Types of Treatment Devices
Injectable agents
Several different agents can also dissolve excess adipose tissue and cellulite. The direct injection of pharmacologic agents into the dermal-subcutaneous junction of the skin is known as mesotherapy or intradermotherapy.
It is claimed that this procedure directly acts on the adipocyte to promote lipolysis or adipolysis and improves the appearance of cellulite and fat.
In a similar technique, known as injectable lipolysis, detergents such as bile salts (sodium deoxycholate) are injected into the subcutis to chemically ablate adipose tissue. Though these injectibles are currently being developed, none of them has FDA approval at present.
Physical manipulation
One device that has FDA approval is the endermologie, which massages and kneads the skin to improve the appearance of cellulite. It consists of two rollers and positive and negative pressure, to manipulate the skin of the patient.
It is believed that this technique stimulates blood and lymphatic flow, which in turn, changes the architecture of the fat and improves the appearance of cellulite.
Endermologie
Studies conducted on Endermologie have indicated that although it may lead to modest improvements in the appearance of fat and cellulite in some patients, it requires ongoing treatments to maintain the improvement. Home therapy units, like Well Box, may be beneficial for patients as they facilitate continuous convenient treatment.
Subcision
Another simple technique that can improve the appearance of cellulite is subcision. The procedure involves inserting a special notched catheter needle into the subcutis of the affected area.
Manipulating the catheter, by pushing and pulling, breaks the fibrous stranding and tethers responsible for the appearance of cellulite. This procedure appears to destroy the fascial tethers which improve the appearance of cellulite.
It also has some side effects like ecchymosis and edema. Further, the clinical utility of this approach usually depends on the surgeon’s skill.
The gold standard treatment for physical removal of excess adipose tissue is liposuction. However, the role of liposuction in the treatment of cellulite is not yet established.
Reports have claimed both, that liposuction can improve, and or worsen the appearance of cellulite. Considering the architectural component of cellulite physiology, bulk fat removal alone may not improve its appearance.
Radiofrequency devices
Radiofrequency (RF) devices use sinusoidal, alternating current (AC) through tissue to generate heat. This AC creates heat from molecular friction by causing ionic flow in the treatment tissue. In effect, the tissue itself is the source of heat. It is believed that RF causes localized heating of a targeted tissue mass, while limiting the potential for collateral spread of energy, neuromuscular reaction or electrolysis.
The adipose tissue has high tissue resistance and a low heat transfer coefficient. Hence, adipose tissue can be readily heated, with the heat being confined to adipocytes. RF devices have been advertised recently, to improve the appearance of cellulite and fat.
Ultrasound devices
Focused ultrasound devices have been developed recently, to treat the subcutis and adipocytes. Typically patients are used to the diagnostic utility of ultrasound imaging devices. The latter have yielded positive initial results and long-term clinical studies are underway. Currently, additional ultrasound devices are being evaluated for possible FDA approval.
There is no doubt that ultrasound technologies are new and evolving in the field of non-invasive fat treatment. Initially, many such approaches were included in liposuction treatments called ultrasound-assisted liposuction (UAL). Although these devices are quite promising, they require further clinical studies to determine their long-term efficacy and safety profile.
Lasers and light sources
Several different light sources and lasers have been advocated as therapeutic options for fat and cellulite (LAL). Although many of them have been included in liposuction procedures, they still require invasive liposuction. Many devices are advertised to improve fat and cellulite even
though there may be no definitive objective evidence regarding their efficacy. In the near future, there may well be more devices that treat fat and cellulite using the multimodality approach and achieve greater efficacy. At present, there are no commercial laser devices that selectively target fat through selective photothermolysis and have FDA approval.
Cryolipolysis
Cryolipolysis is a new and non-invasive kind of treatment for fat. It is a simple, safe and effective procedure for patients to reduce the appearance of unwanted fat over a period of 2-4 months. It is not a substitute for large volume liposuction or the treatment of obesity. It is most suitable for localized, discrete fat bulges.
Summary
Non-invasive body contouring has evolved immensely over the last couple of years. Liposuction and surgical procedures continue to be the main gold standard procedures for patients who need large volume fat removal. However, such non-invasive procedures represent simple methods with limited or no downtime to improve the appearance of cellulite and fat. For patients who seek non-invasive treatments, topical creams, injectable agents and physical manipulation present various options.
Patients have a range of options in the field of lasers and light sources. They include radiofrequency, lasers, focused ultrasound and cryolipolysis. Although these technologies have developed recently, their efficacy in treatment will eventually be established through controlled clinical trials. Currently, there are limited studies that compare the devices and hence making it difficult to compare the efficacy of one against the other. It is best to rely on the patient’s ultimate goal and expectation.
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