Introduction

Cellulite, which appears as orange peel-type or cottage cheese-like dimpling of the skin on the thighs and buttocks, is a
complex, multifactorial, cosmetic disorder of the subcutaneous fat layer and the overlying superficial skin. [Emanuele E,
et al, Int J Dermatol. 2011 Apr;50(4):412-6.]
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Causes

Factors related to cellulite include poor diet, fad dieting, slow metabolism, lack of exercise, hormone changes,
dehydration, fat and skin nature. Skin color may not be the cause for cellulite, but cellulite is not so noticeable on darker
skin.
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Treatments of Cellulite

Treatment of cellulite aims at (1) the reduction of the subcutaneous fat layer, (2) increase in dermal thickness and
elasticity and (3) dissection of hypertrophic connective tissue septae, responsible for the most pronounced dermal
indentions. A variety of treatment options have evolved ranging from topical retinol to interstitial laser. [Proebstle TM.,
Hautarzt. 2010 Oct;61(10):864-72.]

Cellulite Creams
Cellulite creams are marketed as products to dissolve fat and smooth skin. Some advertising claims also promise the
reduction of “cellulite”, waffly looking or orange-peel type skin caused by fatty deposits.

Aminophylline, an approved prescription drug used in the treatment of asthma, is an ingredient used in many of these
thigh cream products that marketers claim will dissolve the fat and smooth the skin. Since some individuals suffer from
allergic reactions to ethylenediamine, a component of aminophylline. Persons who suffer from asthma may wish to avoid
these products so that they don’t become allergic to aminophylline. [FDA.gov February 24, 2000]

Liposuction
Liposuction removes fat deposits inside the body, not fat just underneath the skin.

Mesotherapy
Mesotherapy is the injection of various chemicals such as vitamins, minerals, amino acids and enzymes to area just
beneath the skin, as to break down the fat (cellulite).

Massage and Spa Treatments
Massage and Spa Treatments are comfortable, but they do not remove the cellulite.

Laser Treatment
There are various types of laser treatments available or under development for cellulite, please, review the section of
supportive research for details.
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Supportive Research

Nonablative lasers and nonlaser systems
Different technologies such as lasers, Intense Pulsed Light (IPL), and radiofrequency have been introduced. Most
nonablative laser systems emit light within the infrared portion of the electromagnetic spectrum (1000-1500 nm). At
these wavelengths, absorption by superficial water containing tissue is relatively weak, thereby effecting deeper tissue
penetration.

Nonablative technology have been used for several indications such as skin tightening, periorbital tissue tightening,
treatment of nasolabial lines and jowl, body sculpting/remodeling, cellulite reduction, scar revision and remodeling and
for the treatment of photodamaged skin. [Sachdev M, et al, Indian J Dermatol Venereol Leprol. 2011 May-Jun;77(3):380-
8.]

Phototherapy plus Treadmill
Twenty women (25-55 years old) were separated in two groups: the control group, which carried out only the treadmill
training (n = 10), and the LED group, with phototherapy during the treadmill training (n = 10). The training was
performed for 45 minutes twice a week over 3 months at intensities between 85% and 90% maximal heart rate (HR
(max)). The treatment was evaluated by interpreting body composition parameters, photographs and thermography.
This was primarily a treatment for cellulite with a reduction of saddlebag and thigh circumference. At the same time, the
treadmill training prevented an increase of body fat, as well as the loss of lean mass. Thermal images of the
temperature modification of the thighs are presented. These positive effects can result in a further improvement of body
aesthetics using infrared-LED together with treadmill training. [Paolillo FR et al, J Cosmet Laser Ther. 2011 Aug;13(4):
166-71]

Tripolar radiofrequency
Twenty-eight women underwent anticellulite treatment using radiofrequency, 17 women were in the placebo group. The
therapy was monitored by classical and high-frequency ultrasound. Cellulite was reduced in 89.286% of the women who
underwent radiofrequency treatment. [Mlosek RK et al, J Eur Acad Dermatol Venereol. 2011 Jun 21.]

Lymph drainage and cervical stimulation
Perimetry was performed at the gluteal fold, at 5 cm and 10 cm below the gluteal fold for both legs, and 5 cm and 10 cm
below the navel. The patients were submitted to a treatment regimen of 1.5 hours per day adapted for the treatment of
cellulite, consisting of manual and mechanical lymph drainage and cervical stimulation using the Godoy and Godoy
technique. After 10 sessions over two weeks, the patients were evaluated again. Reductions were identified at both
points below the navel, the points on the thighs, and at the gluteal fold. [de Godoy JM et al, Clin Cosmet Investig
Dermatol. 2011; 4: 55–59.]

Caffeine
Caffeine, the most widely used anti-cellulite ingredient, favours fat break-down by inhibiting the phosphodiesterase
enzyme and encouraging a high intracellular level of cAMP. [Vogelgesang B,Int J Cosmet Sci. 2011 Apr;33(2):120-5.]

Three studies were performed to investigate the mechanism of action and evaluate the efficacy of a topical cosmetic
slimming product combining tetrahydroxypropyl ethylenediamine, caffeine, carnitine, forskolin and retinol. The Ex vivo
study on skin explants showed that caffeine and forskolin both stimulated glycerol release and demonstrates for the first
time that retinol and carnitine in combination synergistically stimulated keratinocyte proliferation, which leads to an
increase epidermal thickness. The clinical study associating circumference measurements on five selected parts of the
body, cutaneous hydration measurements as well as blinded expert grading of skin aspect was conducted on 78 women
who applied the product or placebo twice daily for 12 consecutive weeks. After 4 weeks of twice-daily application of the
product, significant reductions in circumference of abdomen, hips-buttocks and waist were already observed.
Improvements concerned all the measured body parts after 12 weeks. Orange peel and stubborn cellulite decreased
significantly from 4 weeks of treatment and tonicity improved from 8 weeks, demonstrating that the product improved
skin aspect. [Roure R, et al, Int J Cosmet Sci. 2011 May 13.]

Adiponectin Gene Expression
Adiponectin is an adipocyte-derived hormone mainly produced by subcutaneous fat that shows important protective anti-
inflammatory and vasodilatory effects. A total of 15 lean women with cellulite and 15 age- and BMI-matched women
without cellulite participated in a study. Real-time reverse transcription polymerase chain reaction (RT-PCR) was used to
assess adiponectin gene expression. Plasma adiponectin levels were measured using a commercial enzyme
immunoassay kit. Adiponectin mRNA expression in the subcutaneous adipose tissue of the gluteal region was
significantly lower in areas with cellulite compared with those without. However, plasma adiponectin levels did not differ
between women with and without. [Emanuele E et al, Int J Dermatol. 2011 Apr;50(4):412-6]

Sulfo-carrabiose
A series of studies has shown that spermine and spermidine, two ubiquitous polyamines, encouraged fat storage and
slowed fat break-down in the adipose tissue. Besides, it was shown that heparan sulfate glycosaminoglycans had a
strong affinity for polyamines. Researchers used molecular modelling to screen several ingredients with a structure
similar to that of heparan sulfate glycosaminoglycans. This way, they identified sulfo-carrabiose as a potent molecule for
trapping spermine and spermidine. When sulfo-carrabiose was incorporated in a cosmetic formula, significant
improvements were observed in thigh circumference, with better results than those obtained with caffeine after 28 days
of use. Furthermore, a combination of caffeine and sulfo-carrabiose led to results significantly better than those
obtained with caffeine alone. [Vogelgesang B, et al, Int J Cosmet Sci. 2011 Apr;33(2):120-5.]

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Product Classification of Cellulite Laser - Medical Devices

Device                                            Laser, cellulite appearance
Regulation Description                   Laser surgical instrument for use in general and plastic surgery and in dermatology.
Definition                                        For the removal of fat through laser lipolysis.
Physical State                                Laser system using fiber optic delivery system to deliver the laser energy to the site
                                                through a cannula
Technical Method                          Delivery of laser energy via a cannula into the subdermal area to dissolove fat and
                                                disrupt the septae that affect the appearance of cellulite
Target Area                                    Area that have cellulite issues
Regulation Medical Specialty         General & Plastic Surgery
Review Panel                                 General & Plastic Surgery
Product Code                                 OYW
Submission Type                            510(k)

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Laser surgical instrument for use in general and plastic surgery and in dermatology

Modified Alma Lasers Family of Accent Radiofrequency (RF) Systems (Accent, Accent XL, Accent Elite
The indications for use of K101147 are [1] the non-invasive treatment of wrinkles and rhylids using a combined
treatment with Unipolar handpieces, and [2] temporary reduction in the appearance of cellulite by the use of massage
component or simultaneous application of the RF energy and mechanical manipulation. [510(K) Number K101147]

Cynosure Cellulaze (TM) Laser
Cynosure Cellulaze Laser is intended for the improvement in the appearance of cellulite as supported by long-term
clinical data (at least 6 months with no observed reduction in treatment benefits up to 9 months of observation.[K123407]

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Laser Cellulite Side Effects

The side effects of laser treatment for cellulite include pain, swelling, bruise and hottness. There may also be also a
chance of infection and inflammation.

MAUDE Adverse Event Report: VELASHAPE 01/19/2009
Underwent an initial velashape procedure at laser center and experienced excessive bruising on the legs. It was
explained to the patient that there may be "some" bruising from the procedure, but the result was bruising from knee to
hip on the exterior and partially on the internal part of both thighs. Very painful, red, swollen and hot to touch - needed
icing for 48 hours and compression pants to be able to function. The center is looking into possible cancellation of
contract for further treatments and took photos two days after treatment following complaint by patient. The patient
found the procedure painful enough and the bruising excessive enough to warrant a report to the fda since it was highly
advertised as the only fda approved non-surgical cellulite reduction procedure on the market and minor bruising
possible. In early 2009 - went through a velashape treatment on abdomen, and inner and outer thighs. During treatment
- experienced pain, especially on the legs, yet allowed to proceed. Within less than two hours from treatment - bruising
began on inner and outer thigh area which ended up as a mass swelling, red, hot, bruising in the entire area treated.
Although patient notified that treatment may result in some bruising, appeared dangerous to the patient's health and
resulted in excessive pain for days after treatment. Patient reported bruising via email to laser center on the evening of
the treatment and via phone the following morning. Center reported to regional manager who required patient to travel
to facility to have photos taken for report two days after treatment. Bruising still highly visible and painful. Dose: 2x5
minutes per section. Frequency 2 x's. Route: subdermal. Diagnosis: to reduce cellulite. Event abated after use stopped:
no.
Discuss with your doctor before taking any alternative medicine. This article is for information only. Do not copy nor transfer this article or a portion of
this article to another website or blog. ALL RIGHTS RESERVED. 2013
Cellulite, treatment, caffeine, lasers, creams, thigh creams           June 2013