Treatment of Dimpling from Cellulite

Abstract

Background: Cellulite can be seen on the skin in widespread alterations of the skin surface and dimpling. The purpose of this study was to assess the effectiveness and safety of the manual subcision technique to treat dimpling from cellulite, using a specific class IIA medical device (Celluerase).

Methods: The multi-center observational study assessed 200 women treated in a single session for different dimpling, using manual subcision administered by Celluerase. Aesthetic outcomes were evaluated by the authors, and the patients assessed satisfaction levels.

Results: Two hundred women between 20 and 55 years were treated. The medical evaluation of patients saw improvements with an average score of 8.1, whereas the subjective evaluation by patients gave an average improvement score of 7.8. Adverse events were reported.

Discussion: Women have septa orientation at right angels to the skin surface, and those with cellulite have an irregular septa conformation, with some septa being hypertrophic-thickened, and others being narrowed-lysed. Magnetic resonance imaging has confirmed that cellulite depressions are associated with a significant increase of thickness of underlying subcutaneous fibrous septa. Subcision has immediate results because it eliminates traction on the skin.

Conclusion: The study has shown the effectiveness and safety of the manual subcision in the treatment of dimpling. The device used, designed specifically for this technique, has shown itself to be very helpful and effective in terms of practical use, aesthetic outcome and safety, with various advantages compared with other commonly used devices.

Fig. 1.

A 45-year-old woman with widespread alterations to skin texture (orange peel).

Fig. 2.

A 42-year-old woman with dimpling in the buttock area and on the back of the thighs, an excellent candidate for subcision.

Fig. 3.

Graphic representation of the variation in subcutaneous connective tissue in a woman without cellulite and with cellulite. In all women, the fibrous septa are mainly at right angles to the skin’s surface. In cellulite, they are variable in size, thickened, and lysed. The thickened fibrous septa cause the skin to be retracted toward the muscle fiber, causing dimpling.

Video Graphic 1.

See video, Supplemental Digital Content 1, which shows step-by-step the manual technique of subcision. Including marking out the dimpling lesions with tangential overhead lighting, infiltration with anesthetic solution in a superficial right plane and posttreatment management. This video is available in the “Related Videos” section of the Full-Text article on PRSGlobalOpen.com or available at http://links.lww.com/PRSGO/A766.

Fig. 4.

The dimpling to be treated is marked with the patient in the standing position. An auxiliary light from above is useful in highlighting these lesions. Those who can only be seen with muscle contraction or by handling the area must not be treated.

Fig. 5.

Infiltration with anesthetic solution is carried out on the lesion to be treated and which is marked beforehand. After a few minutes, the infiltrated areas will look lighter in color due to a passing ischemia caused by the adrenaline (see right buttock).

Fig. 6.

The cutting edges of the device are kept parallel to the skin’s surface, keeping the index fingertip in contact with the formation detected on the device (A). The device is inserted 5 mm from the lateral margin of the dimpling (B) at an angle of about 60°. The movement continues as far as the hypodermis (C), which is perceived when there is no more resistance to the movement itself. The operator makes circular movements—clockwise and counterclockwise—parallel to the surface of the skin, moving laterally and forward. The physician will easily perceive the cutting of the hypertrophic septa.

Fig. 7.

Images pre- (A) and immediately posttreatment (B). The treated areas will look swollen, bruised, and irregular, but they are already free from retraction.

Fig. 8.

A 33-year-old woman treated with 1 subcision session using Celluerase (A). Result at 1 month (B).

Fig. 9.

A 42-year-old woman treated with 1 subcision session using Celluerase (A). Result at 3 months (B).