Cellulite Treatments Lack Support

[Bailey]

Cellulite treatments may lack supportive evidence of efficacy - real skinny on techniques designed to blast away troublesome condition


National report — Few aesthetic procedures are more desperately desired than cellulite reduction, and in response to that strong demand is no shortage of supply, in the form of lasers and light, heating and cooling devices, wraps, creams and other concoctions. But do any of them work?
Some published studies show hints of improvement in treated areas and colorful histologies suggesting tissue and fat changes. However, when it comes to the bottom line — patient feedback — the efficacy of most treatments is underwhelming.


Before (left) and three months after one treatment with the Thermage Body Tip 16.0 (Solta Medical). The patient had 288 pulses from the tip applied over the entire abdomen. (ALL PHOTOS CREDIT: ROBERT WEISS, M.D.)

An ongoing survey on the patient feedback Web site http://RealSelf.com/ perhaps says it best. The "Was it Worth It?" survey, ranking aesthetic treatments according to patient satisfaction, showed cellulite treatment to be next to last on the list of 33 procedures, with only mesotherapy ranking lower. The radiofrequency tissue-tightening device Thermage (Solta Medical) ranked only two spots higher, and fellow tissue-tightening device Accent (Alma Lasers) was also in the bottom 10.





And although patients' sentiments tend to be overshadowed by heavy marketing efforts to the public, many physicians share that lack of enthusiasm. The existence of a truly reliable, consistent technology offering long-lasting improvement of cellulite remains elusive, they say, and, according to Mathew Avram, M.D., no technologies that exist even come close to offering the kind of results that could be considered significant improvement.

"At this point, I don't think there is even a leading candidate," Dr. Avram tells Cosmetic Surgery Times. "There is simply no technology that can improve cellulite in a significant and long-term manner. That doesn't mean there aren't things being developed that might come down the road in the next year or two, but at this point, there just isn't a game-changer."
The silver lining to that isn't glaring, but it does exist. Current modalities, for all of their shortcomings, still have a role for that niche of patients who would rather have something — even if it's short-lived and less than spectacular — than nothing.

"There are clearly some patients who are happy with seeing just a modest benefit for a temporary period of time, and if that is all they require and expect, then you might have a satisfied patient," says Dr. Avram, director, Dermatology, Laser and Cosmetic Center at Massachusetts General Hospital and affiliate faculty at the Harvard Medical School's Wellman Center for Photomedicine. What's essential, however, is setting those expectations from the start, he adds.

"We have to be honest with patients and tell them that the technologies that exist for cellulite treatment have only temporary and limited effectiveness."

For those patients who know the facts and choose to give it a try anyway, devices that show the strongest results include radiofrequency devices Accent and Thermage; VelaSmooth (Syneron), a combination radiofrequency and infrared light device; and Primaeva, a bipolar radiofrequency micro-needle device, according to Macrene Alexiades-Armenakas, M.D.

SKIN SURFACE TECH "Accent has been shown to be the most efficient in terms of treatment numbers for skin surface technologies," says Dr. Alexiades-Armenakas, an assistant clinical professor at Yale University School of Medicine.

As opposed to VelaSmooth, which requires seven to 14 treatments, Accent takes just four treatments. However, Accent is more time-intensive and expensive, Dr. Alexiades-Armenakas says. Results with Accent in a study that she co-authored were mild, but surprisingly long-lasting.

"The results were consistently modest for the skin surface technologies and lasted until at least a three-year follow-up in my trial patients," she says.

For the study, patients were given an average of four treatments at two-week intervals, and the results showed about an 11.25 percent of mean improvement in leg dimple density; about a 10.75 percent mean improvement in dimple distribution; and about 2.5 percent improvement in dimple depth (J Cosmet Laser Ther. 2008 Sep;10(3):148-153).




One critical consideration is picking the right patients, and with the Accent, that means patients with skin laxity, Dr. Alexiades-Armenakas notes.

Their results may not score home runs yet, but the new devices nevertheless represent a positive movement toward truly effective cellulite treatment, Dr. Alexiades-Armenakas points out. "Each new device gives better results, and patient satisfaction is steadily improving with each generation of technology."

BODY CONTOURING In terms of body contouring, another device that is evolving is the Thermage RF device, and Anne M. Chapas, M.D., says she had encouraging results with the company's new Thermage Body product, with results lasting up to six to 12 months when patients maintained diet and exercise programs.

In a study that was in press at the time of publication, Dr. Chapas reports that the new Body Tip 16.0 produced a reduction in abdominal circumference in 68 percent of patients after four months of treatment.
"The ideal patient for most noninvasive body contouring procedures is at their ideal weight or no more than 10 to 15 pounds above their ideal weight," she says. "Patients should be looking to tighten skin or contour small pockets of adipose tissue, and they need to maintain healthy diets and regular exercise."

Unlike cellulite improvement, body contouring can be reasonably well documented, giving patients an added level of confidence in results, Dr. Chapas adds.

"Most patients are extremely satisfied with the body-contouring techniques, because we can document their results with measurements and photos," she says. "Cellulite technology still has a long way to go, since we can only document improvement in photos."

TOUGH NUT TO CRACK The big challenge that makes cellulite such a tough nut to crack — and to treat — is that it involves addressing very complex issues regarding the texture of fat and skin, Dr. Avram explains.
"Certain lasers can work well for body contouring and the removal of fat, but cellulite is largely caused by the architecture of skin in women, and in order to affectively treat cellulite for a long period of time, you really have to change that architecture and the way the fat is organized under the skin. That makes it very difficult to accomplish, whether through technology or surgery. It's hard enough to improve fat, noninvasively, but to improve cellulite is far more complicated," Dr. Avram says.

Patients who choose to go ahead with any treatment with the hopes of improving cellulite should be well-informed of the challenges — and spared any false hope of any significant improvement, Dr. Avram emphasizes.

"What we as physicians need to do is explain to patients what cellulite is, that it is a normal condition for females, that it really doesn't have much to do with their weight, and the two things that current treatments have in common are that none are significantly beneficial in the long term, and all are either moderately or very expensive," Dr. Avram says. "As long as we're honest and upfront and we assess critically how successful these treatments are, our patients will be happy and we'll do them a service."


Disclosures:

Dr. Avram holds stock options with Zeltique.
Dr. Chapas is an investigator for Solta, Syneron and Zeltique.
Dr. Alexiades-Armenakas has conducted Food and Drug Administration trials for almost every skin tightening technology on the market.

[Vivian]

cellulite is like the common cold, why can't it be fixed!!!!!

[PinkButterflyGlitter]

Does anyone know what treatment Kim Kardashian got done for her cellulite? Supposedly she was really happy with the results and she said it got rid of all of her cellulite. I'd love to know exactly what she got done.....

[Canadian Princess]

Originally Posted by PinkButterflyGlitter

Does anyone know what treatment Kim Kardashian got done for her cellulite? Supposedly she was really happy with the results and she said it got rid of all of her cellulite. I'd love to know exactly what she got done.....

I was reading that somewhere...I think it was VelaShape Laser treatment for her cellulite...