1. health and fitness
2. therapy

Journal of Cosmetic and Laser Therapy, 2011; 13: 13–20
ORIGINAL ARTICLE
Reduction in thigh circumference and improvement in the
appearance of cellulite with dual-wavelength, low-level laser energy
and massage
J Cosmet Laser Ther Downloaded from informahealthcare.com by HINARI on 03/30/11
For personal use only.
MICHAEL H. GOLD1, KHALIL A. KHATRI2, KELLEY HAILS3, ROBERT A. WEISS4
& NATHALIE FOURNIER5
1Tennessee
3Seacoast
Clinical Research Center, Nashville, TN, USA, 2Skin & Laser Surgery Center of New England,
Rejuvenation Center, 4Laser Skin and Vein Institute, and 5Centre Laser Dermatologie Phlébologie
Abstract
Objectives: This study evaluated the efficacy and safety of a low-level, dual-wavelength laser energy and massage device for
improving the appearance of cellulite and reducing thigh circumference. Methods: Subjects (n ⫽ 83) with mild to moderate
cellulite enrolled in this IRB-approved, open-label, multicenter study. Their right or left thighs received eight treatments
with a low-level, dual-wavelength laser and massage device. The untreated contralateral thigh served as a control. Circumferences of the upper, middle, and lower thighs (treated and untreated) were measured before the fifth and eighth treatments
and 1 month after the final treatment. Results: Reduction in thigh circumference of the treated areas exceeded those of the
control areas for the upper, middle, and lower thigh in most subjects. The maximum reduction (–0.82 cm) occurred in the
upper thigh at 1 month. The mean reduction of the upper, middle, and lower thigh circumferences was –0.64 cm for the
treated thighs compared to –0.20 cm for untreated thighs. The difference was significant (p ⬍ 0.0001). Fifty-nine (71.1%)
treatment thighs lost circumference compared to 44 (53.0%) control thighs. Resolution of adverse effects including erythema, swelling, and increased urination was seen within 30 minutes after treatment. All were resolved without sequelae
and within the expected duration. Conclusion: The low-level, dual-wavelength laser energy and massage device safely improves
the appearance of cellulite while reducing thigh circumference.
Key Words: cellulite, circumference, low-level laser, massage
Introduction
A major cosmetic concern, cellulite is found in
approximately 85% of postpubertal women (1).
Women with this condition present with irregular
skin dimpling, most frequently on the thigh and buttocks, that resembles cottage cheese (2) or orange
peels. Enlarged adipocytes, weakened connective tissue, and reduced microcirculation have been implicated in the pathogenesis of cellulite (3,4). Although
cellulite occurs in both slim and obese persons,
the condition can be accentuated by excess body
weight (1,3).
A variety of non-invasive devices are FDA-cleared
for temporarily improving the appearance of cellulite. These include a handheld device that kneads the
skin, a device with bipolar radio frequency (RF) and
infrared (IR) energy that can also massage the skin,
a low-fluence 810-nm diode laser with vacuum massage capability, a vacuum massage device with or
without a 660–880-nm probe or 880-nm light pad
device, and a suction and mechanical massage device
that provides 650-nm light and 915-nm laser energy
(5). Other modalities include subcision (6,7), mesotherapy and injection lipolysis (8,9), ultrasound- and
laser-assisted liposuction (10,11), RF (12), topical
aminophylline (9,13), and retinol (14). Scientific
proof of efficacy is anecdotal and based on subjective
assessments for most of these modalities.
This study evaluated the efficacy and safety of a
low-level, dual-wavelength laser energy and massage
device for the temporary reduction of thigh circumference and, through the use of photographs before
and after treatment, improvement in the appearance
of cellulite.
Correspondence: Michael H. Gold, Tennessee Clinical Research Center, 2000 Richard Jones Road, Nashville, TN 37215, USA. Fax: 1 615 383 1948. E-mail:
[email protected]
(Received 17 February 2010 ; accepted 26 December 2010 )
ISSN 1476-4172 print/ISSN 1476-4180 online © 2011 Informa UK, Ltd.
DOI: 10.3109/14764172.2011.552608
14
M. H. Gold et al.
Methods
J Cosmet Laser Ther Downloaded from informahealthcare.com by HINARI on 03/30/11
For personal use only.
Subjects
Subjects (n ⫽ 83, all women; mean age 39.7 years
[37.8 to 41.6, 95% CI]) with mild to moderate
cellulite on the thighs enrolled in this open-label,
multicenter study. Subjects maintained a stable
body weight during the previous 6 months and
were required to maintain their baseline food and
activity patterns during the study period. Subjects’
average weight at study entry was 139.4 ⫾ 18.0
pounds (range 108.1–219.1). The median body
mass index (BMI) value at baseline was 23.10
(interquartile range [IQR] ⫽ 3.57). Sixty-one
(73%) of subjects had normal (18.5–24.9) BMI
levels. Weights were measured at baseline and at
the final (eighth) treatment visit.
Subjects completed a relevant medical history
questionnaire and underwent a cutaneous examination. Exclusion criteria included pregnancy, lactation,
coagulation disorders, serious systemic disease, dermatologic conditions requiring treatment in the target
areas, history of neuropathy, anti-cellulite treatment
during the past 3 months, and daily use of aspirin or
corticosteroids. All subjects provided written informed
consent to treatment. The study was approved by the
Western Institutional Review Board.
Treatment device
A low-level, dual-wavelength laser and massage
device (SmoothShapes; Eleme Medical, Merrimack, NH, USA) was used in this study. The
proprietary combination of the 650 and 915-nm
wavelengths with vacuum and contoured rollers
for massage is called Photomology™ (15,16). The
handpiece, or photomology module, includes two
rollers, a vacuum chamber, four 650-nm lightemitting diodes (LEDs), and eight 915-nm laser
diodes. The rollers manipulate and smooth the
skin to facilitate fluid and fat mobilization and
enhance lymphatic drainage as well as microcirculation. The suction level is selectable up to 500
millibars (375 mmHg). Motion sensors in the
handpiece stop light emission if the module is not
in firm contact with the skin and moving, ensuring
that skin temperatures never exceed 40°C during
treatment.
Treatment procedure
The authors applied dual-wavelength laser energy,
vacuum, and controlled mechanical massage simultaneously to the target areas. The right or left thighs
of subjects received eight treatments, always at a
maximum power setting of 10 W. Subjects were
treated twice weekly for 4 weeks, for a total of eight
treatments. The contralateral thigh was not treated
and served as a control. The treatment thigh was
randomly assigned with a random integer table.
Subjects who were randomly assigned an even
number had their left thigh treated and subjects
who were assigned an odd number had their
right thigh treated. The front and back of each
thigh (80-in2 area) were treated for approximately
15 minutes: a total treatment time of 30 minutes
per thigh. Subjects received multiple passes
with the handpiece in transverse and longitudinal
directions.
Thigh circumference
Measurements were taken at baseline before treatment, just before treatments five and eight, and
1 month after treatment eight (final). Circumferences were measured at three thigh positions: the
lower, middle, and upper areas. Vertical heights of
each measurement were determined at baseline
with a laser level device and recorded in the subject’s chart for accuracy and reproducibility during
subsequent measurements. One person, trained by
Eleme staff, performed all measurements at each
site, and the three positions measured were identical for each subject over time. A spring-loaded tape
was used to ensure that the tension of the tape was
constant. The person who measured thigh circumferences was blinded to which thigh was being
treated.
Preliminary evaluation
Circumferential reduction was evaluated by comparing circumferences of the lower, middle, and
upper thighs before the initial treatment with circumferences at the final treatment for both the
treated and untreated thighs. Differences in circumferences were evaluated for significance by the
paired t-test, using p ⬍ 0.05 as the cut-off level.
Improvement in cellulite appearance was evaluated
by comparing pre-treatment photographs with
post-treatment photographs. Data were also collected for subjects who returned for a 3-month
follow-up visit.
Data combination
Thigh circumferences were also quantified by combining the upper, middle and lower measurements in
three ways: (i) mean circumference (arithmetic average of the three measurements), (ii) sum of the three
measurements, and (iii) estimated volume (constant
slope and fixed height [13 cm] assumed from upper
to lower measurements). Changes from baseline were
evaluated at just before treatment five, just before
treatment eight, and 1 month after the final (eighth)
treatment.
Improvement in cellulite with laser and massage
15
Table I. Mean reductions in circumference for treated and control thighs.
1 Month
Location on thigh
Upper
Middle
Lower
Mean of upper, middle, and lower
3 Months
T
C
p-value
T
C
–0.82
–0.69
–0.40
–0.64
–0.23
–0.22
–0.17
–0.20
⬍ 0.0001 (s)
⬍ 0.0001 (s)
0.0062 (s)
⬍ 0.0001 (s)
–0.35
–0.46
–0.14
–0.32
0.11
–0.04
–0.02
–0.02
p-value
0.0001
⬍ 0.0001
0.2397
⬍ 0.0001
(s)
(s)
(ns)
(s)
T ⫽ treatment; C ⫽ control; s ⫽ significant; ns ⫽ non-significant.
Results
J Cosmet Laser Ther Downloaded from informahealthcare.com by HINARI on 03/30/11
For personal use only.
Thigh circumference reduction
All 83 subjects completed the 1-month follow-up visit.
As shown in Table I, reductions in mean thigh circumference of the treated areas exceeded those of the control areas for the upper, middle, and lower thigh in all
cases. The maximum reduction (–0.82 cm) occurred
in the upper thigh at 1 month (Figure 1). The mean
reduction of the upper, middle, and lower thigh circumferences was –0.64 cm for treated thighs compared to
–0.20 for control thighs at 1 month (Figure 2). Clinical
examples are presented (Figures 3–5).
At 1 month, reductions in the treated thighs were
significantly higher than those of the control thighs
in all cases. The 3-month data must be regarded as
preliminary since only 72 subjects returned at this
time. As shown in Table I, circumferential reductions
of the treated thighs were significantly greater than
the untreated thighs for the upper and middle areas,
and for the mean of all three thigh locations.
Combination of data
As stated earlier, thigh circumferences were also
quantified by combining the upper, middle and lower
measurements in three ways: (i) mean circumference,
(ii) sum of the three measurements, and (iii) estimated volume. Mean ⫾ SD data are presented in
Table II for each of these three calculations at each
time point. There were no missing data.
Repeated measures analyses of variance (ANOVAs) were conducted on each measurement. In each
Figure 1. Mean reductions in thigh circumference for treated areas
of the upper, middle, and lower thighs at 1 month. (RIC ⫽ reduction
in circumference.)
instance, the group (treated vs control thigh) ⫻ time
(baseline, treatment five, treatment eight, 1-month
follow-up) interaction was significant (p ⬍ 0.001),
suggesting that circumference reduction was greater
in the treated thigh. For each set of analyses, the cutoff level was set at p ⫽ 0.05/3), or 0.017, rather than
0.05 because three tests were being conducted within
each set of analyses. Means ⫾ SD for changes from
baseline for each of the three measurements are
shown in Table III.
Percent reduction
For mean circumference, sum of the three measurements, and estimated volume, follow-up tests were
conducted for the percent changes from baseline to
take into account minor baseline differences between
groups. Matched pair t-tests were used to assess the
significance of change from baseline, comparing
treated to control thigh. Differences were significant
(p ⬍ 0.001) at each time point. Mean percent changes
from baseline for each of the time points are shown
in Table IV.
The 1-month follow-up data (Table III) are summarized in Table V with 95% confidence intervals
(CIs). As indicated previously, the differences
between treated and control thighs were significant
for each of the three measurements.
Circumference changes by category
Thirteen treatment thighs (15.7%) showed a circumference loss of 2 cm or more as compared to three
Figure 2. Mean reductions in thigh circumference for treated and
control areas of upper, middle, and lower thighs at 1 month.
(RIC ⫽ reduction in circumference.)
J Cosmet Laser Ther Downloaded from informahealthcare.com by HINARI on 03/30/11
For personal use only.
16
M. H. Gold et al.
Figure 3. The left lateral thigh of a 29-year-old female before
treatment (left) and 1 month after eight treatments (right).
Circumferential reductions were 2.1, 2.6, and 1.1 cm for the
upper, middle, and lower thigh, respectively. Photographs courtesy
of Dr Khalil Khatri.
Figure 5. The posterior thigh of a 32-year-old female before
treatment (left) and 1 month after eight treatments (right).
Circumferential reductions were 3.2, 1.7, and 1.2 cm for the
upper, middle, and lower thigh, respectively. Photographs courtesy
of Dr Robert Weiss.
(3.6%) control thighs. Nineteen treatment thighs
(22.9%) lost between 1.0 cm and 1.99 cm, as compared to 15 (18.1%) control thighs. In summary, 59
(71.1%) treatment thighs lost circumference compared to 44 (53.0%) control thighs; 24 (28.9%)
treatment thighs added circumference versus 39
(47.0%) control thighs during the study.
Table VI provides a categorical cross tabulation of
average circumference change from baseline to follow-up providing a paired (within subject) analysis.
Each entry represents a specific number of subjects
in both groups. For example, three (3.6%) subjects
lost 2 cm or more in both thighs and 22 (26.5%)
subjects gained circumference in both thighs.
Changes in body weight
Figure 4. The posterior thigh of a 27-year-old female before
treatment (left) and 1 month after eight treatments (right).
Circumferential reductions were 4.0, 3.5, and 2.4 cm for the
upper, middle, and lower thigh, respectively. Photographs courtesy
of Dr Khalil Khatri.
The weight of all subjects was measured at baseline
and at treatment eight. Seventy subjects (84%) maintained their weight to within 5 pounds (2.3 kg) of
their pretreatment weight. Thirteen subjects (16%)
gained 5 or more pounds (2.3 kg or more) during
the study. For subjects who achieved a reduction in
circumference in the treated thigh, the mean weight
of the responders did not differ significantly from the
mean weight of the non-responders (p ⫽ 0.0883).
Mean circumferential reductions were –1.16 cm for
the treated thighs and –0.56 cm for control thighs.
For subjects who showed an increase in circumference for the treated thigh (n ⫽ 22), the mean weight
gain was 2.936 pounds (1.3 kg), which was significant (p ⫽ 0.0080). For this group, the mean increase
in thigh circumference was 0.70 cm for treated thigh
and 0.67 cm for the control thigh.
Food and drink intake and exercise information was
requested from subjects; however, only 38 (46%) complied. This information did not prove to be useful.
Improvement in cellulite with laser and massage
17
Table II. Mean circumference, summed circumference, and volume for both groups at the indicated treatment visits.
Treatment visit (mean [SD])
Measurement
Mean (cm)
treated thigh
control thigh
Sum (cm)
treated thigh
control thigh
Volume (ml)
treated thigh
control thigh
Baseline
Treatment 5
Treatment 8
1-Month follow-up
49.00 (3.42)
48.86 (3.51)
48.62 (3.38)
48.73 (3.49)
48.62 (3.40)
48.75 (3.57)
48.37 (3.55)
48.65 (3.74)
147.01 (10.26)
146.57 (10.53)
145.85 (10.14)
146.20 (10.46)
145.85 (10.21)
146.24 (10.72)
145.10 (10.64)
145.96 (10.64)
2534.40 (379.59)
2516.77 (395.38)
2497.65 (373.31)
2501.12 (389.22)
2487.08 (373.91)
2510.52 (397.21)
2465.86 (393.74)
2496.41 (413.36)
J Cosmet Laser Ther Downloaded from informahealthcare.com by HINARI on 03/30/11
For personal use only.
Adverse effects
Resolution of adverse effects including erythema,
swelling, and increased urination was seen within 30
minutes after treatment. All were resolved without
sequelae and within the expected duration.
Discussion
The results of the present study confirm those of
Lach (17) in which the combination of low-level,
dual-wavelength laser with massage prototype provided significantly greater reduction in subcutaneous
fat than massage alone, as shown by magnetic resonance imaging (MRI). The 650-nm light increases
collagen production, reduces edema, increases cell
membrane permeability, and relieves pain inflammation, all without destroying fat cells (18–20). The
915-nm energy selectively heats fat (21) and promotes wound healing (22). The vacuum-assisted
mechanical massage facilitates the mobilization of
interstitial fluid and fat, promotes lymphatic flow as
well as subcutaneous blood flow, all of which promotes a healthier more collagenic tissue. The massaging facilitates the movement of fat toward and
into the lymphatic system while the contoured rollers
promote lymphatic drainage (17). Although not evaluated in the present study, this device is also used for
the relief of minor muscle aches and pain, relief of
muscle spasms, and temporary improvement of local
blood circulation. Unlike Lach, we based our results
on changes in measured thigh circumferences before
and after treatment rather than MRI.
As shown in Table VII, our thigh circumference
reductions are in general agreement with those of
Alster and Tanzi (23) with their combination of RF,
IR, and massage, and with those of Sadick and Magro
(24) with the same device. Alster and Tanzi treated
the ‘upper anteromedial and posterolateral thigh’
while Sadick and Magro treated the upper and lower
thigh. Both studies included an untreated control, as
in our study. Since the remaining studies in Table VII
did not include a control, it is difficult to compare
our results with theirs.
Sadick and Magro reported a 0.84-cm mean
decrease in the upper thigh circumference and a 0.5cm decrease in the lower thigh. In our study (Table
I), the corresponding mean reductions were 0.82 and
0.40 cm, indicating that the reductions in the upper
thighs were greater than those of the lower thighs in
both studies. Sadick and Magro also reported that
71.87% of treated subjects achieved a decrease in
overall thigh circumference, which compares well
with the 71.1% of similar subjects in our study.
Sadick and Magro also reported that the greatest
reduction in thigh circumference occurred at 4 weeks,
Table III. Changes from baseline in mean circumference, summed circumference, and volume.
Change (mean [SD])
Measurement
Mean (cm)
treated thigh
control thigh
Sum (cm)
treated thigh
control thigh
Volume (ml)
treated thigh
control thigh
Baseline to treatment 5
Baseline to treatment 8
Baseline to 1-month follow-up
–0.39 (0.70)
–0.12 (0.76)
–0.39 (0.76)
–0.11 (0.78)
–0.64 (1.07)
–0.20 (1.04)
–1.16 (2.11)
–0.37 (2.29)
–1.16 (2.27)
–0.33 (2.34)
–1.91 (3.20)
–0.61 (3.13)
–36.75 (95.57)
–15.64 (95.57)
–47.32 (102.19)
–6.24 (110.68)
–68.54 (124.63)
–20.35 (123.09)
18
M. H. Gold et al.
Table IV. Percent change from baseline for mean circumference, summed circumference, and volume.
Change (mean [SD])
Measurement
Baseline to treatment 5
Baseline to treatment 8
Baseline to 1-month follow-up
–0.77 (1.45)
–0.24 (1.59)
–0.78 (1.54)
–0.22 (1.62)
–1.30 (2.18)
–0.43 (2.17)
–0.77 (1.45)
–0.24 (1.59)
–0.78 (1.54)
–0.22 (1.62)
–1.30 (2.18)
–0.43 (2.17)
–1.38 (3.81)
–0.52 (3.81)
–1.80 (3.99)
–0.17 (4.47)
–2.73 (4.94)
–0.82 (4.96)
J Cosmet Laser Ther Downloaded from informahealthcare.com by HINARI on 03/30/11
For personal use only.
Mean (cm)
treated thigh
control thigh
Sum (cm)
treated thigh
control thigh
Volume (ml)
treated thigh
control thigh
and that the decrease immediately after treatment
and at treatment eight was not significant. In the
present study, the reductions of all thigh areas appear
to reach a maximum at 1 month (Table I) but may
begin to decline at 3 months. This trend is consistent
with the data of Sadick and Magro that the greatest
reduction appears to be at 1 month, and that repeat
treatments would be necessary to maintain the
maximum reduction.
Regarding the combination data, each outcome
variable attempts to incorporate information from all
three measurements taken on each subject during the
study. However, in light of the differential loss across
the upper, middle and lower sites, it is obvious that
the outcome is much influenced by where the measurement is taken. The upper site appears to be most
amenable to treatment.
The summed measurement is not directly comparable to that used for devices in Table VII, and
would appear to, perhaps, take advantage of redundant information.
The volume calculation incorporates information
from all three measurements, and has no redundancy.
It is estimated because the actual configuration of
the thigh is not considered. However, it may be the
most accurate (average) depiction of changes affected
by the treatment. The average volume loss in the
treated thighs from baseline to 1-month follow-up is
Table V. Mean changes at 1 month with 95% confidence intervals
(CIs).
Measurement
Mean (cm)
treated thigh
control thigh
Sum (cm)
treated thigh
control thigh
Volume (ml)
treated thigh
control thigh
Mean change from
baseline to 1-month
follow-up
95% CI
–0.64
–0.20
–0.87 to –0.41
–0.43 to ⫹0.02
–1.91
–0.61
–2.62 to –1.22
–1.29 to ⫹0.07
–68.54
–20.35
–95.75 to –41.34
–47.34 to ⫹6.52
–68.54 ml (–95.75 to –41.34). This is equivalent to
a loss of 2.73% (–3.81% to –1.65%) during treatment, commensurate with a loss of 1 cm from a
50-cm thigh (2.0%).
For subjects who showed an increase in thigh circumference for the treated thigh (n ⫽ 22), the mean
weight gain (2.936 pounds [1.3 kg]) was significant
(p ⫽ 0.0080). The significant increase in body weight
suggests that at least part of the increase in thigh
circumference in the control group may be attributed
to weight gain during the study period.
The strengths of the present study are the large
number of subjects, the inclusion of an untreated control, measurement of thigh circumferences at three
levels, and body weight data at the beginning and end
of the study period. Thigh circumference is considered
an indicator of cellulite product efficacy (1,26). For
subjects who achieved a reduction in circumference in
the treated thigh (n ⫽ 57), the mean weight of the
treated group did not differ significantly from the
mean weight of the non-responders (p ⫽ 0.0883). This
suggests that the reduction in thigh circumference
cannot be attributed to weight loss.
The explanation for the loss in thigh circumference (0.1–2.0 cm or more) in 53% of control thighs
of the present study is unclear. Sadick and Magro
(24) noted that 37.5% of control subjects showed a
0.5–1.5-cm reduction in upper thigh circumference
and 43.75% showed a 0.5–2.5-cm reduction in lower
thigh circumference. Weight loss among subjects was
not significant. The authors indicated that the reason
for the circumferential reduction was ‘difficult to pinpoint’, although the reduction was more dramatic in
the treated thighs, as in the present study. The greater
percentage of subjects in the present study (53% vs
37.5% and 43.75% in the study of Sadick and Magro)
whose control thighs showed a circumferential reduction may be due to differences in the number of subjects (83 vs 20) and in the anatomical location at
which circumferences were measured. Alster and
Tanzi (23) reported no measurable reduction in the
control thighs before and after treatments.
Improvement in cellulite with laser and massage
19
Table VI. Cross tabulation of categorized average circumference change from baseline to follow-up for treated and control thighs.
Control thigh (%)
J Cosmet Laser Ther Downloaded from informahealthcare.com by HINARI on 03/30/11
For personal use only.
Treated thigh (%)
Loss of 2.0 cm or
more
Loss of 1.0–1.99 cm
Loss of 0 0.1–1.0 cm
Gain
Total
Loss of
2.0 cm or more
Loss of
1.0–1.99 cm
Loss of
0.1–1.0 cm
3 (3.6)
6 (7.2)
4 (4.8)
0
0
0
3
(0)
(0)
(0)
(3.6)
5
3
1
15
Limitations of the present study are that the
improvement in cellulite appearance is supported
only by clinical photographs taken before and after
treatment. Numerical data other than thigh circumference reduction are not presented. However, the
authors feel that for the treatment of cellulite, clinical
significance is best evaluated by photographs of actual
results. Although the thigh circumference reductions
in the present study appear modest, they are consistent with those of published studies (23,24) in which
a control was included. The authors support Sadick
and Magro (24) in their assertion that ‘positive results
are not solely based on thigh circumference but
that the smoothness and appearance of the thigh is
particularly significant as well’.
The author cautions practitioners that the
device used in the present study temporarily improves
cellulite. Although patients desire more permanent
(6.0)
(3.6)
(1.2)
(18.1)
10
11
1
26
(12.0)
(13.3)
(1.2)
(31.3)
Gain
0 (0)
4
13
22
39
(4.8)
(15.7)
(26.5)
(47.0)
Total
13 (15.7)
19 (22.9)
27 (32.5)
24 (28.9)
83 (100)
results, they will pursue treatment even if the improvement is temporary because non-invasive technologies
that permanently eliminate cellulite are not available.
The objective of the present study was to evaluate
the efficacy and safety of the laser–vacuum combination for the temporary reduction of thigh circumference and, through the use of photographs before
and after treatment, improvement in the appearance
of cellulite. It may be argued that for a device with
two different technologies (laser and vacuum) an
alternative protocol would have been to treat one side
with vacuum and the other side with the vacuum–
laser combination. Such a study would show if
the laser enhanced the results achieved by the vacuum alone. Although the present study was not
designed to answer this question, a vacuum alone
versus vacuum–laser protocol may be appropriate for
a future study.
Table VII. Reduction in thigh circumferences (RIC) by methods to improve the appearance of cellulite.
Reduction in circumference compared to
pre-treatment value (cm)
Reference
Device
No. of
treatments
Alster and Tanzi (23) (n ⫽ 20)
Sadick and Magro (24) (n ⫽ 16)
massagea
RF, IR,
RF, IR, massagea
8
12
Goldberg et al. (25) (n ⫽ 30)
Bielfeldt et al. (26) (n ⫽ 34)
Unipolar RFc
Cosmetic anti-cellulite
product (rub-on)
TriPollar RFd
Massage, lymphatic
drainage, or connective
tissue manipulation
LPG endermologie
Low-level, dualwavelength laser with
massage
Low-level, dualwavelength laser with
massage
6
Twice-daily
Manuskiatti et al. (27) (n ⫽ 21)
Tunay et al. (28) (n ⫽ 60)
Güleç (29) (n ⫽ 33)
Lach (17) (n ⫽ 74)
Present study
8
15–20
Mean (control), time point
p-value
–0.8 (0), 6 months
–0.5 (–0.28) and –0.84
(0.0625)b, 12 weeks
–2.45 (none), 6 months
–1.5 (none), after 4 weeks of
treatment
–1.71 (none), 4 weeks
–0.50 (none), immediately
after treatment
–
⬍ 0.01
–
⬍ 0.001
0.002
⬍ 0.05
15
14
–2.2 (none), after treatment
–0.09 (none untreated)
⬍ 0.001
–
8
–0.40 (–0.17) and –0.82
(–0.23),b 1 month
⬍ 0.0001
n ⫽ number of subjects; RF ⫽ radio frequency; IR ⫽ infrared.
aVelaSmooth, Syneron Medical, Yokneam, Israel; bLower and upper thigh, respectively; cAlma Lasers, Buffalo Grove, IL, USA; dRegen,
Pollogen Ltd, Tel Aviv, Israel.
20
M. H. Gold et al.
The device in the present study safely improves
the appearance of cellulite as shown by clinical photographs, statistically significant reductions in thigh
circumference in the present study, and by MRIproven fat reduction in the study of Lach (17). The
encouraging results warrant additional studies with
more subjects.
13.
14.
15.
16.
Conclusion
The low-level, dual-wavelength laser energy and
massage device safely improves the appearance of
cellulite while reducing thigh circumference.
J Cosmet Laser Ther Downloaded from informahealthcare.com by HINARI on 03/30/11
For personal use only.
17.
Financial disclosures
Each author has received research support from
Eleme Medical, Inc.
18.
19.
References
1. Draelos Z, Marenus KD. Cellulite. Etiology and purported
treatment. Dermatol Surg. 1997;23:1177–81.
2. Rosenbaum M, Prieto V, Hellmer J, Boschmann M,
Krueger J, Leibel RL, et al. An exploratory investigation of
the morphology and biochemistry of cellulite. Plast Reconstr
Surg. 1998;101:1934–39.
3. Avram MM. Cellulite: A review of its physiology and treatment. J Cosmet Laser Ther. 2004;6:181–5.
4. Draelos Z. The disease of cellulite. J Cosmet Dermatol.
2005;4:221–2.
5. Wanner M, Avarm M. An evidence-based assessment of treatments for cellulite. J Drugs Dermatol. 2008;7:341–5.
6. Orentreich DS, Orentreich N. Subcutaneous incisionless
(subcision) surgery for the correction of depressed scars and
wrinkles. Dermatol Surg. 1995;21:543–9.
7. Hexsel DM, Mazzuco R. Subcision: A treatment for cellulite.
Int J Dermatol. 2000;39:539–44.
8. Braun M. Lipodissolve for body sculpting. In: Goldman MP,
Bacci PA, Leischoff G, Hexsel D, Angelini F, editors. Cellulite: Pathophysiology and treatment. New York: Taylor and
Francis; 2006. p. 301–22.
9. Leibaschoff G, Steiner D. Mesotherapy in the treatment of
cellulite. In: Goldman MP, Bacci PA, Leischoff G, Hexsel D,
Angelini F, editors. Cellulite: Pathophysiology and treatment.
New York: Taylor and Francis; 2006. p. 171–87.
10. Leibaschoff G. Surgical treatment. In: Goldman MP, Bacci PA,
Leischoff G, Hexsel D, Angelini F, editors. Cellulite: Pathophysiology and treatment. New York: Taylor and Francis; 2006.
p. 211–50.
11. Igra H, Satur NM. Tumescent liposuction versus internal
ultrasonic-assisted tumescent liposuction. A side-to-side comparison. Dermatol Surg. 1997;23:1213–8.
12. Emilia del Pino M, Rosado RH, Azuela A, Graciela Guzmán
M, Argüelles D, Rodríguez C, et al. Effect of controlled
volumetric tissue heating with radiofrequency on cellulite
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
and the subcutaneous tissue of the buttocks and thighs. J
Drugs Dermatol. 2006;5:714–22.
Artz JS, Dinner MI. Treatment of cellulite deformities of the
thighs with topical aminophylline gel. Can J Plast Surg.
1995;3:190–2.
Kligman AM, Pagnoni A, Stoudemayer T. Topical retinol
improves cellulite. J Dermatolog Treat. 1999;10:119–25.
Pankratov MM, Stoll ML, Morrison A, et al. Photomology™
– Some experimental evidence in support of postulated mechanism of action. Lasers Surg Med. 2008;40(abstr).
Pankratov MM. Does body countering need to be painful?
Photomology™ – A dynamic combination of dual-band low
intensity light therapy with vacuum and mechanical massage
for non-destructive treatment of cellulite and subcutaneous fat
reduction. Proceedings of Light-Activated Tissue Regeneration and Therapy Conference, 2007, Tomar, Portugal. Lecture
Notes in Electrical Engineering. Springer; 2008 (in press).
Lach E. Reduction of subcutaneous fat and improvement in
cellulite appearance by dual-wavelength, low-level laser energy
combined with vacuum and massage. J Cosmet Laser Ther.
2008;10:202–9.
Abergel RP, Lyons RF, Castel JC, Dwyer RM, Uitto J. Biostimulation of wound healing by lasers: Experimental
approaches in animal models and in fibroblast cultures. J Dermatol Surg Oncol. 1987;13:127–33.
Neira R, Toledo L, Arroyave J, Solarte E, Isaza C, Gutierrez
O, et al. Low-level laser-assisted liposuction: The Neira 4 L
technique. Clin Plast Surg. 2006;33(1):117–27.
Neira R, Arroyave J, Ramirez H, Ortiz CL, Solarte E, Sequeda
F, et al. Fat liquefaction: Effect of low-level laser energy on
adipose tissue. Plast Reconstr Surg. 2002;110:912–22.
Anderson RR, Farinelli W, Laubach H, Manstein D, Yaroslavsky AN, Gubeli J 3rd, et al. Selective photothermolysis of
lipid-rich tissues: A free electron laser study. Lasers Surg
Med. 2006;38(10):913–9.
Longo L, Evangelista S, Tinacci G, Sesti AG. Effect of diodeslaser silver arsenide-aluminium (Ga-Al-As) 904 nm on
healing of experimental wounds. Lasers Surg Med. 1987;7:
444–7.
Alster TS, Tanzi EL. Cellulite treatment using a novel combination radiofrequency, infrared light, and mechanical tissue
manipulation device. J Cosmet Laser Ther. 2005;7:81–5.
Sadick N, Magro C. A study evaluating the safety and efficacy
of the VelaSmooth system in the treatment of cellulite. J
Cosmet Laser Ther. 2007;9:15–20.
Goldberg DJ, Fazeli A, Berlin AL. Clinical, laboratory, and
MRI analysis of cellulite treatment with a unipolar radiofrequency device. Dermatol Surg. 2008;34:204–9.
Bielfeldt S, Buttgereit P, Brandt M, Springmann G, Wilhelm
K-P. Non-invasive evaluation techniques to quantify the efficacy of cosmetic anti-cellulite products. Skin Res Tech. 2008;14:
336–46.
Manuskiatti W, Wachirakaphan C, Lektrakul N, Varothai S.
Circumference reduction and cellulite treatment with a
TriPollar radiofequency device: A pilot study. J Eur Acad
Dermatol Venereol. 2009;23:820–7.
Tunay VB, Akbayrak RT, Bakar Y, Kayihan H, Ergun N.
Effects of mechanical massage, manual lymphatic drainage
and connective tissue manipulation techniques on fat mass in
women with cellulite. J Eur Acad Dermatol Venereol. 2009;
23:1–5.
Güleç AT. Treatment of cellulite with LPG endermologie. Int
J Dermatol. 2009;48:265–70.