SURIGICAL ARTISTRY NOTES: CELLULITE ANATOMY AND CURRENT TREATMENTS

These are notes from a Continued Medical Education activity done by Calvin Lee, MD. Surgical Artistry views may differ from the notes below which are done by Medscape and Dr. Sasaki. The notes are intended to help others who are interested in aesthetic medicine, including other doctors, and to direct viewers to the original presentation:

Cellulite Revisited: An Anatomical and Clinical Study

2/16/2012 date of program. Found on www.medscape.com

Gordon H. Sasaki, MD. Loma Linda Professor and private practice in Pasadena

Paracrine functions of Adipose cells (Adipocytes)

Store energy
Chemical messengers
inflammatory components,
Adiponectin (increases insulin sensitivity),
Resistin (increases insulin resistance, converts fatty acid to glucose),
Plasminogen activator inhibitor (increases pro-clotting),
angiotensinogen (vaso constrictor),
leptin (a central nervous system depression for food intake and increases metabolism)
large source for estrogen and cortisol.

Adipose Tissue Overview

Can increase their volume by 6 times (hypertrophy) and can increase in number (hyperplasia).
From age 20 to age 60 - about the same number of adipocytes (fat cells) in our bodies
After gastric bypass, the size of adipocytes decrease

Patterns of fat distribution: Pear shape vs. Apple shape

Apple shape - visceral fat associated with hypertension, type 2 diabetes, and hypercholesterolemia

9 month fetus: male vs. female different. Induced possibly by adrogenic influence

Cellulite demographics

posterolateral thighs
buttocks
lower abdomen
can found anywhere there is fat
descirption: orange peel, mattress dimpling
Mostly found in women
Strong hereditary input
People with a normal body mass index can be affected by cellulite

Cellulite appearance

Skin dimpling or depression when standing or sitting
Bulging, pitting, dimpling, and plaque like deformation
Aesthetic problem, not a pathopysiologic problem

Possible Etiologies (causes)

Decreased integrity/elasticity of dermins
Weakening of dermal-subcutaneous border
Adipocyte hypertrophy or hyperplasia
Contraction of Septae
Increased compression of fat into reticular dermis

Cellulite treatment options

Cosmeceutical creams - multiple sessions short duration of response
Mesotherapy - multiple sessions short duration of response
Endermologie - multiple sessions short duration of response
Carbon dioxide therapy - subcutaneous, multiple sessions short duration of response
UltraShape - multiple sessions short duration of response
Ultherapy - focused ultrasound, destroys adipose tissue, causes collagen to contract
Liposonix - focused ultrasound, destroys adipose tissue, causes collagen to contract
TriActive - 808 nm near infrared diode laser, multiple sessions short duration of response
VelaSmooth - radiofrequncy, suction/massage, multiple sessions short duration of response
SmoothShapes - dual wavelength laser plus massage, multiple sessions short duration of response
Subcision - severing septae with 18G needle, 70% patient satisfaction, side effects of bruising, hyperpigmentation, and depressions in the area.
Ultrasonic or laser assisted lipolysis - liposuction can sometimes make cellulite worse
Cellulaze - 1440nm side firing pulsed laser, no suctioning, compression garment, increases thin thickening and collagen elasticity

Cosmeceuticals

Many studies hard to replicate, show some decrease in thigh girth
Aminophylline
Aminophylline/yohimbine
Caffein/theophylline/herbal extracts
Caffeine/carnitine

Liposuction can worsen the appearance of cellulite

Future directions

cryolipolysis - selective cooling of fat cells leading to apoptosis for noninvasive fat reduction, FDA cleared for body contouring, pending for cellulite reduction

Etiology of cellulite remains unknown.

Current treatments are unpredictable and of short duration

What does Surgical Artistry do/recommend for Cellulite? In order of our priorities for Cellulite

Diet
Exercise
Surgical Subcision (subcutaneous incision with a 18 g needle)
Possibly Acupuncture subcision (like surgical subcision, but with an acupuncture needle - hurts less, doesn't make complete cuts, and should be used with acupuncture cupping)
Possibly Acupuncture cupping (suction on cup-like devices). Cupping is usually done with acupuncture subcision (which hurts less and bruises less than surgical subcision - but the idea is similar). We currently don't offer cupping services at Surgical Artistry, but we are considering it in the future and we have the equipment. The limiting factor is time/staffing for us. There are some home kits for cupping which we have not evaluated, but may be considered. But call us if you want us to consider introducing this to you.

Consider the cosmetceutical creams that contain caffeine - we currently do not carry these
The results of Subcision, acupuncture cupping, and creams are not very dramatic. Most of our patients are most pleased with diet and exercise. With smaller fat cells, the cellulite appearance diminishes.

Note from Calvin Lee, MD (July 2012): We haven't been impressed enough with the current treatments of cellulite. I have made a webpage previously on this topic of cellulite treatments; however, I think there has only been minimal improvement since I made that webpage in 2008. It was back in 2008 when we thought about purchasing some of these machines (ie. Velashape), but after doing further research on it, we decided against getting them. We have in the past carried caffeine based creams; however, we didn't see enough improvement to keep carrying that product. Some patients loved it, but most didn't see a difference. However, with time, I think there will be hope in this arena. So keep researching and checking back with us. What can Surgical Artistry do? Currently our best recommendation for cellulite is diet, exercise, acupuncture cupping (essentially suction/massage), subcision for deep regions and keep our fingers crossed on improvements in anti-cellulite technology.

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This Surgical Artistry webpage is for information only, not medical advice.
www.surgerytoday.com homemade website by Calvin Lee, MD and Tzuying Tammy Wu, MD, Modesto, CA
Date of edit: 07/22/2012