Body Lean Gel Phonophoresis Versus Radiofrequency in Treatment of Localized Cellulite in Females

Size: px

Start display at page:

Download "Body Lean Gel Phonophoresis Versus Radiofrequency in Treatment of Localized Cellulite in Females"

Gloria Maxwell
5 years ago
Views:

1 Med. J. Cairo Univ., Vol. 8, No., September: 39-, 16 ody Lean Gel Phonophoresis Versus Radiofrequency in Treatment of Localized Cellulite in Females MOHMED S. WER, M.Sc.; WFF H. ORHN, Ph.D.; SM F. EL-SYED, M.D. and GER H.I. ISMIL, Ph.D. The Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University bstract Purpose: To investigate which is more effective in treatment of cellulite, the radiofrequency or the phonophoresis using body lean gel (caffeine and l-carnetine). Subjects: Thirty female patients with abdominal cellulite participated in the study, they were selected from out clinic of gynecology at Housh Esa Public Hospital, through the period from November 1 till Feb. 16, there age ranged from to 5 years. They were divided into two groups of equal numbers, 15 patients for each group., they received body lean gel that transmitted through the ultrasound. Using Digisonic WM3 ultrasound stimulator. The ultrasound delivered for 5min/5cm with a frequency of 1MHz, intensity of 1.5W/cm and with continuous mode, sessions per week for months. who had received the radiofrequency energy, 1 session every weeks for months with a frequency of MHz. The duration of each session is about minutes Methods: ll the subject were evaluated pre and post completing the study through using the measuring tools; skin caliper, tape measurement, and photonumeric cellulite severity scale. Results: The post treatment results of the study provided a significant improvement in both group with non significant difference between both groups. Conclusion: It is concluded that there is no difference between the application of caffeine and l-carnetine phonophoresis and the radiofrequency on cellulite treatment. Key Words: Phonophoresis Radiofrequency Photonumeric cellulite severity scale. Introduction CELLULITE refers to a local alteration of the relief of the skin which acquires an orange-peel, or mattress, appearance. The orange-peel appearance results from the bulging of fat lobules out of their connective frame, into the dermis. The phenomenon is most commonly seen on hips, buttocks, and thighs but can also touch other areas, including Correspondence to: Dr. Mohamed S. Waer, The Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University the abdomen. Up to 9% of woman, over years of age, are affected at various degrees, against only % of men [1]. Cellulite, described first in 19, is a female feature which induces obsessional suffering in 3% of the women. It is a complex disorder involving the microcirculatory system and lymphatics, the extracellular matrix and the presence of excess subcutaneous fat that bulges into the dermis (herniation of the dermo hypodermal junction) []. Different methods can be used to study the deteriorations linked to Cellulite. In addition to classical methods such as photograder standardized photographies circum-ference and cutaneous fold measurements, more specialized techniques are now available to determine the efficacy of anticellulite treatments. Photogrammetry has shown that dietary complement containing amongst others ingredients bioflavonoids and ginko biloba induce a significant slimming effect [3]. Radiofrequency current is defined as a high-frequency electric current in the.3-1mhz range []. Sainio, et al. [5] examined the ingredients in 3 cellulite cream products. In total, 63 different substances were found, with most cellulite creams having an average of ingredients. otanicals (substances from a fruit) and emollients (moisturizing creams) are the chief ingredients in all products. The most common active agent is caffeine, as it is a stimulatory agent for lipolysis. ll cellulite creams also contain some type of fragrance. The authors note that one-fourth of the substances in cellulite creams have been shown to trigger allergies. Therefore, the risk of unpleasant effects should always be known. Caffeine also stimulates lipolysis via the inhibition of PDE activity and by increasing the cmp 39

2 ody Lean Gel Phonophoresis Versus Radiofrequency in Treatment levels in adipocytes. Then caffeine activates HSL, which leads to the degradation of triglycerides in the lipolysis process, and takes part in the reduction of cellulite [6]. Patients and Methods I- Subjects: Thirty female patients with abdominal cellulite participated in the study to investigate which is more effective in treatment of cellulite, body lean gel phonophoresis or the radiofrequency. Inclusive criteria: - ll patients were females having abdominal cellulite. - Their ages ranged from -5 years. - Cellulite was ranged from mild to moderate. - ll patients were assessed carefully before the starting of the study procedures. - Clinically, medically and psychologically stable. Exclusive criteria: - Evidence of psychological disorders. - Patients with life threatening disorders as renal failure and myocardial infarction. - Patients with acute viral disease, mental disorders and skin cancer. - Patients who have immune deficiency disorders. - lcoholic patients, extremely aged patients and Pregnant uterus. - Patients with acute infection in the area to be treated. Procedures: Pires-de-Campos et al., explored the effect of gel application on swine hypodermis (dorsal area): Gel with ultrasound treatment (3MHz, intensity:.w/cm, rate: 1min/cm ), gel with caffeine (5%, water-in-water), and gel with caffeine and ultrasound, daily for 15 days. prespecified (fifth) area received no topical application and was used as control. mong all the experimental groups, only caffeine treatment associated with ultrasound therapy was effective [7]. synergistic mixture including caffeine, carnitine, forskolin, and retinol was also reported to improve several parameters linked to cellulite [8]. Phonophoresis is the use of ultra sound to enhance the delivery of topically applied drugs. Effectively, medicines contained within or under the ultra sound gel are pushed by the sound waves of the ultra sound driven deep below the skin. Phonophoresis administered medications can penetrate the body much deeper than those massaged by hand over the surface of skin [9]. Subjects were assigned into two equal groups ( & ): () 15 patients who had abdominal cellulite, they received body lean gel that transmitted through the ultrasound. 5min/5cm, 1 MHz, 1.5W/cm and, continuous mode, sessions per week for months. () 15 patients who had abdominal cellulite, received the radiofrequency energy, 1 session every weeks for months. II- Instrumentation: - Measuring tools: 1- Skin caliper. - Rounded tape measurement. 3- Cellulite severity scale. - Treatment tools: 1- Digisonic WM3 (US unite). - ody lean gel (caffeine and l-carnin). 3- Radiofrequency unite. Results - Comparison of the results of cellulite severity scale between both groups of the study: 1- Comparison of the pre values between both groups: Table (1) shows that there were a non-significant difference in the Cellulite severity scale (pretreatment) Fig. (1) shows the comparison of Cellulite severity scale (pre-treatment) between both groups of the study. - Comparison of the post values: s revealed form (Table 1), that the Cellulite severity scale had non-significant difference in the Cellulite severity scale after treatment application (post-treatment) Fig. () shows the comparison of Cellulite severity scale (post-treatment) between both groups of the study. - Comparison of the results of abdomen circumference between both groups of the study: 1- Comparison of the pre values between both groups: Table () shows that there were a non-significant difference in the bdomen circumference (pre-treatment) Fig. (3) shows the comparison of bdomen cir-

3 Mohamed S. Waer, et al. 1 cumference (pre-treatment) between both groups of the study. - Comparison of the post values: s revealed form (Table ), that the bdomen circumference had non-significant difference in the bdomen circumference after treatment application (post-treatment) between both groups. Fig. () shows the comparison of bdomen circumference (post-treatment) between both groups of the study. C- Comparison of the results of skin caliper between both groups of the study: 1- Comparison of the pre values between both groups: Table (3) shows that there were a non-significant difference in the Skin caliper (pre-treatment) Fig. (5) shows the comparison of skin caliper (pre-treatment) - Comparison of the post values: s revealed form (Table 3), that the skin caliper had a non-significant difference in the skin caliper Table (): Comparative analysis of bdomen circumference between two groups of the study. X bdomen circumference ±SD ±7.1 ±5.39 ±6. ±.6 MD t-value p-value Level of significance N.S N.S after treatment application (post-treatment) between both groups of the study. Fig. (6) shows the comparison of skin caliper (post-treatment) between both groups of the study. Table (1): Comparative analysis of Cellulite severity scale between two groups of the study. X ±SD MD t-value p-value Level of significance Cellulite severity scale ± 1.6 ± N.S.33 ± N.S N.: X : Mean. p-value : Probability level. ±SD : Standard Deviation. N.S. : Non-Significance. MD : Mean Difference. S : Significant ± 1.8 Table (3): Comparative analysis of skin caliper between two groups of the study. X Skin caliper ±SD ±.7 ±.8 ±.5 ±.69 MD.3.31 t-value p-value Level of significance N.S N.S N.: _N.: X : Mean. p-value : Probability level. X : Mean. p-value : Probability level. ±SD : Standard Deviation. N.S. : Non-Significance. ±SD : Standard Deviation. N.S. : Non-Significance. MD : Mean Difference. S : Significant. MD : Mean Difference. S : Significant. cellulite severity scale Fig. (1): Comparison of Cellulite severity scale (pre-treatment) cellulite severity scale Fig. (): Comparison of Cellulite severity scale (post-treatment)

ody Lean Gel Phonophoresis Versus Radiofrequency in Treatment abdomen circumference 1 1 8 6 11.73 99.6 Fig. (3): Comparison of bdomen circumference (pre-treatment) abdomen circumference 1 1 8 6 96.

(6): Comparison of skin caliper (post-treatment) between both groups. Discussion Cellulite is frequently found on the thighs and buttocks of women.

It begins in puberty and progresses during the life. Nowadays, some factors involved in the genesis of this condition are better understood [1].

4 ody Lean Gel Phonophoresis Versus Radiofrequency in Treatment abdomen circumference Fig. (3): Comparison of bdomen circumference (pre-treatment) abdomen circumference Fig. (): Comparison of bdomen circumference (posttreatment) 8 6 Fig. (5): Comparison of skin caliper (pre-treatment) between both groups. skin caliper skin caliper Fig. (6): Comparison of skin caliper (post-treatment) between both groups. Discussion Cellulite is frequently found on the thighs and buttocks of women. lthough cellulite is not a disease, it is considered a non inflammatory phenomenon with alterations in the subcutis. It is a common clinical condition that usually affects women. It begins in puberty and progresses during the life. Nowadays, some factors involved in the genesis of this condition are better understood [1]. The cause of cellulite remains unknown, although there are a number of different hypotheses including sexually dimorphic skin architecture, altered connective tissue septae, vascular changes, and inflammatory factors [11]. In addition to the thighs and buttocks, cellulite may occur in the breast, upper arms, lower abdomen, and other areas of subcutaneous adipose deposition. The condition is found in slim as well as obese individuals, can be accentuated by excess weight, and is very prevalent in adult women [1]. Rossi and Vergnanini relate that estrogen provokes alterations in collagen. In fact, cellulite worsens with pregnancy, menstrual cycle, use of contraceptives, and hormonal replacement. nother estrogen's influence related by those authors is the stimulation of lipoprotein lipase, an enzyme responsible for lipogenesis, process which leads to the fat accumulation [13]. mong all the experimental groups, only caffeine treatment associated with ultrasound therapy was effective. The results showed a significant reduction in the thickness. Sainio, Rantanen and Kanerva examined the ingredients in 3 cellulite cream products. In total, 63 different substances were found, with most cellulite creams having an average of ingredients. otanicals (substances from a fruit) and emollients (moisturizing creams) are the chief ingredients in all products. The most common active agent is caffeine, as it is a stimulatory agent for lipolysis [1]. The role of topical treatments in cellulite removal is divisive. n initial challenge for any topical cream is that it must be able to penetrate the skin and dermis to reach the targeted fat tissue before being absorbed by the tissue. lthough numerous topically applied ointments are advertised as cellulite-diminishing creams, there are minimal data substantiating any of these claims. The majority of the creams function to promote fat lipolysis.

5 Mohamed S. Waer, et al. 3 Methylxanthines (e.g., caffeine, aminophylline and theophylline) are agents that stimulate lipolysis [15]. The application of a radiofrequency current is being tested to observe whether it can cause weakening dermis connective tissue in the hips, thighs and buttocks to tighten up. The heating process from the current leads the collagen proteins in connective tissue to denaturalize (undergo changes in their protein structure) and then tighten as they regain their structural integrity [16]. Goldberg, et al., also employed radiofrequency treatments (six treatments, every other week) and noted that immediately following treatment and 6 months afterward, there were noticeable decreases in cellulite appearance. Side effects of this radiofrequency treatment are minimal (little blisters), but the long-term effects are unknown at this time. Other researchers have reported similar improvements in cellulite appearance and minimal side effects with radiofrequency treatments [17]. Pires-De-Campos et al., explored the effect of gel application on swine hypodermis (dorsal area): Gel with ultrasound treatment (3MHz, intensity:.w/cm, rate: 1min/cm ), gel with caffeine (5%, water-in-water), and gel with caffeine and ultrasound, daily for 15 days. prespecified (fifth) area received of the subcutaneous adipose tissue, as well as damage of the adipocytes, consequently decreasing the number of cells [7]. Radiofrequency (RF) treatments are procedures involving the use of a Radiofrequency (RF) energy device to heat up and tighten tissue to boost blood flow and break down cellulite and fat. The radiofrequency energy heats the skin without damaging it, in order to break down fatty cells and stimulate collagen production, which improves skin tone and elasticity [18]. These thermal RF and optical systems are generally non-disruptive in that the adipocyte cell membrane and cellular functions are not damaged. Therefore, the disadvantages of these nondisruptive body contour and cellulite systems is the transient effect on adipose tissue and the contour enhancements that may be achieved [19]. lthough the impact of caffeine on the human organism is well understood, the mechanism of the cosmetic action of caffeine has not been fully explained. Given that coffee and caffeine are used increasingly for the production of many cosmetics, it seems interesting to clarify whether it is really able to improve the skin's appearance and the hair's condition. The ability of caffeine to penetrate the skin barrier is essential when discussing the mechanism of its action on skin and hair []. Multiple treatment modalities including application of topical agents, massage-based therapies, subcision, and liposuction have been employed with little scientific evidence that any of these therapies are beneficial [1]. lthough many topical treatments including xanthines, retinoids, lactic acid, and herbals are available over the counter, there is no large-scale study demonstrating the effectiveness of these products []. ccording to the previous results, this study found that the application of both the phonophoresis using caffeine and l-canetine and the radiofrequency on abdominal cellulite resulted in significant reduction in the skin fold, the abdominal circumference measurement and the cellulite severity without significant difference between the both groups. Conclusion: The study found that no difference in efficacy of application of the body lean gel phonophoresis versus the radiofrequency on treatment of cellulite. References 1- EMNUELE E., ERTON M. and GEROLDI D.: multilocus candidate approach identifies CE and HIF1 as susceptibility genes for cellulite. J. Eur. cad. Dermatol. Venereol., (8): 93-5, 1. - PIERRD G.E. NIZET J.L. and PIERRD-FRNCHI- MONT C.: Cellulite From Standing Fat Herniation to Hypodermal Stretch Marks. mer. J. Dermatopathol., (1): 3-7,. 3- SOLER-ROUNET: Etude par photogrammétrie de l'efficacité amincissante du complément Cellulase Urto chez des volontaires sains féminins, 1. - DEL PINO E., et al.: Effect of controlled volumetric tissue heating with radiofrequency on cellulite and the subcutaneous tissue of the buttocks and thighs. Journal of Drugs in Dermatology, 5 (8): 79-17, SINIO E.L., RNTNEN T. and KNERV L.: Ingredients and safety of cellulite creams. European Journal of Dermatology, 1 (8): ,. 6- VOGELGESNG., ONNET I., GODRD N., SOHM. and PERRIER E.: In vitro and in vivo efficacy of sulfocarrabiose, a sugar-based cosmetic ingredient with anticellulite properties. Int. J. Cosmet. Sci., 33: 1-5, PIRES-De-CMPOS M.S., LEONRDI G.R., CHORILLI M., SPDRI-RTFISCH R.C., POLCOW M.L. and GRSSI-KSSISSE D.M.: The effect of topical caffeine

6 ody Lean Gel Phonophoresis Versus Radiofrequency in Treatment on the morphology of swine hypodermis as measured by ultrasound. J. Cosmet. Dermatol., 7: 3-7, ROURE R., ODDOS T., ROSSI., VIL F. and ERTIN C.: Evaluation of the efficacy of a topical cosmetic slimming product combining tetrahydroxypropyl ethylenediamine, caffeine, carnitine, forskolin and retinol, In vitro, ex vivo and in vivo studies. Int. J. Cosmet. Sci., 33 (6): 1-8, KER K.G., RORTSON V.J. and DUCK F..: review of therapeutic ultrasound: iophysical effects. Phys. Ther., 81: , KHN M.H., VICTOR F., RO. and SDICK N.S.: Treatment of cellulite: Part I. Pathophysiology. J. m. cad. Dermatol., 6 (3): 361-7; quiz 371-, DRELOS Z.: The disease of cellulite. J. Cosmet. Dermatol., : 1-, VRM M.M.: Cellulite, a review of its physiology and treatment. J. Cosmet. Laser Ther., 6 (): 181-5,. 13- ROSSI..R. and VERGNNINI.L.: Cellulite: review. J. Eur. cad. Dermatol. Venereol., 1: 51-6,. 1- SINIO E.L., RNTNEN T. and KNERV L.: Ingredients and safety of cellulite creams. European Journal of Dermatology, 1 (8): ,. 15- WNNER M. and VRM M.: n evidence-based assessment of treatments for cellulite. Journal of Drugs in Dermatology, 7 (): 31-5, SDICK N.S. and MULHOLLND R.S.: prospective clinical study to evaluate the efficacy and safety of cellulite treatment using thecombination of optical and RF energies for subcutaneous tissue heating. J. Cosmet Laser Ther., 6: 187-9,. 17- FINK J.S., et al.: Use of intense pulsed light and a retinylbased cream as a potential treatment for cellulite: pilot study. Journal of Cosmetic Dermatology, 5: 5-6, FISHER G.H., JCOSON L.G., ERNSTEIN L.J., et al.: Nonablative radiofrequency treatment of facial laxity. Dermatol. Surg., 31 (9 Pt ): 137-1, SDICK N.S. and MULHOLLND R.S.: prospective clinical study to evaluate the efficacy and safety of cellulite treatment using the combination of optical and RF energies for subcutaneous tissue heating. J. Cosmet Laser Ther., 7: 81-5, 6. - ZHNG W.Y.: benefit-risk assessment of caffeine as an analgesic adjuvant. Drug. Saf., : 117-, GOLDMN., GOTKIN R.H., SRNOFF D.S., PRTI C. and ROSSTO F.: Cellulite, new treatment approach combining subdermal Nd: YG laser lipolysis and autologous fat transplantation. esthet. Surg. J., 8: 656-6, 8. - ERTIN C., ZUNINO H., PITTET J.C., et al.: doubleblind evaluation of the activity of an anti-cellulite product containingretinol, caffeine, and ruscogenine by a combination of several non-invasive methods. J. Cosmet. Sci., 5: 199-1, 1.

A G E N D A. I. Non-Invasive Body Contouring II. Benefits III. Treatment Options IV. Treatment Zones V. Q&A VI. Media VII.Results

A G E N D A. I. Non-Invasive Body Contouring II. Benefits III. Treatment Options IV. Treatment Zones V. Q&A VI. Media VII.Results A G E N D A I. Non-Invasive Body Contouring II. Benefits III. Treatment Options IV. Treatment Zones V. Q&A VI. Media VII.Results What is Non-Invasive Body Contouring? Don t want any incisions when contouring?