Quantitative & Qualitative Evaluation of the Efficacy of a 1440 nm Nd:YAG Laser With Novel Bi-Directional Optical Fiber in the Treatment of Cellulite as Measured by 3-Dimensional Surface Imaging
November 2013 | Volume 12 | Issue 11 | Original Article | 1224 | Copyright © 2013
Bruce Katz MD
Juva Skin & Laser Center and Cosmetic Surgery & Laser Clinic, Mt. Sinai Medical Center, New York, NY
BACKGROUND: Cellulite gives the skin surface an orange peel or mattress-like appearance thought to be caused by expansion of subcutaneous
fat, fibrotic septae and, dermal laxity and atrophy.
OBJECTIVE: To evaluate the safety and efficacy of a single cellulite treatment using an Nd:YAG 1440-nm laser delivered with a special fiber delivery system and temperature control.
METHODS: Women with cellulite on their thighs and buttocks were enrolled in a prospective Institutional Review Board–approved study. Subjects were 15 healthy females of all Fitzpatrick Skin types with cellulite (grades II-III). A single treatment was performed with an average of seven 5 x 5 cm squares treated per leg. Evaluations with 2D and 3D imaging, patient and blinded evaluator scales as well as skin histology were performed at baseline, 3 and 6 months post treatment.
RESULTS: In the 2D photographs, blinded evaluators were able to identify treated photographs versus baseline in 90% of cases and the number of sites with improvement in contour irregularities was 94%. With 3D imaging, the average decrease in skin depressions (dimples) was 49% at 6 months and 66% of patients showed improvement in overall skin contour at 6 months follow-up. Patient and physician satisfaction scores were high and no adverse events were reported.
CONCLUSION: The Nd:YAG 1440 nm laser with a special fiber delivery system produced significant improvement in cellulite with one treatment after 6 months of follow up. There were no adverse events.
J Drugs Dermatol. 2013;12(11):1224-1230.
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Cellulite is a cosmetic concern of many adult women. The skin develops an orange peel or mattress-like appearance. The components of cellulite are multifactoral and include issues related to subcutaneous fat, fibrous septae and dermal laxity and atrophy. Cellulite is thought to be characterized by expansion of subcutaneous fat. Fat cells are surrounded by bands of connective tissue called septae which connect muscle to the sub-dermal layer. Fat cells held within the perimeters of this area expand and due to fibrotic septae push up against the lax dermis causing the irregular contours of the skin surface.1,2
Cellulite is also associated with hormonal and physical changes. In post-pubertal women, estimates are as high as 85% who develop cellulite particularly in areas of fat accumulation. Post-partum women can also demonstrate an increased volume of fat in thighs and buttocks that lead to herniations up through the dermis.1,2
Objective assessment of cellulite treatment efficacy is difficult. Three-dimensional (3D) imaging has the advantage over two-dimensional (2D) images of allowing precise quantitative spatial evaluation.3,4 In 3D scanning technology light from various directions is reflected off the surface of an object. Optical sensors detect changes in surface topography, and computer algorithms render 3D models from a multitude of surface data points. The 3D analysis provides a way to see more than one plane at the same time in the same image.4 With 3D stereo photogrammetric imaging, an evaluator is able to accurately and reproducibly assess and quantify changes in the coordinates of the face, thighs, buttocks and abdomen.4,5,6
The Nd:YAG 1440-nm device used in our study has been reported to yield marked improvement in cellulite using a 3-step approach to treat each structural component.2 In this report, we present our experience using the Nd:YAG 1440-nm device for a single cellulite treatment, and evaluation of outcomes by both 2D photography and 3D imaging as well as patient and investigator satisfaction surveys.
Healthy non-smoking females between 20 - 55 years of age were eligible for enrollment. Subjects had to accept the obligation not to receive any other procedures in anatomical areas exhibiting cellulite through the 6-month follow-up visit. Subjects had to be logistically able to present for all scheduled follow-up visits.