The efficacy of capacitive radio-frequency diathermy in reducing buttock and posterior thigh cellulite measured through the cellulite severity scale

Abstract

Background: Cellulite, despite its high prevalence in women, has been subjected to very little research, while the majority has been carried out using unvalidated evaluation tools. Objectives: To determine the efficacy of capacitive radio-frequency diathermy (CRFD) in reducing buttock and posterior thigh cellulite and to verify its relationship with the reduction of body weight. Methods: Design: Experimental clinical study consists of two parallel groups. Sample: Totally 54 lower limbs of 27 women (26.41 ± 6.16 years) were considered with each patient's two limbs being assigned one to each group via simple random distribution. First group received local application of CRFD (30 min) and the second received the same treatment followed by a supplementary whole-segment application of CRFD (20 min). Each limb received 20 sessions, twice a week. Variables: Cellulite Severity Scale dimensions score, weight and Body Mass Index (BMI) were taken for the evaluation of the study. Results: A significance of p less than 0.01 was observed for all the variables in both groups, thereby demonstrating the effectiveness of both the treatments; no significant differences were observed between groups (p > 0.05). Conclusions: Monopolar static application of CRFD is effective in reducing buttock and posterior thigh cellulite. It appears that there is not necessarily any relationship between weight loss, decreased BMI and reduction in cellulite.     

Circumference reduction and cellulite treatment with a TriPollar radiofrequency device: a pilot study

Background  A wide variety of treatments for circumference reduction and cellulite are available, but most procedures offer suboptimal clinical effect and/or delayed therapeutic outcome.
Objective  To determine the safety and efficacy of the TriPollar radiofrequency device for cellulite treatment and circumference reduction.
Methods  Thirty-nine females with cellulite received eight weekly TriPollar treatments. Treatment areas included the abdomen, thighs, buttocks and arms. Subjects were evaluated using standardized photographs and measurements of body weight, circumference, subcutaneous thickness, and skin elasticity of the treatment sites at baseline, immediately after and 4 weeks after the final treatment. Physicians' evaluation of clinical improvement scores using a quartile grading scale was recorded.
Results  Thirty-seven patients (95%) completed the treatment protocol. There was significant circumference reduction of 3.5 and 1.7 cm at the abdomen ( P  = 0.002) and thigh ( P  = 0.002) regions, respectively. At 4 weeks after the last treatment, the average circumferential reductions of the abdomen and thighs were sustained. No significant circumferential reductions of the buttocks and arms at the last treatment visit compared to baseline were demonstrated ( P  = 0.138 and 0.152, respectively). Quartile grading scores correlating to approximately 50% improvement in cellulite appearance were noted.
Conclusions  Tripollar radiofrequency provided beneficial effects on the reduction of abdomen and thigh circumference and cellulite appearance.

Conflict of Interest

The authors have no financial interest in this article.     

Considerations on zero-degree cellulite

Cellulite affects almost all women, and it is characterized by surface relief alterations, mainly located on the thighs and buttocks, and other areas. Whereas depressed lesions occur due to the presence of thick subcutaneous fibrous septa that pull the skin surface down, raised areas result from the projection of underlying fat to the skin surface. We support that the absence of cellulite can be defined as the ideal balance between the mechanical forces that act between the subcutaneous structures, such as fat and fibrous septa and muscles, and the overlying skin.     

A prospective clinical study to evaluate the efficacy and safety of cellulite treatment using the combination of optical and RF energies for subcutaneous tissue heating

BACKGROUND: There have not been any published studies on the use of radiofrequency (RF)–light‐based technologies for the treatment of cellulite. Only preliminary results have recently been reported (ASDS Proceedings, September 2004).

OBJECTIVE: This two‐center study investigated the safety and effectiveness of combined energies for cellulite treatment using the VelaSmooth? system.

METHODS: Thirty‐five female subjects with cellulite and/or skin irregularities on the thighs and/or buttocks were treated with the VelaSmooth device. Patients received from eight to 16 treatments twice weekly. All patients maintained their normal lifestyle, and diet and fluid consumption. The circumference of the right and left medial thighs was measured at both baseline and approximately 4 weeks after the last treatment. During the last follow‐up visit, the physician graded the level of improvement in skin smoothing and/or cellulite improvement using pre‐ and post‐treatment photographs. Three patients provided biopsy specimens for histological assessment.

RESULTS: All study patients showed some level of reduction in thigh circumference after 8 weeks of treatment; indeed, 70% of all patients showed such a reduction after 4 weeks of treatment. Also, 100% of all patients showed some level of improvement in skin texture and cellulite. The mean decrease in circumference was 0.8 inches. Some patients demonstrated reductions of more than 2 inches. There were minimal complications associated with treatment.

CONCLUSION: This preliminary study demonstrates that the VelaSmooth system can have a beneficial effect on cellulite appearance. Further studies are needed to better define the mechanisms by which RF and light energies affect subdermal tissues and develop a method of quantified cellulite analysis.     

Reliability of a standardized tool for evaluating severity of cellulite in the female posterior thigh

Numerous products and minimally-invasive procedures are available to reduce cellulite. However, there are a limited number of tools to evaluate the effects of these interventions and some are relatively complex to implement.

Objective

This study evaluated the reliability of a standardized grading system for scoring the overall severity of cellulite on the posterior thigh. The study evaluated inter-rater and intra-rater (test/re-test) reliability of the method and engaged in an iterative process to develop a reliable method to evaluate changes in the appearance of cellulite.

Methods

There were two stages in the validation process. The first stage was an open process without evaluator training. The second stage was a more controlled process with training given and moderator involvement to review grade selections. In the first stage, inter-rater reliability was examined across five evaluators who were asked to evaluate 24 photographs (right thighs) based on a cellulite graded severity chart. During the second stage, the same photographs were examined by paired evaluators who had received additional training. Scores were independently moderated by a third person. The inter-rater reliability and intra-rater reliability over a 4-week interval were evaluated using intraclass correlation coefficients (ICCs).

Results

Twenty-four female participants (18–51 years, mean 31.68 ± 9.03 years) with a mean BMI of 29.04 ± 6.52 participated in the trial. Five female evaluators completed the initial evaluations. In stage 1, the inter-rater reliability (ICC_2,5) was 0.838 (95%CI:0.700–0.922) and test/retest ICC_3,1 values ranged from 0.360–0.990. In stage 2, the inter-rater reliability for 2 evaluators improved to 0.978 (95%CI:0.948–0.991), and the test/retest reliability of the moderated scoring method improved to 0.993 (95%CI:0.983–0.997).

Conclusion

The iterative process developed a simple and reliable method of rating cellulite severity, with excellent inter-and intra-rater reliability, based on evaluating images of cellulite against a standard set of graded severity images. A reliable method of assessing cellulite severity is essential for undertaking future clinical trials to evaluate cellulite treatments.     

Diagnostic criteria,severity classification and guidelines of localized scleroderma

We established diagnostic criteria and severity classification of localized scleroderma because there is no established diagnostic criteria or widely accepted severity classification of the disease. Also, there has been no clinical guideline for localized scleroderma, so we established its clinical guideline ahead of all over the world. In particular, the clinical guideline was established by clinical questions based on evidence‐based medicine according to the New Minds Clinical Practice Guideline Creation Manual (version 1.0). We aimed to make the guideline easy to use and reliable based on the newest evidence, and to present guidance as specific as possible for various clinical problems in treatment of localized scleroderma.     

Acoustic wave therapy for cellulite,body shaping and fat reduction

Background: Cellulite is a common aesthetic condition that affects almost every woman. Objective: To evaluate the efficacy of acoustic wave therapy (AWT) for cellulite and body shaping. Methods: In this open-label, single-centre trial, 30 women presenting moderate or severe cellulite underwent 12 sessions of AWT on the gluteus and back of the thighs, over six weeks. The following assessments were performed at baseline, and up to 12 weeks after treatment: Cellulite Severity Scale (CSS), body circumference measurements, subcutaneous fat thickness by magnetic resonance imaging (MRI), quality of life related by Celluqol^® and a satisfaction questionnaire. Results: The treatment reduced cellulite severity from baseline up to 12 weeks after the last treatment session (subjects presenting severe cellulite: 60% to 38%). The mean CSS shifted from 11.1 to 9.5 (p < 0.001). Hips circumferences reduced from 99.7 and 103.2 cm to 96.2 and 100.3 cm (respectively, p < 0.001). The average thickness of the subcutaneous fat tissue also decreased (28.3 ± 6.5 mm to 26.7 ± 6.1mm; p < 0.001). The treatment also improved quality of life. More than 90% of the subjects would undergo the treatment again and 89% were satisfied with the results. No serious adverse events were reported. Conclusions: AWT is a safe treatment to improve cellulite appearance and reduce body circumferences.     

A multicenter study of cellulite treatment with a variable emission radio frequency system

Radio frequency (RF) systems have been reported as producing electrothermally mediated and subcutaneous effects. The present study evaluates a new approach to treat cellulite with a bipolar RF device. The buttocks of 50 patients were treated, 10 from each of five multinational centers with a novel bipolar RF technology set at 6 J/cm³, which changes its frequency between 0.6 and 2.4 MHz according to impedance of tissue. Twelve weekly sessions were given for 12 minutes on each buttock, with a treatment end point of 42°C external skin temperature. Cellulite changes and tissue condition were assessed before and immediately after the first session, before the final 12th session, and 2 months thereafter. The patient Satisfaction Index was recorded. Objective evaluation involved clinical photography, three-dimensional optical skin surface measurement, and histological findings. Almost all patients noted improvement of cellulite and body silhouette at the final session, which slightly decreased at the 2-month assessment. Improved skin appearance was objectively detected. Histological findings following the first session showed reactive edema and lysis of adipocyte membranes, possibly implicated in the final effects achieved. The RF technology used in the present multicenter study improved the general aspect of skin and cellulite, with high patient Satisfaction Index. Maintenance sessions might lead to even better and longer-lasting results.     

A two-center, double-blinded, randomized trial testing the tolerability and efficacy of a novel therapeutic agent for cellulite reduction

Introduction Cellulite is the unsightly dimpling and nodularity found on the thighs and buttocks of many postadolescent women. Unfortunately, poor understanding of its pathophysiology coupled with very few scientifically based studies have left us with limited treatment options that are tolerable and effective. Purpose To review current concepts of the etiology and nature of cellulite and summarize available treatment options. To evaluate a novel, pathophysiologically based, topical agent for treatment. Materials and methods A total of 40 women with a moderate degree of cellulite (20 from each of the two research centers) entered a double‐blinded, randomized trial where an anticellulite cream was applied on a nightly basis to the affected sites for four continuous weeks. Each subject was randomized to receive active cream on either the right or left leg, with the contralateral side serving as placebo control. Bioceramic‐coated neoprene shorts were worn overnight to enhance penetration of the topical agents by occlusion. High‐quality digital photography was taken before treatment and after 4 weeks, with tangential full‐spectrum lighting. Five blinded, independent physician reviewers assessed the photographs for improvement. Subject questionnaires were completed to assess tolerability and efficacy. Results Of the 34 subjects who completed the study, 62% (21/34) noticed an overall improvement in their cellulite, with 62% (13/21) reporting greater improvement in the thigh that received active product. All 34 subjects found the shorts and creams easy and pleasant to use. Overall, the average measured decrease in thigh circumference was 1.9 cm (range: 0.1–4.5) with active product, and 1.3 cm (range: 0.1–3.0) with placebo. Upon review of the pre‐ and poststudy photographs, dermatologist evaluators found thighs treated with active product showed greater improvement than thighs treated with placebo in 68% of subjects. Conclusions The active topical agent used in this study was found to be effective in reducing the appearance of cellulite. All subjects tolerated the formulation well with no adverse effects. The success of this research validates the pathophysiologic concepts used to formulate the topical compound. This study both increases our understanding of the nature of cellulite and establishes a tolerable, effective product to treat it.     

Analgesic electrical currents associated with carboxytherapy in women with cellulite: A randomized controlled trial

Background

Pain is considered the main limiting factor in carboxytherapy. Electroanalgesia has gained recognition in the field of dermatology and to date, only transcutaneous electrical nerve stimulation (TENS) has proved to be effective at reducing pain associated with carboxytherapy; however, the effect of medium frequency currents has yet to be investigated.

Aims

Compare the effects of TENS, interferential current (IFC), and Aussie current on pain intensity associated with carboxytherapy and sensory comfort in the treatment of cellulite.

Patients/Methods

Seventy-five women aged 18–49 years with moderate and/or severe gluteal cellulite were randomized into three groups: TENS (n = 25), IFC (n = 25), and Aussie current (n = 25), which underwent three sessions of carboxytherapy associated with an electrical current. Current amplitude was adjusted after each puncture, according to the maximum tolerance reported by participants, below the motor threshold. Pain intensity was measured using a numeric rating scale (0–10) and sensory comfort with the visual analogue scale (0–10).

Results

There was no significant intergroup difference in pain intensity (p > 0.05) and sensory comfort (p = 0.502) during the application of carboxytherapy throughout the three treatment sessions.

Conclusion

TENS, IFC, and Aussie currents showed no difference in pain intensity reduction and no current was found to be more comfortable.     

A bipolar radiofrequency,infrared, vacuum and mechanical massage device for treatment of cellulite: A pilot study

Abstract

Cellulite has a complex and multifactorial etiology. Synergistic action on treating cellulite has gained support in the treatment of cellulite. This study evaluated safety and efficacy of a bipolar radiofrequency, infrared, vacuum and mechanical massage device for cellulite treatment and reduction of body measures. This was a pilot study, which assessed 9 subjects who presented body mass index from 18 to 25 Kg/Kg and at least grade 6 in the Cellulite Severity Scale (CSS). All subjects underwent a 12-session treatment of posterior thighs and buttocks. There was a significant reduction of the hip circumference (p = 0.001), however, no changes in thigh circumferences were observed (p = 0.4). CSS has improved specifically on both buttocks [p = 0.002 (left side) and p = 0.038 (right side)], and no changes were observed on thighs. The studied device demonstrated efficacy in the reduction of cellulite severity and body circumference measures in the buttocks.     

Development and validation of a photonumeric grading scale for assessing lip volume and thickness

Background Currently, there is the need of a validated grading scale for assessing lip volume/thickness. Objective The aim of this study was to assist clinicians in managing individuals seeking lip rejuvenation and to provide an objective method for evaluating the efficacy and longevity of such treatments. Methods Using accepted criteria for the development of dermatological grading scales, we have developed and validated a photographic grading scale for assessing lip volume and thickness based on digital parallel‐polarized light imaging. Results The photographic grading scale was shown to be a valid and reliable instrument for assessing lip volume and thickness, with good inter‐ and intra‐grader consistency. The validity of the scale was demonstrated by its correlation with clinical evaluation and 3‐dimensional measurements. Conclusions This validated lip‐volume/thickness grading scale should prove helpful in clinical trial settings to standardize clinical evaluations and to quantify results and measure the longevity of dermal fillers and other procedures for lip rejuvenation.     

A multilocus candidate approach identifies ACE and HIF1A as susceptibility genes for cellulite

Background Cellulite is a common complex cosmetic problem for many post‐adolescent women characterised by relief alterations of the skin surface, which give the skin an orange‐peel appearance. Although genetic factors have been suggested to play a role in the development of cellulite, the genetic background of this condition remains unclear. We therefore conducted a multi‐locus genetic study examining the potential associations of candidate gene variants in oestrogen receptors, endothelial function/adipose tissue hypoxia, lipid metabolism, extracellular matrix homeostasis, inflammation and adipose tissue biology, with the risk of cellulite. Methods Using a case–control study of 200 lean women with cellulite and 200 age‐ and BMI‐matched controls (grade 0 according to Nurnberger–Muller scale), we examined the association of cellulite with 25 polymorphisms in 15 candidate genes. Results Two of the 25 polymorphisms were significantly associated with cellulite at the P < 0.01 level. After allowance for age, body mass index, the prevalence of contraceptive use and smoking in logistic regression analysis, the multivariable‐adjusted odds ratios for cellulite were 1.19 (95% CI: 1.10–1.51; P < 0.01) for ACE rs1799752 and 0.61 (95% CI: 0.45–0.88, P < 0.01) for HIF1A rs11549465. Conclusions This study, which demonstrates an independent role of ACE and HIF1A in predisposing to cellulite, may provide novel information on the pathophysiology of this common cosmetic problem, and offer a topic for research for novel beautification interventions.     

Evaluation of the newly established acne severity classification among Japanese and Korean dermatologists

Recently, we established an acne severity classification that is based on scientific evidence. Our classification allows three different methods for grading, which include general impression of consulted dermatologist, photograph-based estimation by independent experts, and grading by lesion counting. In our classification, we proposed standard photographs for the estimation of general severity to adjust the basis of judgments. In this study, we evaluated the validity of our classification. We made questionnaires of acne severity using acne patients' photographs, which were selected from the collection of representative photographs of our classification. Participants answered these questionnaires before and after our presentations about our classification of acne severity. We identified the conformity rate with our consensus decision. The results revealed that average conformity rates were raised from 67.0% to 88.9% among Japanese dermatologists and from 68.0% to 79.8% among Korean ones. These data show the adequacy of both our grading system itself and its presentation. We believe our classification will be one of the most effective and reasonable grading systems to classify acne severity.     

A nail psoriasis severity index

BACKGROUND: The Psoriasis Area and Severity Index does not take the severity of nail involvement into account. OBJECTIVES: To devise a system of scoring for nail psoriasis. METHODS: A system of scoring for nail psoriasis was devised that takes into account the site of the pathology, i.e. (i) the matrix, (ii) the subungual tissues distal to the lunula, or (iii) the whole nail unit. RESULTS: The proposed scoring system evaluates several signs of nail psoriasis separately, each on a 1-3 scale: pitting, Beau's lines, subungual hyperkeratosis and onycholysis. CONCLUSIONS: Using this classification it will be possible to assess and grade nail pathology simply and accurately.     

Diagnostic criteria,severity classification and guidelines of systemic sclerosis

Several effective drugs have been identified for the treatment of systemic sclerosis (SSc). However, in advanced cases, not only their effectiveness is reduced but they may be also harmful due to their side‐effects. Therefore, early diagnosis and early treatment is most important for the treatment of SSc. We established diagnostic criteria for SSc in 2003 and early diagnostic criteria for SSc in 2011, for the purpose of developing evaluation of each organ in SSc. Moreover, in November 2013, the American College of Rheumatology and the European Rheumatology Association jointly developed new diagnostic criteria for increasing their sensitivity and specificity, so we revised our diagnostic criteria and severity classification of SSc. Furthermore, we have revised the clinical guideline based on the newest evidence. In particular, the clinical guideline was established by clinical questions based on evidence‐based medicine according to the New Minds Clinical Practice Guideline Creation Manual (version 1.0). We aimed to make the guideline easy to use and reliable based on the newest evidence, and to present guidance as specific as possible for various clinical problems in treatment of SSc.