A Multicenter Study for Cellulite Treatment Using a 1440-nm Nd:YAG Wavelength Laser with Side-Firing Fiber

Abstract

Background: Treatment of cellulite using a 1440-nm YAG wavelength laser with side-firing fiber has proven safe and effective, lasting at least 6 months.

Objectives: The authors evaluate the safety and efficacy of a single, subdermal procedure to treat the underlying structure of cellulite for at least 1 year.

Methods: Fifty-seven patients underwent a 3-step cellulite treatment with a 1440-nm Nd:YAG laser with a side-firing fiber and temperature-sensing cannula. Efficacy was measured by the blinded evaluators to distinguish baseline photos from those taken at 12 months posttreatment, with results on a 5-point, 2-category ordinal photonumeric scale when comparing baseline photos to 12 months posttreatment. Subject and physician satisfaction was assessed based on completion of a satisfaction survey. Adverse events (AE) were recorded throughout the study. Twelve month data were analyzed and compared to 6 month data.

Results: Evaluators chose baseline photographs 97% on average from 6 (-1, +2) months and 91% from the 12 (-3, +2) months posttreatment photographs. At 6 (-1, +2) months, the average improvement score was 1.7 for dimples and 1.1 for contour irregularities. At 12 (-3, +2) months, the average improvement score was 1.4 for dimples and 1.0 for contour irregularities. The average satisfaction score for the physician was 5.6 and the patient was 5.3 on a 6-point scale.

Conclusions: A single, 3-step, minimally invasive laser treatment using a 1440-nm Nd:YAG laser, side-firing fiber, and temperature-sensing cannula to treat the underlying structure of cellulite proved to be safe and maintained effectiveness at least 1 year post treatment. LEVEL OF EVIDENCE 2: Therapeutic.

Figure 1.

The total treatment dosage in joules is based upon the size of the area, the evaluation of the skin, and the grade of cellulite. The average amount of joules used in this study was 1000 J per 5×5 cm². Generally in step 1, 300 joules are allocated for mounds 3 cm and 600 joules for mounds 5 cm. In step 2, 100 joules are allocated for dimples 1 cm, 300 joules for dimples 3 cm and 5cm dimples received 600 joules. In step 3, the remaining joules are applied to the skin subdermally, up to approximately 1000 joules. Deposition of up to an additional 300 to 500 joules/square was allowed in addition to 1000 joules at the investigator's discretion for more complex presentations, such as thicker fibrous bands and larger fat mounds.

Figure 2.

Illustration of bidirectional fiber performing disruption of the deeper fat to lessen the height of the raised mounds. Reprinted with permission from Cynosure (Westford, Massachusetts).

Figure 3.

Illustration of bidirectional fiber performing laterally directed thermal subcision for the disruption of depressed vertical septae. Reprinted with permission from Cynosure (Westford, Massachusetts).

Figure 4.

Illustration of bidirectional fiber performing delivery of superficial energy to the dermis. Reprinted with permission from Cynosure (Westford, Massachusetts).

Figure 5.

Scale for evaluating cellulite dimples, in which a dimple is an isolated circular or oval-shaped depression on the surface of the skin. Each photo represents a number of dimples. Five circles are placed in each photo for evaluation purposes. The circle may or may not contain a dimple. This is done so the evaluator is not confused by nondimpling irregularities, but not biased by being told exactly where the dimples are located. (A) Score 0 (no dimples); (B) score 1 (1 dimple); (C) score 2 (2 dimples); (D) score 3 (3 dimples); (E) score 4 (4 or more dimples). From DiBernardo et al reprinted with permission from Oxford University Press.

Figure 6.

Scale for evaluating contour irregularities. The irregularities become more severe as more concavity and convexity occur in the linear undulations. (A) Score 0 (none—no depressions or raised areas); (B) score 1 (superficial: generalized, small depressions with no protuberances; (C) score 2 (mild: pattern of mild linear undulations with alternating areas of protuberances and depressions); (D) score 3 (moderate: pattern of moderate linear undulations with alternating areas of protuberances and depressions); (E) score 4 (severe: severe generalized linear undulations with alternating areas of protuberances and depressions). From DiBernardo et al reprinted with permission from Oxford University Press.

Figure 7.

(A) This 39-year-old woman presented with moderate-severe cellulite. (B) One year after a single treatment with the 1440-nm Nd:YAG laser. The dotted line encloses the treatment area.

Figure 8.

(A) This 39 year-old woman presented with moderate cellulite. (B) One year after a single treatment with the 1440-nm Nd:YAG laser. The dotted line encloses the treatment area.