This part of the article looks at surgical and injectable methods to treat cellulite. As mentioned before, this is not my own work. The citation of this open access article is shown below. Anything in italics are my additions. Please note that I have left in, the articles original references which lead to relevant supporting articles.
Subcision (that is, a surgical solution) is recommended for cellulite depressions present at rest only and not for depressions that are visible with muscle contraction.9,48 It is a surgical technique that severs the fibrous septal bands tethering the dermis to the subcutaneous adipose tissue.
Subcision can be performed manually or it can be vacuum assisted or laser assisted. More recent techniques include chemical subcision, using collagenase enzyme injections, and acoustic subcision.
Manual subcision is usually performed using a forked cannula or an 18 G noncoring needle inserted to a depth of about 10 to 20 mm into the subcutaneous adipose layer, parallel to the skin surface.
Although efficacious, the main drawback of manual subcision is its adverse effects.48 In addition, the procedure also has the potential for inconsistent results because it is contingent on the surgeon having the proper skills and technique to perform the subcision. Particularly critical is the surgeon’s ability to maintain the correct depth of 10 to 20 mm. If subcision was to be performed too superficially, excessive elevation or skin necrosis could occur, while too deep a subcision could lead to negligible improvement in the targeted depressions.9
A vacuum-assisted subcision system has been developed in response to the shortcomings of manual subcision. This FDA-approved system (Cellfina system, Ulthera, Inc.; Mesa, AZ) uses a unique vacuum-assisted tissue capture platform to provide precise control of the depth and area of release for repeatable durable results. Most common adverse effects were ecchymosis/bruising, edema, areas of palpable softness, and soreness. All adverse events were mild in severity, of short duration, and resolved spontaneously. Results were durable, lasting >3 years.15
In laser-assisted subcision, targeted disruption of subcutaneous fibrous septa is performed with percutaneous subdermal delivery of laser energy. High treatment satisfaction was also reported by at least 90% of physicians and subjects at 6 months.
Chemical Subcision includes Collagenase isolated and purified from Clostridium histolyticum selectively hydrolyzes the triple helical region of collagen and is FDA approved for the treatment of collagen-associated disorders (such as Peyronie’s disease and Dupytren’s contracture).53
In acoustic subcision, rapid acoustic pulses are used to disrupt fibrous septae and stimulate neocollagenesis through acoustic shearing. Clinical improvements in cellulite were seen for up to 12 months and subjects are continued to be followed up to ascertain long-term durability of outcomes.61
There are 2 types of injectable treatments: injectable biologics and injectable fillers. The injectable biologic, collagenase from C. histolyticum, was reviewed under the Chemical Subcision section. The injectable fillers, calcium hydroxylapatite (CaHa) and poly-l-lactic acid (PLLA), are suggested. Based on beneficial skin effects, diluted CaHA has been used as a treatment for cellulite. In a retrospective study, a single treatment of diluted CaHA in combination with microfocused ultrasound with visualization was found to significantly improve cellulite severity and skin laxity from baseline in females with moderate-to-severe cellulite with high subject satisfaction. Both treatments were well tolerated.65
In another study, subcision followed by PPLA treatments in the same treatment session improved cellulite-associated flaccidity, which lasted over a 2-year follow-up period.68 Subject satisfaction was high in both studies.
Cellulite is an aesthetically distressing skin condition mostly affecting females. Multiple therapeutic approaches are available but many only ameliorate cellulite appearance or reduce its severity. Treatments that target the fibrous septa appear to produce more significant improvement that is more durable. Whether these latter treatments can completely “cure” cellulite or prevent its recurrence remains to be seen. Further elucidation of the etiopathogenesis and pathophysiology of cellulite is needed to produce more targeted therapies in the future. For the present, a treatment strategy that utilizes a combination of modalities targeting the multiple etiologies of cellulite might produce the best results.
NOT MY OWN WORK. Taken from:
Gabriel A, Chan V, Caldarella M, Wayne T, O'Rorke E. Cellulite: Current Understanding and Treatment. Aesthet Surg J Open Forum. 2023 Jun 21;5:ojad050. doi: 10.1093/asjof/ojad050. PMID: 37424836; PMCID: PMC10324940.
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