Cellulite sucks. And as we get older, (oh joy!), it gets worse. It has a lot to do with skin tone, fibrous dimpling, and fat. There are methods out there like Cellfina and releases to help with cellulite. I looked at Cellfina, but didn’t end up getting it because of the cost- to me and to you-, and the fact it was really only effective for the deep dimples. What about all of that finer, smaller dimply stuff?
In my latest issue of the Aesthetic Surgery Journal I saw a study out of Brazil. If you don’t know, the Brazilian plastic surgeons do a lot of plastic surgery. This paper was about how to treat cellulite using a combination of releasing the dimples and then fat grafting. What really got me were the pictures. WOW. They were good. I know with these articles I need to take the results with a grain of salt. But I do a lot of fat grafting, and I see how the skin quality improves. This whole idea of broad release and then grafting makes a ton of sense to me.
So. “Cellulite: A Surgical Treatment Approach.” In the October 2018 issue. This was a study over 26 years, with procedures on 126 patients.
They went through the treatments currently available:
- Creams/ Topical treatments:
- vegetable extracts like ginkgo which are supposed to stimulate microcirculation
- Retinol to stimulate collagen
- Xanthines like caffeine
- Lymphatic drainage:
- controversial as to whether is effective
- Endermolgie
- High suction and massage therapy. Unclear if it works.
- Ultrsound
- Causes reduction in localized fat. It can be useful as a helping technology, but it has not been shown good as a sole therapy, and it is questioned at to how long it lasts.
- Radiofrequency
- Results last for 6 months. The heat generated causes damage to the connective tissue and fat. Question is how long does it last?
- Laser
- Removes some fat and causes some skin tightening.
- Mesotherapy
- Injection of substances which are supposed to dissolve fat, but studies show inconsistent results. There is not a set thing they inject, and involves a combination of hormones, enzymes, herbal extracts, vitamins, and xanthines.
- Carboxytherapy
- Injecting CO2, which is supposed to affect circulation and fat.
- Subcision
- Releasing the tether which causes the dimple using a needle or knife. This is like Cellfina, and again I think is good for the deep dimples, not as good for the superficial little ones.
- Surgery:
- UAL, liposuction have been used.
They then went through their technique:
They graded people on their fat distribution, skin quality, photographed, and then assessed by 4 people after at 18 months, and answered a questionnaire of how they felt.
Procedure:
- Tumnescent used
- They harvest about 240cc of fat from the hips using a 3mm cannula on a 60cc syringe
- Then they use a “duck beak” 3mm cannula to do superficial liposuction to release the fibrous connective ligaments (to release the skin from the subcutaneous tissue)
- Unlike subcision using a needle or blade, they feel this technique with a cannula limits damage to the blood vessels, which is important to keep the skin well vascularized so you don’t get skin necrosis, and you will have better blood supply for the grafted fat.
- They use a “pinch test” to confirm the degree of skin loosening.
- Unlike other techniques, they do a broad, flat area, not a “spot” treatment.
- Then they inject a fine layer of fat. Their goal is a layer of new fat 5-8mm thick. (Do they inject with the same cannula? How much per pass? What size syringe? The photos look like the same cannula and a 60cc syringe, but it is unclear)
- They then apply 5cm wide paper strips to decrease swelling and keep the fat in place. This is left in place for 3 weeks and compression garments are used. After 3 weeks they remove the paper tape strips but keep the compression garment for another month.
Complications: 7% required correction due to skin irregularities, retractions, or recurrent cellulite. Bruising was the most common complication, and it resolved with time and massage. There were two cases of small seromas, which resolved with aspiration.
Results: Overall good to excellent, especially in young patients with good skin elasticity.
In their discussion, they state the reasons for cellulite. These include
- hormones. Estrogen stimulated fibroblasts, edema, changes collagen causing formation of the septa in the connective tissue, and stimulates fat formation
- genetic differences. Latinas have more cellulite in hips, where Northern Europeans do in the abdomen.
- Aging. Skin thins and decreases in elasticity.
- Dermal issues. Microcirculation decreases.
- Things which increase fat formation: cortisol, antihistamines, hormone replacement, beta blockers, excessive alcohol.
- smoking. This decreases microcirculation and decreases tissue oxygen levels.
They think their technique is good because of the broad area, the release of the septae, the preservation of the blood supply, and the effect of the stem cells in the fat grafting.
My thoughts?
Their photos are impressive. I agree with a lot of their thought process. They only showed a few patients, so it is unclear how their results are, particularly in older patients. Where I really see cellulite being an issue is in the 45 year and older crowd. How does this work in their skin types? Do they process the fat? How much do they inject back and where? And I wonder about the 3 weeks of staying taped (do they shower?) and the almost 2 months of a garment. For sure an interesting idea though. On a smaller scale, I have tried this as a “spot” treatment in the buttock with varying success.