat fat tissue to a depth of 10mm and the makers claim this process increases oxygen intracellular diffusion. The infrared light part of the product heats subcutaneous fat to a level of 3mm and increases skin elasticity. The suction device is similar to Endomologie®   in that it can manipulate and smooth out the skin. The procedure requires two treatments a week for five to six weeks and the effects last about six months before requiring a top up treatment. The overall cost is about €750 for the complete package.

The future of Cellulite treatments

So where does that leave us?  There is no doubt; most doctors now agree that cellulite is more often seen in women due to hormonal reasons. The scientific rationale behind this has not been fully evaluated. We know that cellulitic fat is arranged in large chambers of macromolecules that are separated by columns of collagen fibres. Whenever excess fat is stuffed into these fibrotic compartments, it will cause them to bulge out, giving the surface dimply appearance of cellulite. Scientists also know that the 'dimpling' is made worse because of underlying water retention and fibrosis caused by impaired circulation and destruction of the tissues in this area. This is the main reason that many treatments can give a temporary solution to the problem. The effect is only temporary because in effect, cellulite is localised fat 'caught in a jail' of surrounding scar tissue and these fibrotic walls must be broken down before we can see a more long-term solution to the problem.

   From my personal point of view, one is still advised to sign up a course of treatments. However, I feel it will take a combination of the above treatments to eventually solve the problem of cellulite. Like the old spaghetti westerns, we probably require a technology like Velasmooth®  to break down the walls of the jail and a compound like phosphotidylcholine to dissolve the baddies contained within. The trials surrounding this combination therapy have already begun in Canada and Italy and slowly but surely patients are beginning to see medicine and doctors at last becoming interesting in dealing with this tenacious condition.

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Dr. Patrick Treacy is Medical Director of Ailesbury Clinics Ltd. He is Chairman of the Irish Association of Cosmetic Doctors and Irish Regional Representative of the BACD. He is a Medical Advisor to the UK's largest cosmetic website Consulting Rooms.