This clinical evaluation shows how to use Acoustic Wave Therapy (AWT) for the temporary reduction of cellulite. Fifteen female patients with an average age of 35 years were treated with the D-Actor 200® (Storz Medical AG) twice per week for a total of eight treatments. Weight and circumference were measured at screening before (V) and after (ZW) the treatments, as well as at the follow-up examination (FU) 4 weeks after the last session. The degree of cellulite was determined by the aesthetic practitioner using a modified Hexsel Scale, referred to as the Cellulite Severity Scale (CSS). Additionally, skin elasticity and Young’s Modulus, a measure of how easy it is to deform the skin from its normal state, were measured in the treated area. The results show that the degree of cellulite — assessed using the CSS — showed a significant improvement from baseline to follow-up. Also, skin elasticity showed a statistically significant difference between V, ZW, and FU.
Cellulite refers to the mattress (or orange peel) phenomenon of the skin, and affects a huge percentage of women of all ethnicities. Cellulite is a non-inflammatory degenerative process, but not a disease; it is a modification of connective tissue caused by biological factors, mostly occurring in females (a small percentage of men may develop cellulite). One of the main negative consequences of cellulite, from a psychological point of view, is low self-esteem.
The aetiology of cellulite is complex. Cellulite is caused by the specific structure of the collagen fibre bundles; the fat cell chambers with the surrounding fibre bundles project straight upwards into the dermis. This is most common in females, while the male subcutis is held together by tangential fibre bundles. The growing fat cells between the septa cause the dimpling effect and reduce the blood and lymphatic microcirculation. This could be the reason for intracellular oedema and reduced lymphatic drainage, resulting in an increased storage of fat1. This leads to alterations of adipose tissue and microcirculation, causing fibrosis of the connective tissue, and results in the well-known mattress/dimpling aspect on the surface of the skin2, 3.
In this clinical evaluation, Acoustic Wave Therapy (AWT) is used for the temporary reduction of cellulite (i.e. the results can last for 1 year or more, but are dependent on lifestyle factors and genetics). It is known that metabolism and circulation are stimulated by the use of acoustic waves in dermatological and cosmetic applications. Proven mechanisms of action of pressure waves are neovascularisation, growth of new blood vessels, and increased cell proliferation4. The side-effects of acoustic pressure waves are low. At most, mild pain and skin reddening can be expected during the treatment5, 6.
The objective of this clinical evaluation was to demonstrate the efficacy and safety of AWT in anti-cellulite treatment. To achieve this, a number of measures, such as thigh circumference measurements, high-resolution ultrasound, viscoelasticity and photographic evaluation, were included.
Materials and methods
For the treatment, the D-ACTOR® 200 (Storz Medical AG, Tägerwilen, Switzerland) was used (Figure 1). The D-ACTOR® 200 is a vibrating massage system (Extracorporeal Pulse Activation Technology; EPAT), which operates with compressed air to perform AWT on targeted tissue. The system comprises a control unit, a pneumatically-driven handpiece with multiple types of transmitters, and a pressurised air source. The pulses are generated by ballistic impact by accelerating a projectile with pressurised air, which strikes the vibration transmitter. The generated vibrations — the radial acoustic waves — propagate directly into the treated tissue.
Two different handpieces were used in this clinical evaluation, the D-ACTOR handpiece with CERAma-x® transmitter and the V-ACTOR® handpiece.