“An introduction to Velasmooth® in the treatment of Cellulite”

Dr. P. Treacy

Ailesbury Clinic Dublin Ireland

MEDICAL DISCLOSURE:

• Dr. Patrick J. Treacy is a Cosmetic Doctor registered in UK and Ireland

• I have previously been registered in United States, Australia, New Zealand and South Africa.

• I purchased my own Velasmooth ® equipment.

• I have no financial interest or stock in Syneron

• I receive no additional remuneration for equipment bought by you after attendance at this lecture.

What is Cellulite?

• Cellulite is a term that is used to describe fat deposits under the skin that give the skin a dimpled like appearance.

• It is estimated that up to 80% of women have a problem with cellulite.

• Cellulite is a term originally coined in European salons and spas in the 1970’s to describe deposits of dimpled fat found on the thighs and buttocks of many women

The History of the term ‘Cellulite’

•Promotion of the concept in U.S. after publication of Cellulite: Those Lumps, Bumps and Bulges You Couldn't Lose by

•Nicole Ronsard, the owner of a New York City beauty salon that specialized in skin and body care

The Concept of Cellulite Grows

Fat Layer of Skin

The fat layer of the skin is located in the

subcutaneous layer of tissue known as the hypodermis.

• Strands of fibrous tissue connect the skin to deeper tissue layers and also separate compartments that contain fat cells. When fat cells increase in size, these compartments bulge and produce a dimpled appearance of the skin.

The Physiology of Cellulite

What happens during Cellulite?

• Cellulite is most often seen in women due to hormonal reasons. The fat is arranged in large chambers of macromolecules separated by columns of collagen fibres.

• In people who are overweight excess fat is stuffed in these fibrotic compartments causing them to bulge out.

What causes the ‘Dimpling’ of Skin?

• The ‘dimpling’ is caused by modification of the texture of the subcutaneous tissue due to oedema and fibrosis secondary to impaired circulation and degradation of the tissue in

this area .

•

So what exactly is Cellulite?

• Cellulite is localised fat ‘caught in a jail’ of interstitial connective

tissue

• Cellulite is a lack of drainage of fluid secondary to venous + lymphatic stasis because of genetic, hormonal and even environmental reasons

1 .HEREDITY

2 .HORMONAL -premenstrual syndrome,

3 .VENOUS and LYMPHATIC stasis

4 .NUTRITION insufficient water intake

- excess of sugars, fats

What are the Causes of Cellulite ?

• Stage 1 Problem seems to appear whenever you press skin

• Stage 2 Dimpling of skin only appears as the patient stands up

•

The Different Grades of Cellulite

•

• Stage 3 ‘Peau de orange’ is present when the patient is lying down

• Stage 4 You can actually feel knots in the tissue when you touch it

The Different Grades of Cellulite

The Physiology of Stages 1 & 2

• Stage 1 and 2

•

•The problem only appears whenever you press skin or the patient standsup. This is caused by localised oedema secondary to vascular and capillary extravasation with dissociation of the adipocytes

The Physiology of Stages 3 & 4

• Stage 3 •‘ Orange skin’ is seen whenever the

patient is lying down. This is caused by the formation of micronodules of both normal and larger adipocytes encapsulated by a network of collagen fibres

• Stage 4

• The problem is present at all times because the micronodules fuse together to form painful

subcutaneous macronodules.

•1996 Dr. Neil Solomon, conducted a double-blind study of 100 people to see whether cellulite differed from ordinary fat.

•The pathologists found no difference between the two clinical types of fat

The Medical Evaluation of Cellulite begins

•1998 ,researchers at the Rockefeller Institute used ultrasound, microscopic examinations, and some fat-metabolism studies to see whether “cellulitic" skin and normal skin differed

The Medical Investigation of Cellulite

• •The researchers concluded

•( a )certain characteristics of skin make women more prone than men to develop cellulite

•( b )there were no differences in the appearance or function of the fatty tissue or the regional blood flow

The Medical Concept of Cellulite

• Products include special washcloths; creams and gels, supplements herbs bath liquids; massagers rubberised pants; brushes; rollers; body wraps; and toning lotions.

The Market for Cellulite products

•“ Anticellulite" products include tablets that work while you are awake and others that reduce

cellulite…..while you sleep!

The Growing Market for Cellulite Products

135 million Europeans are overweight 50 million Europeans suffer from obesity This is an increase of 25% in ten years

Body Wrapping

• The wrapping causes temporary water loss by compression and by perspiration. The water is quickly replaced within 24 hours .

•Body wrap claims this technique works because ‘cellulite’ is really water

logged fatty tissue ..

•Herbal Product developed by Italian chemist called Gianfranco Merizzi. Ingredients include compounds clover extract, evening primrose oil, fucus vesiculosis, bioflavanoids, soya lecithin, ginko biloba, iron

oxide and fish oil .

Cellasene®

• 1998, FDA approved a French technique called Endomologie, for temporarily improving the appearance of cellulite

Endermologie®

• Endermologie® usually takes 10-20 treatments. Monthly maintenance is

required to maintain these effects .

Endermologie®

•Procedure is unable to break down dimpling effect although it can be used in combination therapy

Lipodissolve®

• During 1990’s treatments for cellulite remained largely unsuccessful because they targeted skin appearance. It soon was apparent that dimpling on the surface of the skin would require a deeply acting treatment.

The Treatment of Cellulite

• VelaSmooth™ is a medical device for the treatment of cellulite. Using the combined energy technology — Bi-Polar Radio Frequency and Infrared Light — plus tissue mobilization and suction to safely and effectively re-contour the skin surface

Velasmooth®

Velasmooth®

• RF increases oxygen intracellular diffusion by heating adipose tissue to a depth up to 10 mm

• Infrared Light increases elasticity of skin and heats subcutaneous fat to a depth of up to 3 mm, while safeguarding the skin from damage

• Suction manipulates and smoothes out the skin

Vela Smooth Design

• Ergonomic applicator

• Intuitive, simple interface

• Sophisticated software controlling treatment parameters

Vela Technical Specifications

• Infrared (IR) range 700-2000nm• RF power 30 W• IR power 30 W• Treated area • 40x40 mm (for thighs, buttocks, and abdomen) 25x30 mm (for arms, calf, under-chin, and face)

Large Applicator

4 mechanisms4 mechanisms: IR, RF, Rollers, Skin Curving (Suction): IR, RF, Rollers, Skin Curving (Suction)3 intensity levels3 intensity levels

Small Applicator

No rollersNo rollers

AS3887b VELA SA ASSY.exe

Clinical Indications

• Temporary reduction in circumferences

• Temporary reduction in the appearance of cellulite

• Improvement in the local blood circulation

• Improvement of skin texture

• Relief of minor muscle aches and pain

Contraindications

• Current or history of cancer

• Pregnancy and nursing

• Scarring, infection, or fragile skin at the tx. area

• History of keloid scarring

Patients with a pacemaker or internal defibrillator

Contraindications

• Known photosensitivity to near infrared light

• Use of medications known to induce photosensitivity, including Accutane, and anticuagulants

• Diabetes (Type I or II), unless under control

• Varicose veins in the treated area

Anatomy of Cellulite

Fat cells swell and push upwards as septa are rigidFat cells swell and push upwards as septa are rigidBlood and lymph vessels are compressesBlood and lymph vessels are compresses Accumulation of intracellular fluids and toxinsAccumulation of intracellular fluids and toxins

Cellulite Treatment

Fat deposits caught in chambers of connective tissue (septae) create phenomenon of cellulite

Velasmooth ® treatment destroys the fat by acceleration of metabolic process

Cellulite Treatment

This leads to an improved skin appearance after about 6-10 sessions

Velasmooth ®

Vacuum pinches the skin and attaches it to the rotating electrodes

Mechanism of Increasing Blood Supply

• 90% of blood vessels are closed at normal atmospheric pressure.

• Decreasing the atmospheric pressure vessel cause dilatation and increases blood flow.

Mechanism of Deep Hyperthermia

• Infrared light heats the tissue up to 5mm depth

• RF heats tissue from 5 to 15mm depth

IR LampParabolic reflector

Infraredfilter

RF electrodes

Deep Hyperthermia by IR + RF

• Infrared (IR) light heats the tissue down to the deep dermis

• RF heats tissue down to the subcutis

Lamp

Parabolic reflector

Infraredfilter

RF electrodes

Rollers- Mechanical effect

•Rollers and Vacuum Suction (150 mbar or 750 mm of Hg)

• Massaging effect facilitates drainage of trapped intercellular fluid to lymphatics

Rollers- Mechanical effect

• Breaking connective tissue bonds also helps to reduce

volume of fat chambers in hypo-dermis

Suction Helps Hyperthermia

• Suction brings the target closer to the IR and RF source

• Target is the blood vessels in the deep dermis and in the subcutaneous fat layer and the tissue around

Suction Mechanism for Increased Blood Suction Mechanism for Increased Blood SupplySupply

• 90% of blood vessels are closed at normal atmospheric pressure

• Decreasing the atmospheric pressure increases vessel dilation and blood flow

• Thinning the cell membrane also helps in increased substance exchange between fat cells and vessels

Vela Smooth Idea

Re-contouring of skin surface by:

• Increasing metabolic rate in adipose tissue due to:– Increased blood supply

– Increased oxygen diffusivity and exchange

Between blood vessels and fat cells

• Reduced fat chambers size due to:– Reduced size of fat cells

– Mechanical breakage of connective tissue bonds

– Intercellular fluid drainage

Hyperthermia Effect on Metabolism

• Increases substance exchange between fat cells and blood vessels

• Increase rate of fat metabolic reaction

Oxygen Transport Coefficients in Water

Temperature OC

Viscosity of H2O [centipoises]

Diffusivity of O2 [cm2/s]

20 1.002 1.97x10-5

40 0.653 3.24x10-5

50 0.547 3.99x10-5

60 0.467 4.88x10-5

Hyperthermia increases diffusivity of oxygen and decreases skin viscosity delivering more oxygen from capillaries to mitochondrion

Hyperthermia Effect on Rate of Metabolism

• Arrhenius law for yield of chemical reaction

Y=At eBT Where A and B as constant, t is time and T is temperature

• Rate of metabolic reaction is exponential function of tissue temperature.

Treatment Schedule

• Number of treatments – 8-10

• Treatments frequency - twice a week

• Supporting treatment - Once in 1 to 3 months

• Treatment duration 30-40min

Typical improvement curve(based on C. Lee M.D. data)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Number of treatments

Impr

ovem

ent

StrongStrongeffecteffect

Saturating Saturating effecteffect

ModerateModerateeffecteffect

Treatment Indication

• Cellulite

• Non proportional fat distribution

• Post liposuction non-uniformity of adipose tissue

Cellulite Treatment

• Number of passes and levels of energy should be adjusted to obtain stable erythema over the treated area

• Slow replacement of applicator or staying on one place not longer then 5 pulses

Velasmooth ® Cellulite treatment

G.Boey M.D.,Canada

Velasmooth ® Cellulite

Dr. Christopher Ho, Vela

Dr. Shah, Vela

Dr. Shah, Vela

Dr. Shah, Vela

Tina Alster M.D. , Vela

Dr. Shah, Vela

Non-proportional Fat Distribution

• Some parts of the body accumulate more fat and have to be treated more aggressively to improve body contour

Anchor Zones

• Even small reduction of fat in anchor zones significantly improves the body contouring

Treatment of Anchor Zones

• The anchor zones should be treated at maximal settings

• Average number of passes applied to the anchor zones should be higher that for rest of the body at least by 2 passes

Before After

Body ContouringH. Akai, M.D. Tokyo, Japan

Treatment of Post Liposuction Patients

• Improves the results– Allows homogenization of adipose tissue

– Improve healing process

– Reduce loose skin

• Treatment technique– Two passes with slow replacement of applicator or with

staying on one place during 4-6 pulses

– Two passes with fast moving the applicator with stronger pressing the skin

Dr. A. Del Giglio, Italy, Post Liposuction Treatment

Hyperthermia Effect on Metabolism

• Heat produced by IR increases oxygen dissociation from oxy-hemoglobin in heated dermal blood vessels

• Heat produced by RF increases rate of oxygen intracellular diffusion by deep hypodermal heating

• Fat metabolic reaction in adipocytes mitochondria is increased

• Use of stored energy from fat cells (lipolysis) results in shrinkage of cells themselves

Treatment Protocol

• Treat thighs, buttock and abdomen with large applicator, and arms, calf, under-chin, and face with small applicator

• ~10 Treatments performed twice a week

( Patients with lymphatic drainage problems need more sessions)

• Maintenance treatments done monthly, then bi-monthly

• Average treatment time 30-45 min

– ~10 mins per area (thigh, buttock, abdomen, arms, chin)

– No more than 5 sec dwell on one site

Treatment Parameters

• Best results with maximal (3rd) level

• Reduce IR for dark skin or over dark tattoo

• Reduce RF on curved areas with bad coupling

• Reduce suction on sensitive areas (abdomen, inner-thigh) and on loose skin

Treatment Parameters

• Use lower levels for muscle aches, poor circulation and skin texture

• Increase levels in subsequent sessions

• Repeat passes until persistent endpoints are apparent

• Endpoints are general erythema, edema and warmth

Treatment Tips

• Pretreatment - exfoliation and trimming of long hair

• Avoid anticoagulants (if medically permitted), as they increase the chance of bruising

• Use conductive water spray – not gel!

• Replenish spray only when movement of roller is affected – not when the spray appears dry

Treatment Tips

• Treating without spray – keep skin very clean

• Work in general direction of the lymphatics – • ONE WAY

• Change direction to achieve best contact. • Keep ONE WAY

Facilitate Lymphatic Drainage

Before and After 8 Cellulite TreatmentsBefore and After 8 Cellulite Treatments

Before After

Before and After 8 Cellulite Treatments

Fat Anchor Zones

• Evidence of body contouring by fluids redistribution in anchor zones• Result = reduction in circumference

THANK YOU!

QUESTIONS?