REVIEW OF THE APPLICATION AND DRAWBACKS OF ULTRASOUND DEVICES IN THE TREATMENT OF CELLULITE: PRODUCT ASSESSMENT
UNFORSEEN NEW CHALLENGES OF ULTRASOUND BASED NON-INVASIVE TREATMENT OF CELLULITE BY BODY SCULPTURING RE-SHAPING OR CONTOURING
Dr Goldberg, a specialist dermatologist from the United States, emphasized at IMCAS Paris 2008, that cellulite remains the most treatment resistant cosmetic condition. Many informed persons request non-invasive treatment or re-shaping of cellulite as apposed to surgery (i.e. abdominoplasty or liposuction). Options available for the treatment of cellulite include, Velasmooth, Velashape, Ultrashape, Endermologie, Smootheshape, radiofrequency, mesotherapy ( Mesoestetic), phosphatidylcholine (PPC) injections, no-needle mesotherapy ( Lipo Kontour), Thermage, and Medsculp lipolysis. For the moment, none of the aforementioned therapies can match the end-point analysis or measured outcomes of liposuction in the hands of a top class plastic surgeon. The most attractive new innovative treatment to traditional therapy of cellulite is the Velashape (recent upgrade of the Velasmooth), manufactured by Syneron Medical Ltd, and only device FDA approved. Efficacy is induced by infrared, RF energy that creates controlled inflammation while the tissue massage promotes microcirculation and drainage. And with the launching of Velashape, there is no arguing with results (see Velasmooth publication of Sadick 2007 et al); the appearance of cellulite is improved and confirmed by BOLANDCELL biotechnologists in Cape Town. Mostly used as a stand-alone treatment but can be use in conjunction with light-based devices for further skin-tightening such as in the neck. Accent XL platform shows promise in cellulite (Dr David Goldberg of New York), but maintenance treatment is imperative at one or two years because of fat recurrence and re-deposition. New arrivals in the cellulite treatment arena is REGEN from Pollagen Ltd ( Tel Aviv, Israel), and Cynasure, Smartlipo 10 W, that promotes laser lipoysis. Like the Ultrashape, the SMARTLIPO also permanently destroys fat cells ( lipodestruction) and coagulates tissue. Liposonic Inc., have launched a new ultrasound system in competition to Ultrashape and Smartlipo. Smoothshapes, also will be available soon (according to the manufacturer), and combines a dual wavelength laser system (650nm and 900nm diode laser) with suction and massage to treat cellulite. A new term is photomyology. Dermoelectroporation (by Mattioli Engineering) is the latest alternative to injections and the device is called Transderm Mesosystem. Smoothshapes 100 combines a dual-band light and laser with vacuum massage and is strong competition for Ultrashape, RF and Velasmooth devices. Body recontouring is also now possible with the BTL no-needle mesotherapy device and can be used for cellulite.
TREATMENT OUTCOMES OF CELLULITE
Dr Goldberg, specialist dermatologist of New York, and IMCAS 2008 Faculty, places the problem of cellulite in correct perspective, “ A variety of creams, massage technologies and other devices have been shown to do nothing for the long-term treatment of cellulite” ( IMCAS 2008).
LIMITATIONS OF ULTRASOUND DEVICES SUCH AS ULTRASHAPE AND SIMILAR DEVICES, FOR THE TREATMENT OF CELLULITE (IMCAS 2008)
- Ultrasound is only a partial treatment for cellulite, and a failure rate of 10% is documented (treatment failures or non-responders).
- Most devices have limited clinical assessment and poorly referenced publications are available that do not help clinicians.
- Drawbacks of Ultrashape ( Ascher, IMCAS 2008)
- Difficult to treat the buttock areas, back, inner thighs ( transducer problems)
- Arms, face, knees not yet accessible for treatment ( transducer)
- Treatment time in salon, SPA, or clinic is far too long ( 75 minutes)
- Obese persons are poor candidates
- Non-responders or failures are common and problematical ( = > 10 %)
- Variable results are observed ( and depends on adipose coat thickness)
- Post-liposuction or trauma, indurated dense fat, male breasts, fibrous bands, and small fat deposits under tight skin result in treatment failures ( Scheflan, IMCAS 2008)
- Stand-alone treatment fails in a high proportion of cases and necessitates use of other complimentary devices (at huge costs) to optimize treatment (i.e. RF or Endermologie): IMCAS 2008.
- Ultrasound non-responders are a huge clinical problem and stand-alone therapy is not cost effective for clients seeking effective treatment of cellulite.
ULTRASHAPE: SEVERAL NEW EMERGING PROBLEMS DETECTED IN CLINICAL STUDIES REGARDING USE OF ULTRASOUND FOR CELLULITE (IMCAS 2008)
- Patient selection by a medical practitioner is needed, in the clinic or aesthetic practice, to classify the type of cellulite and to exclude factors that contribute to non-response.
- Ultrasound alone does not work in all persons with cellulite. Treatment is partial in most cases ( Ascher, IMCAS 2008)
- Combination or add-on therapy is now imperative to address the problem of non-responders. This adds a new dimension to the costs of the treatment of cellulite.
- Multiple treatments are needed and patients will need more time in the clinic, SPA (at considerable cost) to achieve satisfactory results over long periods.
- It appears that add-ons like, RF and massage are needed to boost efficacy. Two months treatment in the clinic, salon or SPA may be needed now to deal with the emerging problem of non-responders and variable results observed.
Combinations of RF, before and after ultrasound are needed plus LPG (to add massage and drainage component). Arms do respond, but the abdomen needs US plus RF for effective contouring (IMCAS 2008 and panel discussion). Therefore treatment cycles over 2 months are needed and clients have to come to the clinic a lot. This could mean twice per week for 2 months and the treatment will then be cost ineffective. This has all occurred as a result of non-responders after the application of US. Currently, many protocols are now being devised to deal with the problem of non-response and the solutions are not at hand (IMCAS 2008). But combination therapy seems here to stay, and the application of various devices in concert, will tax the resident medical staff, now putting the application of US beyond the management of beauticians (informed consent and refocusing on treatment outcomes, efficacy, and patient aspirations).
Ongoing work is needed to assess if the technology is working and early identification of non-responders. The place of combination therapy is needed to be clarified (IMCAS 2008). Quantification and validation of add-on treatments before and after is needed i.e. US+RF+LPG. At this point in time, it is not known if these combination therapies will lead to better patient satisfaction and how the costs will impact on the clinic and client. Purchases and investment, by the clinic/SPA/salon of an US+LPG+RF may well exceed R2.5 million, in which case the clinic will not be able to break even or to make a suitable return on investment. Potential clients are considering the VELASHAPE, from Syneron, that provides micro current stimulation (RF), suction and massage. If combination treatments are added to US, then researchers will be compelled again to review the lipid studies done with US alone, simply because fat or lipid metabolism via the systemic circulation differs from enteric absorbed fat via the portal circulation. More validation in technologies is needed and costs are an issue (IMCAS 2008). Dietary interventions and physical activity is also important, making life-style adjustments, imperative if satisfactory results are to be achieved by the non-invasive treatment of cellulite.
FIG 1 : Treatment of cellulite by ultrasound devices was an important topic for panel discussion at IMCAS PARIS JANUARY 2008.
FIG 2: Conference Palace. Palais des Congres de Paris. Home of IMCAS. A specialist consultant of BOLANDCELL in Cape Town, presented two papers at the international congress on the application of AUTOLOGOUS PLATELET RICH PLASMA in aesthetic medicine and new advanced skin quantification methods to validate efficacy objectively regarding biostimulation of the aging and solar damage epidermis and dermis.
Fig 3: Macroscopic anatomy of a section of human epidermis and underlying hypodermal adipose tissue ( lobules and fibrous septa). It is apparent that ultrasound as stand-alone treatment is insufficient to treat cellulite effectively and that clinical results are currently variable. Combination add-on treatment is essential and may consist of RF ( before and after) + US+ LPG. This means that ultrasound alone offers only partial treatment for cellulite, and may result in treatment failures and non-responders ( range is 5-10%). Radiofrequency and massage seem to be critical components of cellulite treatment.