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Fat and cellulite remodeling or sculpting has not succeeded with the advent of non-invasive fat contouring devices or machines including ultrasound, and still has not reached the results of liposuction. Poor results or no-results , are common feedback from clients, in more than 60% of clients undergoing such interventions. But clients, even with no improvement on these machines are happy, because they did not undergo cosmetic surgery, avoided risks, and can at least talk about their experiences in the salon. Deficiencies and omissions in the current technologies have been highlighted, and have impacted negatively on outcomes of cellulite treatment. The demand for salon-based, pain-free fat removal or smoothening  of contours, by non-invasive devices, has led to disappointment, but is on the increase. Fat-popping of adipocytes and efficacy with ultrasound still remains controversial as well as speculative, with unprecedented need for upgrade of devices to achieve client expectations, best practice and outcome-standards in 2-years. Because ultrasonic devices focused on fat-contouring, at best can only smooth out minor-lumps and bumps at the moment, and clients have to lie on the table for hours just to lose 1 or 2 cm circumference at most. Not really a nip and tuck. There are no best-practice treatments quite yet, and recurrence ( fat-recollection or break-outs) at the treatment site is a major setback, despite what manufacturers say about adipocyte destruction and ultrasound durability. Less than 7 treatments  of whatever machine is used, render , basically no definitive or consistent result, and recurrence can be guaranteed in the salon. Most doctors now need to use add-ons or combinations, including RF in the salon, to show any affect at all. This is because the first generation models rendered poor cosmetic results and fat contouring was not properly achieved. Manufactures and doctors had to back-down on predictions and claims, because of poor and inconsistent outcomes, that annoyed clients. So, two devices and two-fees are needed to treat cellulite clients. Ultrasound and now added-RF. Studies show that body-wrapping, popular in the past in salons, render greater thigh circumference fat-loss than after 5 ultrasound treatments, at one-tenth the cost. Clients still need life-style changes, Power Plate™ and diet correction over years, after ultrasound or other treatments, to correct body-mass index. There are no miracles, silver bullet solutions, or cures for cellulite affecting the lower abdomen, thighs, back of thighs, saddle-bags and love-handles, and this includes ultrasound. Fat-contouring misfortunes arise from false ideas or perceptions, and poor advice or inappropriate patient selection. Fiction of superiority of one product in the non-invasive range over another abound , and boastful doctors, proliferate.

Fat-contouring machines try to satisfy the consumer’s dawn to science. Problems are evident. Research testing has mostly been in-house, clouded with secrecy, and is a biased affair. Woman repeatedly shoot themselves in the foot enduring perpetual dissatisfaction by unrealistic treatment or claims, regarding cellulite amelioration, coupled then by bouts of apathy. But they go back for more, hoping that their appearance can be improved in the salon. Even if the clients see no results, they say their choice represents sound judgment without indoctrination, unclouded by wishful thinking or marketing. Fat-contouring marketing with flamboyant pamphlets or absence of long-lasting results or proof-of-science, is a manipulation-toy targeting gullible woman, with whom industry and cosmetologists  play cat and mouse.

The fat contouring market is rich in devices and treatments: Ultracontour™, LPG™, Endermologie™, Synergie™, Velasmooth™ and Velashape™, Ultrashape™, Svelte™, topical creams, Triactive™, Carboxy-Therapy ( CDT™ and Rioblush™), mesotherapy, manual lymphatic drainage, Neoprene™ shorts and tights, Lipodissolve™ and Liposonix™, to mention a few. Not a lot of reassurance and bewildering for potential clients, who keep asking….Doctor does it really work, and will it work for me ?. Doctor’s credentials, references and local experience in their salon, become important. The manufacturers of ultrasound fat-remodelling devices have admitted that combination therapy is now needed to address the variable results and deficiencies of ultrasound. Some have resorted to the use of complimentary RF to address the epidermal component. So, another double-fee for the client, and more treatment sessions. Senseless to use so many combinations. So, as a client, if your doctor’s ultrasound fat-contouring device in the salon does not have RF, needs additional further add- on or combination options to do the job properly , ask him to refer you rather to a salon that provides a comprehensive fat-contouring service with say Velasmooth™ or Velashape™ ( Contact Syneron; or Radiant Health,Gauteng RSA), both of which have built in RF and massage capabilities. The latter devices are in use and operational in most major centres in South Africa. On the other hand, most ultrasound focused companies looking at cellulite-contouring, are grappling with the addition of massage technologies and RF, but have admitted that they cannot attain tissue-tightening. New upgraded and stronger light-sources have been introduced. For the informed-client with suitable budget, cosmetic surgery via liposuction/Smartlipo™ and abdominoplasty render durable results and a flat stomach. But the problems of cellulite do not go away over-night: ” The multifactorial etiology and nature of cellulite make it a particularly difficult condition to treat ”: Doris Hexsel (1).But there is hope for clients seeking non-operative treatment of cellulite, and  want to avoid an operation to get rid of fat collections. Provided they sit down with the therapist, don’t rush, and have a fact-revealing discussion including exercise and dietary aspects, in order to facilitate an informed decision. Because many treatment sessions are needed in the vast majority of clients seeking fat-contouring, and visible results may only be obvious in the mirror after the 7-10th treatment session. You may, however, be one of the lucky few ones that see notable changes after 4 treatments.

REFERENCE: (1). Goldman MP et al. Cellulite. Pathophysiology and Treatment, Taylor & Francis, New York, 2006 (Valuable study resource).


Earlier generation devices available for fat-contouring, such as Ultrashape™, Endermologie™, Synergie™, and Velashape™ do not seem to achieve the smoothening results of liposuction or Smartlipo™. This also applies to other RF devices. Liposuction removes controlled quantities of fat by suction, and therefore debulks the deeper fat depots in the treated zone: areas that ultrasound or massage cannot reach properly.  That is, appropriate mechanical debulking of the fat. Both Ultrashape™ and Velashape™ can contour modest fat deposits, but cannot remove quantities of fat, AS SEEN AFTER LIPOSUCTION/SMARTLIPO™. These other devices can smooth superficial fat under the epidermis but the results are costly and non-permanent. In the end, liposuction is more cost effective. The concept of fat destruction by ultrasound offers no real clinical advantage over the Velashape™/ Velasmooth™ that contours by RF, skin-toning and massage. In the case of Velashape™, the microcirculation and lymphatics are addressed by ELOS Technology. The ELOS technology used in Velashape™ and Velasmooth™ is FDA approved for the short-term treatment of cellulite in man. From a medical-legal point of view the ELOS driven machine can be driven by a medical practitioner and/or trained beautician/medical assistant. Ultrashape technology is not approved by FDA (but CE marked) at the time of posting of this review. Therefore the use should be restricted to qualified medical practitioners only (or medically trained personnel/clinicians and registered with HPCSA), and beauticians/ nurses should not man apparatus that physically and intentionally destroy sub-epidermal fat. Although perceived as minimally invasive, it is quite understandable that intentional destruction of fat in an enclosed compartment or space will be seen (and raise eyebrows) as invasive by the medical profession and balanced, informed opinion. This differs from the use of ultrasound under guidance during surgery, when most of the released fat is sucked out under controlled conditions, and approved by plastic surgery associations/regulatory bodies. Because ultrasound is used to treat renal stones, does not mean that it is not harmful with exposures up to 80 minutes at a time to treat cellulite. Possibly 2-3 cm per limb circumference can be reduced/remodeled/ sculptured in the short-term by these non-invasive devices ( very minimal) and this circumferential loss is quickly regained in 6-9 months at follow-up in persons not following a weight–reduction diet. It is important to understand from an anatomical point of view that cellulite and obesity is basically one and the same thing and only really differs in grades. The results of Ultrashape™ and other ultrasound driven devices, are being monitored because of the controversy and unresolved issues regarding fat/lipid metabolism after fat popping. One criticism that has been leveled at Ultrashape™and other ultrasound devices for fat modification, by academics, is that the fat that is released after ultrasonic destruction, together with the released fatty acids, has nowhere to go to, and is an unphysiological situation in a tissue compartment ( trapped by encapsulating anatomical fibrous septa and planes). No doubt the fatty acids that drift around for days is ultimately absorbed into the lymphatics and then swept away or oxidized. There is no definitive proof that the released and stagnating fat particles, following fat /adipocyte destruction, is absorbed into the veins, and can lead to pulmonary and fat-embolization ,but studies are still outstanding. Clearly, the absorption is not the same as during absorption of fat particles in the GIT. The destruction of fat by ultrasound in an uncontrolled fashion in persons with lipid disorders, hyper-cholesterolaemia and hyper-triglycerides needs to be studied and these individuals may be at risk. The role in Trans fat also needs to be clarified. Also it controversial if patients who are treatment failures, can be safely re-exposed to further ultrasonic irradiation at a second and third session later on, apart from the initial 5-6 sessions. This dilemma may not apply to  Velasmooth™ and Velashape™ that are FDA approved devices, and modulate by gentle massage and RF. Also LPG™ is safe with follow-up treatment sessions because the method of fat modulation does not rely on fat destruction.

Smartlipo™, an upgraded minimally invasive liposuction-technique to treat cellulite renders far superior body sculpturing results than other cosmetic devices currently used in clinics, SPAS and MediSpas. This was inevitable, due to the poor non-permanent performance of these devices in ameliorating cellulite. One of the outcome problems that have become evident with the use of various fat-contouring devices such as Ultrashape™, Velasmooth™ and Accent™ to treat cellulite are as follows.

  • Because of the inability to render clinical satisfactory results in terms of effective and desired body sculpturing end-point analysis, over servicing of clients with costly combination therapy has become problematical. Many persons with cellulite are resistant to Ultrashape™ and other ultrasound related devices aimed at cellulite sculpturing treatment. You may be one of these.
  • To lose 1-2 cm of circumferential fat has now meant 8-15 treatments and then treatment failures still occur.
  • Invariable reported results have pressurized clinics to administer add-on treatments i.e. RF + Ultrashape™ + LPG™+ Velashape™, meaning many visits , up to 6 months to the clinic at very high costs and wasted time. This was very obvious at IMCAS Paris Cosmetic Congress 2008.
  • Uncertainty and safety of prolonged multiple ultrasound exposures to the patient’s abdomen and pelvic organs as used in ultrasound and other ultrasonic devices. This can be problematical in early pregnancy if the fetus is exposed to pulsed ultrasound on a weekly basis. Perhaps such clients should provide evidence of pregnancy status, by a pathologist before ultrasound therapy is commenced. This would also apply to the use of  Velasmooth™ and Velashape™. Most clients will need 8 treatments to lose a mere few centimeters, at substantial costs, but means that the total cumulative exposure to ultrasound waves/irradiation will be around 600 minutes ( 8x75 min), or 10 hours which is far more than used in diagnostic radiography or time used to break up renal stones. This would no doubt impact negatively on a fetus in an undisclosed pregnancy. Many women still bear children in the age group, 40-45 years. Diagnostic ultrasound, yes, but not therapeutic cyclical treatment for cellulite with a baby in the womb.
  • Following Ultrashape™ and similar ultrasound devices destruction of fat cells, lipid fluid can stagnate in the treatment areas for up to 14 days, according to reports given at IMCAS PARIS 2008.
  • Destruction of fat cells by ultrasound for cosmetic purposes is not a physiological approach and places the human metabolism and hepatic clearing mechanisms (especially in persons with lipid disorders and therefore cardiac risk factors) under strain.
  • Interrupted, 600 minute exposure to fat destruction in persons undergoing cellulite treatment with impaired lipid metabolism or cholesterol disorders cannot be considered safe, due to lack of proof-of-concept in the literature.
  • BOLANDCELL cell biologist-experts have shown that ultrasound destruction of adipocytes does not result in permanent body sculpturing as previously thought, and that the adipose derived mesenchymal cells, fibroblasts and stem cells irritated by the ultrasound waves soon form new adjacent fat cells and explain the variable results that now have become clinically evident and apparent.
  • Compensatory weight gain and fat deposition in other areas (redistribution of fatty tissue) are now a problem in persons treated with ultrasound-sculpturing for cellulite (as seen after abdominoplasty); despite the denial that ultrasound is only advocated to sculpture the orange-peel contour of the skin, but not to address obesity.
  • Results are not lasting, necessitating dietary measures, looking at lipid metabolism and intake of TRANS FAT, and a life-style adjustment.

The wheel has turned away from MediSpas, again in favour of surgical liposuction, but more specifically Smartlipo™, because of the affordability, non-invasive nature, immediate and excellent results after one treatment. Read on.


Male client: Lower belly. Previous failed treatment after Ultrashape™ and therafter Velasmooth™, despite diet and exercise. Minimally invasive fat sculpturing ( by ultrasound and massager/RF) thus made no impact on this client. Ultrasound devices only produce very modest effects on the superficial cellulite in such clients, is costly, and non-permanence outcomes are the usual outcome at 9 months. The ultrasound device is physically not capable of destroying the millions of adipocytes that make up the fat lobules. These clients, with thicker fat layering are more suited to SMARTLIPO™ because a positive outcome can be predicted in almost every case. Upgraded ultrasound devices as of 2007 and provided minimal improvement. Ultrashape™, Velasmooth™, Velashape™, LPG™, Accent™, Thermage™ are unable to give the results of laser-assisted liposuction in such a situation.


  • Smartlipo™ is manufactured by Cyanosure© and the surgical technology of laser liposuction is approved by FDA as of 2006.
  • Smartlipo™ is almost the same technique as conventional suction liposuction, but differs in that a laser-tip is used; the procedure is basically minimally invasive, performed by a plastic or cosmetic surgeon under local anaesthesia or conscious sedation in a hospital operation room. So the procedure is performed by a specialist under local anaesthesia with the patient awake in an operating suite, under full conventional aseptic conditions (and control regulations), in a private clinic. SO YES, YOU ARE HAVING AN OPERATION IN A HOSPITAL AND THE DOWN SIDES OF SURGERY INCLUDING SIDE-EFFECTS NEED TO BE DISCUSSED WITH YOUR DOCTOR IN AN OPEN AND FRANK WAY.
  • The procedure is also referred to as tumescent liposuction or liposuction. New competitive models are now on the market and you should make enquiries.
  • Results with one treatment are far superior to conventional fat contouring such as with Ultrashape™, Accent™, LPG™, Velashape™ at your salon or clinic, but not better than conventional liposuction. But a lot safer.
  • There is minimal down time and some persons are back at work within 48 hours.
  • The procedure is classified as minimally invasive surgical technique, but general anaesthesia is normally not needed. But your surgeon must be well trained and show his/her certificate.
  • The operation is an elective operative procedure/intervention and referred to as laser-assisted liposuction. One treatment session takes 2-3 hours in theatre and that is the end of the fat in the lower belly, fat handles. And you don’t have to go back every week for 10 treatments like with other fat modulating and contouring devices for maintenance treatment such as Ultrashape™, LPG™, Accent™ or Velasmooth™. No extra payments, no more visits to the clinic and another 450 hours fractionated over many weeks, under a device that produces non-garanteable and dubious or durable results. So, it is important to weigh up the pros and cons of non-invasive devices (i.e. Ultrashape™ or Velashape™) and surgical liposuction. Liposuction is usually a one off treatment but the other skin beauty treatments need a minimal of 6-10 sessions before a decent, measurable and durable result is seen. At the moment, all these devices afford short term and negligible improvement of cellulite in the range of 6-9 months. Maintenance treatment is imperative, or the device treatment will be a failure in 100% of cases and the older the client becomes due to anatomical mesomorphic fat deposition associated with aging.
  • The laser tip melts and liquefies the fat and tightens the skin almost the same as RF. So that extra cost is cut out. And you are at least treated by a specialist and not a beautician or non-medical therapist. So the level of communication is so much higher with less bluffing and superficiality.
  • A result can be expected in every case. The process is gentle and precise, but as previously mention takes 2-3 hours as a one off treatment. So the belly and love handles can be done at one session. Your saving on ultrasound irradiation will then be over 450 hours. And add on ultrasound theafter is not indicated.
  • Compared to conventional liposuction, there is less bruising and risk, and you avoid general anaesthesia.
  • Smartlipo™ uses a 1064 nm Nd: Yag laser ( Cyanosure©), that coagulates the vessels in the fat, during the procedure and reduces the chances of bruising and fluid collection. The risk of infection is very low but may occur in very fat people.
  • The procedure permanently reduces and destroys fat, far more superior than ultrasound devices such as Ultrashape™.
  • The procedure is good for the neck, lower abdomen, back of legs, love handles, saddle bags. Most of these areas cannot be effectively managed by ultrasound with any security of prolonged results.
  • Post operative care is needed for safety and to detect any complications. After all it is a hospital surgical procedure in theatre, albeit minimally invasive and very appealing now because of predictable results not attained by ultrasound. In this way you can transform and sculpture your body utilizing revolutionary and cutting edge technology at the surgeons finger tip. The way to-day is laser technology and not prolonged exposure to ultrasound irradiation in order to break up fat in cellulite in an uncontrolled fashion. You will need compression bandages to avoid fluid collections like we use in varicose vein surgery. You will need about 3 months to make a complete recovery, but will be go back to work within 48 hours in most cases.
  • Total costs are about R30000 and less than fractionated ultrasound every week for 10 weeks at R2000 per treatments session. AND YOU WILL NEED NO MAINTENANCE TREATMENT EVERY WEEK. As you avoid the inconvenience of going to the clinic every week and the added irritation of having to do that, especially if you are only going to lose 1-2 cm, that will soon recur because of stem cell regeneration in the irradiated area. Also Smartlipo™ induces minimal scarring if done through the belly button.
  • Persons on aspirin and coumadin (anti-coagulation) will have to have these drugs stopped for a while, so as to prevent haematoma formation. But that also applies to ultrasound treatment for cellulite.
  • So one is assured that you are undergoing FDA approved fat dissolution and removal (suction) with tumescent liposuction. Currently, ultrasound treatment for cellulite is not approved, but may be so in the future.
  • So: One treatment session, immediate results, procedure is performed on an out-patients basis under local anaesthesia, in a hospital theatre setting and is affordable. Can be used to tone and tighten up “ droopy” skin after previous liposuction, because collagen contraction is addressed at the same time. Permanent results can be expected (not achieved by ultrasound treatment of cellulite) as measured outcome. Face, double chin, neck, back, knees, lower abdomen and belly, love handles and saddle bags can be treated. Many of these areas cannot be done effectively by fat-contuiring devices such as LPG™, Ultrashape™, Accent™ and Velasmooth™ without resort to many fractionated treatment sessions. Many of these device treatments are based on a dream and often the client aspirations are too high. There is no quick fix for cellulite and many costly treatment sessions are needed and often fail. The skin fat devices simply do not always work and clients need to ponder if they want to throw hard earned money away. You will be seen, in the case of SMARTLIPO™ by a specialist during the consultation to assess your health status and if you are a good candidate for Smartlipo™ and which area can be treated. Remember, you must have realistic expectations and self confidence. Please tell your doctor what you expect from the procedure/him/her. In most cases you will qualify for Smartlipo™ laser body sculpting laser-lipolysis.


Human epidermis and hypodermis showing adipose tissue. Medical devices claimed to sculpture fat, such as Ultrashape™, Velasmooth™, Thermage™, Accent™, LPG™ can only slightly modify the skin and subepidermal fatty layer. These devices are not capable of treating the whole picture and explains treatment failures, client dissatisfaction and variable results. This case is suitable for SMARTLIPO™ during which procedure the deeper fat is dissolved by laser and then sucked out. The device also tightens the skin making further treatment by the above devices unnecessary. The SMARTLIPO™ is a one-off treatment with negligible down time and is performed in every case by a trained specialist plastic surgeon. Call a plastic surgeon before having skin sculpturing by devices or RF , when poor results can be anticipated in a large cohort of clients.


    • Karmo FR et al. Plast Reconstr Surg 2001; 108: 241-7; discussion 248-8.
    • Kenkel JM et al. Plast Reconstr Surg 1998; 102: 213-20
    • Brown SA et al. Plast Reconstr Surg. 2004; 113:1796-804
    • Ichikawa K et al. Lasers Surg Med. 2005; 36: 43-6
    • Prado A et al. Plast Reconstr Surg. 2006; 118: 1032-45
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DISCLAIMER: BOLANDCELL does not provide medical advice or treatment recommendations. It is the client’s responsibility seeking cellulite treatment or other treatments to see a registered medical doctor or specialist, for advice, consultation (to develop a sensible doctor-patient relationship), preferably an experienced expert in the field, in order to assess general health condition and skin-status. Plastic–surgeons, aestheticians and dermatologists can be consulted as well as pharmacists. Medical health-care givers/providers should strictly follow the manufactures instructions, and not allow untrained-staff to use ultrasound devices. BOLANDCELL Website, does not recommend treatment services, therapists, doctors, clinics, devices or advice, and is not responsible, or accept responsibility for poor choices, or unsatisfactory outcomes. This site accepts no responsibility for the decisions of clients seeking, cosmetic interventions, fat-contouring or body-sculpting treatments, options or outcomes. The client and therapist are contractually bound and a sensible discussion is needed to high-light controversial cosmetic, under-lying health or aesthetic issues, especially if predicted outcomes are unreliable or inconsistent, side-effects are known, as frequently documented in the literature.


Use the in-site search engine and keywords provided for your convenience, to update you on cosmetic and beauty treatment advances:

  • Facial rejuvenation and wrinkle-treatment with cultured fibroblasts
  • Plasma facial resurfacing with Swiss-based, REGENLAB™ platelet-rich plasma or PRP ( available in South Africa since 2006).
  • Revitalash™ or Latisse™ rejuvenation of eye-lashes; and how to grow or condition new eyelashes ( NEW )
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  • Facial rejuvenation by the new Swiss-based, REGENLAB™ PRP-CELLULAR MASK or PRP MASK without need for any needles, and allows for gradual restoration of the facial epidermis with your own plasma  ( NEW )
  • Rejuvenation and anti-psoriasis treatment with Carboxy-Therapy  ( NEW)
  • Fabulous non-laser or IPL treatment, and more natural clearance of lentiges or solar pigments on the back of your hands with topical Neostrata™ Pigment Lightening Gel ( 1.4 oz/ 40g ). Available from registered physicians. Apply twice daily or as directed by a physician

Posted 3 January 2009: Independent Consultant Biomed Expert

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