1
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Ko J, Cho SB. Clinical Efficacy and Safety of Low-Energy Extracorporeal Shock Wave Therapy for Various Conditions of Deep Dermal and Subdermal Fibrosis. Skin Res Technol 2024; 30:e70082. [PMID: 39366905 PMCID: PMC11452247 DOI: 10.1111/srt.70082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 09/14/2024] [Indexed: 10/06/2024]
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) enhances extracellular matrix remodeling and tissue regeneration by promoting growth factor release, regulating blood and lymphatic flows, and reducing fat and fibrotic tissues. Focused shock wave therapy (F-SWT), radial shock wave therapy (R-SWT), and combined F-SWT and R-SWT have been used to deliver different patterns of shock energy depending on the characteristics of the target lesions. METHODS We investigated the efficacy and safety of ESWT in patients with dermal and subdermal fibrosis. Fifty-two patients treated with F-SWT and/or R-SWT for dermal and subdermal fibrosis caused due to various reasons were retrospectively analyzed by reviewing their medical records, clinical images, and ultrasound study images. RESULTS The mean number of pulses administered for F-SWT on the cheek, temple, and chin were 2600.0 ± 1040.8 shocks/session and for R-SWT were 5080.0 ± 2234.6 pulses/session, and the number of treatment sessions were 8.0 ± 4.4. In patients who were treated with ESWT on the abdomen, the mean number of pulses for F-SWT were 2600.0 ± 2408.3 shocks/session and for R-SWT were 8400.0 ± 894.4 pulses/session, and the number of treatment sessions were 3.2 ± 1.6. Most patients were satisfied with the results. Pain during ESWT was well tolerated and post-ESWT edema was more common in R-SWT than in F-SWT. CONCLUSION Our data demonstrated that ESWT effectively and safely improved the clinical appearance and functional movement of patients with dermal and subdermal fibrosis caused due to various reasons.
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Affiliation(s)
| | - Sung Bin Cho
- Yonsei Seran Dermatology and Laser ClinicSeoulSouth Korea
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2
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Foppiani JA, Raska O, Galinaud C, Stearns S, Hernandez Alvarez A, Taritsa IC, Schuster KA, Ho OA, TerKonda S, Lee BT, Lin SJ. Comparing Collagenase and Tissue Subcision for Cellulite Treatment of the Buttock and Thigh Regions: A Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5857. [PMID: 38911581 PMCID: PMC11191026 DOI: 10.1097/gox.0000000000005857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/04/2024] [Indexed: 06/25/2024]
Abstract
Background In this systematic review, we assessed the therapeutic efficacy and safety of Clostridium histolyticum collagenase (CCH) and tissue subcision (TS) for treating cellulite, which ranges from subtle to pronounced lesions. Methods A systematic review was performed following PRISMA guidelines for CCH and TS treatment to the thigh and gluteal regions. A proportion meta-analysis was then conducted using Stata statistical software. Results A total of 14 studies were incorporated into the final analysis. Nine focused on TS and five on CCH injection, collectively reporting outcomes for 1254 patients. Of these, 465 received CCH injection and 789 underwent subcision. For bruising, rates were 89% [95% confidence interval (CI), 71%-96%] with CCH injection and 99% (95% CI, 85%-99%) for subcision; pain requiring analgesic was reported at 74% (95% CI, 55%-87%) for CCH and 60% (95% CI, 43%-76%) for subcision; both showed induration at 7% (95% CI, 5%-11% for CCH, 95% CI, 2%-25% for subcision), whereas skin discoloration was higher post-CCH injection at 16% (95% CI, 10%-26%) compared with 7% (95% CI, 5%-10%) postsubcision. Conclusions Both CCH and TS seem effective treatments for cellulite. However, upon evaluating the adverse outcomes between the two modalities, subcision demonstrated a higher incidence of bruising, albeit similar rates of induration compared with CCH injection. Conversely, the CCH injection group manifested a higher propensity for pain requiring analgesia and notably exhibited increased instances of skin discoloration compared with their subcision patient group. Further standardized research is crucial for more informed cellulite treatment decisions and for comparing efficacy, safety, and cost-effectiveness between TS and CCH.
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Affiliation(s)
- Jose A. Foppiani
- From the Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
- Department of Pathophysiology, Universita Karlova, Prague, Czech Republic
| | - Otakar Raska
- Department of Pathophysiology, Universita Karlova, Prague, Czech Republic
| | - Cécilia Galinaud
- Department of Pathophysiology, Universita Karlova, Prague, Czech Republic
| | - Stephen Stearns
- From the Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Angelica Hernandez Alvarez
- From the Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Iulianna C. Taritsa
- From the Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Kirsten A. Schuster
- From the Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Olivia A. Ho
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Fla
| | | | - Bernard T. Lee
- From the Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Samuel J. Lin
- From the Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
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3
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Yang F, Guo J, Kang N, Yu X, Ma Y. rESWT promoted angiogenesis via Bach1/Wnt/β-catenin signaling pathway. Sci Rep 2024; 14:11733. [PMID: 38777838 PMCID: PMC11111732 DOI: 10.1038/s41598-024-62582-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 05/20/2024] [Indexed: 05/25/2024] Open
Abstract
Previous reports have established that rESWT fosters angiogenesis, yet the mechanism by which rESWT promotes cerebral angiogenesis remains elusive. rESWT stimulated HUVECs proliferation as evidenced by the CCK-8 test, with an optimal dosage of 2.0 Bar, 200 impulses, and 2 Hz. The tube formation assay of HUVECs revealed that tube formation peaked at 36 h post-rESWT treatment, concurrent with the lowest expression level of Bach1, as detected by both Western blot and immunofluorescence. The expression level of Wnt3a, β-catenin, and VEGF also peaked at 36 h. A Bach1 overexpression plasmid was transfected into HUVECs, resulting in a decreased expression level of Wnt3a, β-catenin, and VEGF. Upon treatment with rESWT, the down-regulation of Wnt3a, β-catenin, and VEGF expression in the transfected cells was reversed. The Wnt/β-catenin inhibitor DKK-1 was utilized to suppress Wnt3a and β-catenin expression, which led to a concurrent decrease in VEGF expression. However, rESWT treatment could restore the expression of these three proteins, even in the presence of DKK-1. Moreover, in the established OGD model, it was observed that rESWT could inhibit the overexpression of Bach1 and enhance VEGF and VEGFR-2 expression under the OGD environment.
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Affiliation(s)
- Fan Yang
- Department of Rehabilitation Medicine, Suzhou Municipal Hospital, Suzhou, 215002, China
| | - Juan Guo
- Department of Rehabilitation Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Nan Kang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Xiaotong Yu
- Institute of Meta-Synthesis Medicine, Beijing, 100097, China
| | - Yuewen Ma
- Department of Rehabilitation Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
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4
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Lippi L, Ferrillo M, Losco L, Folli A, Marcasciano M, Curci C, Moalli S, Ammendolia A, de Sire A, Invernizzi M. Aesthetic Rehabilitation Medicine: Enhancing Wellbeing beyond Functional Recovery. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:603. [PMID: 38674249 PMCID: PMC11052208 DOI: 10.3390/medicina60040603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
Although rehabilitation medicine emphasizes a holistic health approach, there is still a large gap of knowledge about potential interventions aimed at improving overall wellbeing through cosmetic interventions. Therefore, this narrative review investigates the role of different rehabilitative techniques in enhancing aesthetics, quality of life, and psychosocial wellbeing for patients with disabilities. The study follows the SANRA framework quality criteria for a narrative review. Literature searches across PubMed/Medline, Web of Science, and Scopus identified articles focusing on rehabilitation strategies within the aesthetic rehabilitation domain. The review identified evidence supporting injection procedures, such as Botulinum Toxin, Platelet-Rich Plasma, Hyaluronic Acid, Ozone, and Carboxytherapy, and assessing their applications in several disabling disorders. Additionally, physical therapies like Extracorporeal Shock Wave Therapy, Laser Therapy, Microcurrent Therapy, Tecar Therapy, and physical exercises were explored for their impact on cutaneous microcirculation, cellulite treatment, wound healing, and scar appearance improvement. Lastly, the manuscript underlines the role of manual therapy techniques in addressing both physical discomfort and aesthetic concerns, discussing their effectiveness in adipose tissue therapy, scar tissue mobilization, and regional fat thickness reduction. Taken together, this review emphasizes the role of a multidisciplinary approach, aiming to provide valuable insights into potential benefits for both functional and aesthetic outcomes.
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Affiliation(s)
- Lorenzo Lippi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (S.M.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Martina Ferrillo
- Department of Health Sciences, School of Dentistry, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Luigi Losco
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081 Baronissi, Italy;
| | - Arianna Folli
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (S.M.); (M.I.)
| | - Marco Marcasciano
- Plastic Surgery, Experimental and Clinical Medicine Department, Division of Plastic and Reconstructive Surgery, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Claudio Curci
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy
| | - Stefano Moalli
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (S.M.); (M.I.)
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (S.M.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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5
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Khalil S, Galadari HI. Cellulite: An Update on Pathogenesis and Management. Dermatol Clin 2024; 42:129-137. [PMID: 37977679 DOI: 10.1016/j.det.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Cellulite is a common cosmetic concern among postpubertal women. Despite its high prevalence, there have been only a few high-quality studies assessing its exact prevalence, risk factors, and pathophysiologic mechanisms. It has been difficult to achieve long-lasting results with the available treatments, including topical agents, energy-based devices, subcision, and injectables. In this review, the authors summarize the proposed etiologic factors, grading scales, and treatment options. Further well-designed studies are essential to improve our knowledge of the condition and lead to improved treatment strategies.
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Affiliation(s)
| | - Hassan I Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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6
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Dhillon RK, Dayan SH, Hexsel D, Shridharani S, Chilukuri S, LaTowsky B, Fabi SG. Update: Cellulite Therapies and Optimizing Treatment Combinations. Aesthet Surg J 2023; 43:1508-1520. [PMID: 37184131 DOI: 10.1093/asj/sjad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023] Open
Abstract
Cellulite in the proximal lower extremities is a reported concern among many adult females. The unsightly appearance of cellulite leads many affected individuals to seek treatment by trained specialists. The objective of this review is to provide the reader with an update on new and innovative therapies for cellulite including various treatment combinations to maximize therapeutic outcomes, and strategies for minimizing adverse events. The availability of new technologies and the results from recent clinical trials provide additional tools and data to consider when creating treatment plans for cellulite patients. This update to previous treatment recommendations is based on the most recent developments in cellulite management including the personal experiences of the authors with an emphasis on injectable enzymes, acoustic subcision, targeted verifiable subcision, and biostimulators. Formal clinical studies are warranted to compare various treatment modalities and further investigate combination regimens. LEVEL OF EVIDENCE: 5
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7
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Tai Y, Tonmoy TI, Win S, Brinkley NT, Park BH, Nam J. Enhanced peripheral nerve regeneration by mechano-electrical stimulation. NPJ Regen Med 2023; 8:57. [PMID: 37848428 PMCID: PMC10582163 DOI: 10.1038/s41536-023-00334-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023] Open
Abstract
To address limitations in current approaches for treating large peripheral nerve defects, the presented study evaluated the feasibility of functional material-mediated physical stimuli on peripheral nerve regeneration. Electrospun piezoelectric poly(vinylidene fluoride-trifluoroethylene) nanofibers were utilized to deliver mechanical actuation-activated electrical stimulation to nerve cells/tissues in a non-invasive manner. Using morphologically and piezoelectrically optimized nanofibers for neurite extension and Schwann cell maturation based on in vitro experiments, piezoelectric nerve conduits were synthesized and implanted in a rat sciatic nerve transection model to bridge a critical-sized sciatic nerve defect (15 mm). A therapeutic shockwave system was utilized to periodically activate the piezoelectric effect of the implanted nerve conduit on demand. The piezoelectric nerve conduit-mediated mechano-electrical stimulation (MES) induced enhanced peripheral nerve regeneration, resulting in full axon reconnection with myelin regeneration from the proximal to the distal ends over the critical-sized nerve gap. In comparison, a control group, in which the implanted piezoelectric conduits were not activated in vivo, failed to exhibit such nerve regeneration. In addition, at both proximal and distal ends of the implanted conduits, a decreased number of damaged myelination (ovoids), an increased number of myelinated nerves, and a larger axonal diameter were observed under the MES condition as compared to the control condition. Furthermore, unlike the control group, the MES condition exhibited a superior functional nerve recovery, assessed by walking track analysis and polarization-sensitive optical coherence tomography, demonstrating the significant potential of the piezoelectric conduit-based physical stimulation approach for the treatment of peripheral nerve injury.
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Affiliation(s)
- Youyi Tai
- Department of Bioengineering, University of California, Riverside, CA, 92521, USA
| | | | - Shwe Win
- Department of Bioengineering, University of California, Riverside, CA, 92521, USA
| | - Natasha T Brinkley
- Department of Bioengineering, University of California, Riverside, CA, 92521, USA
| | - B Hyle Park
- Department of Bioengineering, University of California, Riverside, CA, 92521, USA
| | - Jin Nam
- Department of Bioengineering, University of California, Riverside, CA, 92521, USA.
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8
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Gabriel A, Chan V, Caldarella M, Wayne T, O’Rorke E. Cellulite: Current Understanding and Treatment. Aesthet Surg J Open Forum 2023; 5:ojad050. [PMID: 37424836 PMCID: PMC10324940 DOI: 10.1093/asjof/ojad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Cellulite is an aesthetically distressing skin condition that manifests as dimples and depressions, producing an uneven surface to the skin. Occurring in 80% to 90% of females, mostly on the thighs, buttocks, and hips, it is associated with profound negative psychosocial and quality of life issues. Its ethiopathogenesis and pathophysiology are likely to be multifactorial and complex and not fully understood. There is no effective treatment for cellulite, although a number of different treatment modalities are available, from noninvasive to minimally invasive. The efficacy of most treatments is unpredictable and improvements in cellulite appearance are short lived, although significant progress has been made with newer treatments. This review provides an update on the current state of knowledge about cellulite, with an emphasis on patient assessment and an individualized treatment approach for optimal results. Level of Evidence 5
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Affiliation(s)
- Allen Gabriel
- Corresponding Author: Dr Allen Gabriel, Department of Plastic Surgery, 703 Broadway, Suite 700, Vancouver, WA 98660, USA. E-mail:
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9
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Bass LS, Hibler BP, Khalifian S, Shridharani SM, Klibanov OM, Moradi A. Cellulite Pathophysiology and Psychosocial Implications. Dermatol Surg 2023; 49:S2-S7. [PMID: 37000912 DOI: 10.1097/dss.0000000000003745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
BACKGROUND Cellulite is a highly prevalent aesthetic condition in postpubertal women. OBJECTIVE The objective of this article was to describe the latest data on the pathophysiology of cellulite and to highlight the psychosocial aspects that should be considered when treating cellulite. METHODS A roundtable meeting was convened to discuss and share views on the latest data on the pathophysiology and psychosocial aspects of cellulite. The participants' experience helped guide a narrative review on this topic. RESULTS The pathophysiology of cellulite primarily involves fibrous septal changes. Strategies targeting the fibrous septa have shown the most consistent efficacy, while showing inconsistent or short-term results when targeting the other components of cellulite, such as decreased dermal thickness, vascular alterations, and inflammation. Female sex, increased age, and high body mass index contribute to cellulite pathophysiology. CONCLUSION Patients seeking treatment for cellulite are willing to endure numerous treatments, high cost, temporary and/or delayed results, and invasive procedures with potential adverse effects. Psychological discomfort has been reported among patients with cellulite, and understanding their behaviors and psychological characteristics can help clinicians provide better care to these patients seeking treatment.
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10
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Wigley CH, Janssen TJ, Mosahebi A. Shock Wave Therapy in Plastic Surgery: A Review of the Current Indications. Aesthet Surg J 2023; 43:370-386. [PMID: 36226364 DOI: 10.1093/asj/sjac262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) represents a promising, non-invasive management strategy supporting the treatment of a variety of conditions related to plastic surgery. OBJECTIVES This literature review aimed to give a systematic overview of current applications, its mechanism of action, and its potential to provide tangible therapies in plastic surgery. METHODS The databases PubMed (National Institute of Health, Bethesda, MD), Embase (via Ovid [Elsevier, Amsterdam, the Netherlands]), and the Cochrane Library (Cochrane, London, UK) were searched for articles published up to June 1, 2021. Clinical studies of any design including ESWT in the context of plastic surgery were included. Two reviewers extracted data, and 46 articles were analyzed after application of the inclusion and exclusion criteria. RESULTS Forty-six included studies (n = 1496) were categorized into the following broad themes: cellulite/body contouring/skin rejuvenation, burns/scar treatment, diabetic foot ulcers/chronic wound, and future perspectives of ESWT. Overall, applications of ESWT were heterogenous, and the majority of studies reported effectiveness of ESWT as an alternative treatment technique. Flawed methodology and differences in technical standards limit the outcome and conclusion of this review. CONCLUSIONS There is yet insufficient evidence to support the effectiveness of any specific intervention included in this review; however, all included studies reported improvements in key outcomes. Where reported, ESWT displayed a good safety profile with no serious adverse events. Further research is needed to provide more evidence to delineate the indications of ESWT in plastic surgery.
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Affiliation(s)
- Catrin H Wigley
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, UK
| | - Tim J Janssen
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, UK
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11
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Nguyen CN, Nguyen QBD, Hebert AA, Gold MH. Adverse Events of Non-Invasive Body Contouring: Analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience Database. Dermatol Surg 2022; 48:943-948. [PMID: 36054047 DOI: 10.1097/dss.0000000000003525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/02/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Multiple non-invasive modalities have become popular alternatives to surgical procedures for body contouring. OBJECTIVE To analyze adverse events (AEs) associated with non-invasive body contouring devices reported through the Manufacturer and User Facility Device Experience (MAUDE) database. METHODS AND MATERIALS The MAUDE database were queried for AEs associated with non-invasive body contouring devices between January 2011 and June 2021. An extensive list of keywords and brand and manufacturer names was used. RESULTS A total of 1,325 reports with 1,590 AEs were identified among 6 modalities. More than 70% were reported in the past 5 years. Cryolipolysis made up 38.3% reports, which mostly pertained to paradoxical hyperplasia and hernias. Radiofrequency had the most reports (41.9%). Like laser devices, most of their reports described burns. Focused ultrasound was commonly associated with unintentional fat loss and surface irregularities. Focused electromagnetic field resulted in only 7 reports. CONCLUSION The analysis of present study supports previous studies concerning common local symptoms caused by these devices, but it also reveals complications not reported in previous device studies. This study highlights the importance of proper technique and adherence to device guidelines. Practitioners should be knowledgeable of potential complications from each device to both prevent and manage them accordingly.
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Affiliation(s)
| | - Quoc-Bao D Nguyen
- Department of Dermatology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
- Department of Dermatology, UTHealth Houston, McGovern Medical School, Houston, Texas
| | - Adelaide A Hebert
- Department of Dermatology, UTHealth Houston, McGovern Medical School, Houston, Texas
| | - Michael H Gold
- Gold Skin Care Center, Nashville, Tennessee
- Tennessee Clinical Research Center, Nashville, Tennessee
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12
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Arora G, Patil A, Hooshanginezhad Z, Fritz K, Salavastru C, Kassir M, Goldman MP, Gold MH, Adatto M, Grabbe S, Goldust M. Cellulite: Presentation and Management. J Cosmet Dermatol 2022; 21:1393-1401. [PMID: 35104044 DOI: 10.1111/jocd.14815] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/02/2022] [Accepted: 01/27/2022] [Indexed: 11/30/2022]
Abstract
Cellulite is a common dermatological condition with a female preponderance, affecting up to 90% post-pubertal females. It is characterized with dimpling and denting of the skin surface, giving it a Peau d'orange appearance. Once considered to be a benign physiological isolated skin condition of only an aesthetic concern, cellulite is now considered a pathological entity with systemic associations and a negative psychological impact on patients. Several treatment options from lifestyle modifications, topical cosmetic therapies to energy-based devices have been studied for its treatment. However, treatment remains a challenge despite many new modalities in the armamentarium. Laser and light therapies along with radiofrequency are useful treatment options with good safety profile. Acoustic wave therapy, subcision, and 1440-nm Nd:YAG minimally invasive laser are beneficial in cellulite reduction. Methodological differences in the trials conducted, makes it difficult to compare different treatment modalities. Overall, treatment needs to be individualized based on the patient characteristics and severity of the condition. Combination of treatments is often required in most patients for reducing cellulite.
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Affiliation(s)
- Gulhima Arora
- Department of Dermatology, Mehektagul Dermaclinic, New Delhi, India
| | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | | | - Klaus Fritz
- Dermatology and Laser Center, Reduitstr. 13 ,D 76829 Landau, Germany; "Carol Davila" University of Medicine and Pharmacy 37 Dionisie Lupu Str, Bucharest, Romania
| | - Carmen Salavastru
- "Colentina" Clinical Hospital, Pediatric Dermatology Discipline, Dermato-oncology Research Facility, 19-21 Stefan cel Mare Str. Bucharest , Romania; "Carol Davila" University of Medicine and Pharmacy 37 Dionisie Lupu Str, Bucharest, 020021, Romania
| | - Martin Kassir
- Founding director, Worldwide laser institute, Dallas, USA
| | - Mitchel P Goldman
- Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA
| | - Michael H Gold
- Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA
| | - Maurice Adatto
- Skinpulse Dermatology and Laser Centre, Geneva, Switzerland
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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13
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A Prospective Study Determining Patient Satisfaction with Combined Cryolipolysis and Shockwave Therapy Treatment for Noninvasive Body Contouring. Aesthetic Plast Surg 2021; 45:2317-2325. [PMID: 33515083 DOI: 10.1007/s00266-021-02139-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/10/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND With an increased interest in nonsurgical and minimally invasive body fat reduction and body contouring procedures with limited side effects and downtime, cryolipolysis has emerged as a compelling and safe alternative to surgical fat removal methods. A massage of the treated areas generally follows cryolipolysis treatment to improve blood circulation and increase apoptotic fat cells' removal. In this study, following cryolipolysis, we used shockwave therapy instead of massage to enhance the results of the body contouring treatment and improve the patient's comfort. We then assessed patients' comfort and satisfaction using the combination of cryolipolysis and shockwave therapy in reducing fat volume. METHODS We conducted a prospective study of 30 patients who underwent at least one cryolipolysis therapy cycle followed by shockwave treatment. Subjects were given a posttreatment questionnaire to assess the patient's comfort and satisfaction degree with the combination of cryolipolysis and shockwave therapy for fat reduction. Answers were recorded on a five-point Likert-style scale, entered into a database and were analyzed. RESULTS We found an overall high satisfaction rate for most patients when treated with shockwave therapy after cryolipolysis treatment. The majority of patients described the discomfort associated with treatment as minimal or tolerable (76.7%) and were prepared to recommend cryolipolysis treatment followed by shockwave therapy to friends (68.9%). Overall, 76.7% of patients found the combination therapy comfortable, 68.3% were satisfied with the results, 57.7% said the results met their expectations. CONCLUSION The most important aspects of body contouring methods is a patient's safety, comfort, satisfaction and self-image improvement. In this study, we report a high level of patient satisfaction when using a combination of fat reduction procedures of cryolipolysis followed by shockwave therapy. The majority of cases report being satisfied or extremely satisfied with the treatment and found this body contouring combination method comfortable. Cryolipolysis combined with shockwave treatment appears to be a safe and efficient way of reducing the size of localized and stubborn fat deposits for subjects who desire nonsurgical localized fat reduction. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Comparison of Extracorporeal Shock Wave Therapy versus Manual Lymphatic Drainage on Cellulite after Liposuction: A Randomized Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9956879. [PMID: 34422085 PMCID: PMC8371620 DOI: 10.1155/2021/9956879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/01/2021] [Accepted: 07/31/2021] [Indexed: 11/24/2022]
Abstract
Introduction Cellulite is associated with variations in the skin appearance with cottage cheese, mattress-like, or orange peel. The most common areas for these lesions are the posterior or upper thighs and buttocks and mainly affect females after puberty. The objective of the study was to determine whether extracorporeal shock wave therapy (ESWT) or manual lymphatic drainage (MLD) is more effective for the reduction of the grade of cellulite after liposuction. Methods This study is a single-blinded randomized controlled clinical trial. Thirty females with grade 3 cellulite were randomly distributed into two groups equal in number (n = 15), group A was equipped to ESWT and group B was equipped to MLD. The cellulite grading scale was used to assess cellulite grade, and the skinfold caliper was used to assess the thickness of subcutaneous fat. The assessment was carried out before and four weeks after starting the treatment. Both groups received topical retinol twice daily for four weeks; in addition, group A received ESWT, while group B received MLD, two times/week for 4 weeks. Results The mean values of the skinfold caliper in group A decreased by 24.4% and in group B by 15.38% with a significant difference between the two groups (p < 0.001). Also, the mean values of the cellulite grading scale decreased significantly after treatment in group A compared with the mean values of group B (p < 0.001). Conclusions There was more reduction in the grade of cellulite and thickness of subcutaneous fat in the ESWT group than the MLD group after liposuction.
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Effect of extracorporeal shock waves on inflammation and angiogenesis of integumentary tissue in obese individuals: stimulating repair and regeneration. Lasers Med Sci 2021; 37:1289-1297. [PMID: 34365545 DOI: 10.1007/s10103-021-03387-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
The technology of extracorporeal shock wave therapy (ESWT) has been studied around the world for its possible benefits in the treatment and rehabilitation of aesthetic disorders. To better elucidate its real physiological effect on the integumentary tissue, this study was proposed aimed at evaluating whether ESWT can act to stimulate the inflammatory process and angiogenesis in the dermis and epidermis of obese individuals. This is an immunohistological study that evaluated a set of samples of the integumentary tissue of women with grade II obesity with weight loss of 10% of the initial weight undergoing ESWT treatment; the collection of biological material was performed at the time of surgery of bariatric surgery. For immunohistochemical evaluation, the markers to assess the presence and distribution of inflammatory cells, anti-COX-2, CD3, CD20, CD163, and NK were used. For physiological stimulus pathways for blood vessel angiogenesis, markers CD 34, CD 105 and VEGF were used. Fourteen obese women were included in the study. Positivity was evidenced in the epidermal expression of markers of the inflammatory process COX-2, CD3, CD20, NK cells, CD68, and CD163 (p < 0.0001) in the intervention sample when compared to controls. There was a positive expression for the angiogenesis markers CD105 and VEGF (p < 0.0001) when comparing the intervention group with the control group. It was concluded that ESWT can stimulate a local inflammatory process, mediating and modulating important growth factors to act in the repair process and skin tissue regeneration, being considered a promising treatment for skin diseases related to weight gain or loss.
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Joos E, Vultureanu I, Nonneman T, Adriaenssens N, Hamdi M, Zeltzer A. Low-Energy Extracorporeal Shockwave Therapy as a Therapeutic Option for Patients with a Secondary Late-Stage Fibro-Lymphedema After Breast Cancer Therapy: A Pilot Study. Lymphat Res Biol 2020; 19:175-180. [PMID: 32780632 DOI: 10.1089/lrb.2020.0033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Secondary lymphedema (LE) can occur after breast cancer (BC) therapy with axillary lymph node surgery and/or radiotherapy. Reported incidence varies around 20%. The aim of this study was to see whether low-energy extracorporeal shockwave therapy (ESWT) is a therapeutic option in end-stage secondary upper limb fibro-LE. Methods and Results: A pilot study was performed on 10 adult patients who presented with an end-stage LE after BC treatment. They were all treated with usual physical therapy and all had lymphatic surgery before. Eight sessions of ESWT were applied, 2600 shocks at 0.1 mJ/mm2, 2/week during 4 weeks. Upper limb volume decreased nonsignificantly, from 3086.4 ± 539.47 to 2909.1 ± 471.60 mL. Mean circumference of the upper limb was significantly decreased from 32.3 ± 3.01 to 31.4 ± 2.71 cm at the height of the upper arm, from 29.1 ± 2.89 to 28.1 ± 2.71 cm at the height of the elbow, and from 27.5 ± 4.08 to 26.8 ± 3.75 cm at the height of the forearm. Subjective measurements by visual analog scale showed significant decrease in both hardness from 57.3 ± 15.84 to 24.4 ± 21.89 mm and subjective feeling of edema from 44.2 ± 16.90 to 23.2 ± 21.16 mm. No adverse features were reported. Conclusion: We added some evidence that low-energy ESWT is well supported and has additional benefits also in longstanding fibro-lipo-LE on swelling of the arm leading to more subjective comfort for the patients.
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Affiliation(s)
- Erika Joos
- Department of Physical Medicine and Rehabilitation, UZ Brussels, Brussels, Belgium.,Lymphology Clinic & European Center of Lymphatic Surgery, UZ Brussels, Brussels, Belgium
| | - Ina Vultureanu
- Department of Physical Medicine and Rehabilitation, UZ Brussels, Brussels, Belgium
| | - Tom Nonneman
- Department of Physical Medicine and Rehabilitation, UZ Brussels, Brussels, Belgium
| | - Nele Adriaenssens
- Lymphology Clinic & European Center of Lymphatic Surgery, UZ Brussels, Brussels, Belgium
| | - Moustapha Hamdi
- Lymphology Clinic & European Center of Lymphatic Surgery, UZ Brussels, Brussels, Belgium.,Department of Plastic and Reconstructive Surgery, UZ Brussels, Brussels, Belgium
| | - Assaf Zeltzer
- Lymphology Clinic & European Center of Lymphatic Surgery, UZ Brussels, Brussels, Belgium.,Department of Plastic and Reconstructive Surgery, UZ Brussels, Brussels, Belgium
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Ashem HN, Draz AH, Abdel-Aziem AA. Caffeine phonophoresis versus shock wave therapy for adult women with cellulite: a randomized controlled trial. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2019. [DOI: 10.4103/bfpt.bfpt_27_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sadick N. Treatment for cellulite. Int J Womens Dermatol 2018; 5:68-72. [PMID: 30809581 PMCID: PMC6374708 DOI: 10.1016/j.ijwd.2018.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 12/11/2022] Open
Abstract
Cellulite is a multifactorial condition that is present in 80% to 90% of postpubertal women and is one of the most intolerable esthetic imperfections. There are several theories on the pathophysiology of cellulite, and a number of different therapeutic regimens have been developed, from topical treatments to mechanical or energy-based devices. In this brief review, we summarize the scientific landscape to determine the clinical evidence with regard to the safety and efficacy of cellulite treatment options. Clinical protocols and the author’s experience using a combination of internal and external procedures are also discussed. Studies using laser and light modalities along with radiofrequency have shown improvements in cellulite and a good safety profile, but acoustic wave therapy, subcision, and the 1440-nm Nd:YAG minimally invasive laser have demonstrated the most beneficial results in cellulite reduction. Although there is paucity of scientific evidence for treatments that improve cellulite, future emerging options and their combination may pave the way to eradicate this primarily cosmetic esthetic concern.
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Affiliation(s)
- Neil Sadick
- Department of Dermatology, Weill Cornell Medical College, New York, New York.,Sadick Dermatology, New York, New York
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Cristovam DN, Botelho S, Andrade MF, Marques J, Sousa L. Whole-body vibration in the reduction of the cellulite. J COSMET LASER THER 2018; 21:278-285. [PMID: 30300017 DOI: 10.1080/14764172.2018.1525750] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Evaluate the effects of the whole body vibration in improving of cellulite in the women's gluteal region. METHODS Controlled clinical trial performed with 42 women, with cellulite in the gluteal region, detected by means of clinical examination. After evaluation, the women were divided into two groups: Whole-Body Vibration (WBV_G) and control (C_G). The evaluations were performed at the beginning and the end of 10 sessions and superficial skin temperature, perimetry in the gluteal region, analysis of body contouring, analysis of improvement by blind reviewers and instrument of satisfaction, by numeric scale were investigated. RESULTS In the thermographic analysis, the WBV_G obtained significant increase of superficial skin temperature on the right (p = 0.02) and left (p = 0.02) gluteal region. There was no difference in intra- and intergroups in perimetry and the analysis of body contour. The WBV_G obtained a higher percentage of improvement by assessment of the blind reviewers (p = 0.003) and greater aesthetics satisfaction (p = 0.006), when compared to C_G. CONCLUSION WBV provided an improvement in the aspect of the cellulite when assessed by blind reviewers and greater participants' satisfaction, providing a significant increase in the superficial skin temperature in the gluteal region.
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Affiliation(s)
- Danielli Nunes Cristovam
- a Graduation in Physical Therapy , Federal University of Alfenas , Alfenas , Minas Gerais , Brazil
| | - Simone Botelho
- b Doctor, Postgraduate Program in Rehabilitation Sciences , Federal University of Alfenas , Alfenas , Minas Gerais , Brazil
| | - Marília Fernandes Andrade
- c Master, Postgraduate Program of Biosciences Applied to Health , Federal University of Alfenas , Alfenas , Minas Gerais , Brazil
| | - Joseane Marques
- d Doctor, Postgraduate Program in Surgical Sciences , State University of Campinas , Campinas , São Paulo , Brazil
| | - Ligia Sousa
- b Doctor, Postgraduate Program in Rehabilitation Sciences , Federal University of Alfenas , Alfenas , Minas Gerais , Brazil
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Meyer PF, Consulin MCD, Rodrigues T, Pereira AM, Lopes PCM, da Silva RMV, de Vasconcellos LS. Effects of contrast cryolipolysis on flank region adiposity: Case study. J Cosmet Dermatol 2018; 17:1059-1062. [PMID: 30246297 DOI: 10.1111/jocd.12785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 06/24/2018] [Accepted: 07/19/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Contrast Cryolipolysis is a non-invasive technique that aims to reduce localized adiposity with its heating-cooling-heating method, resulting in a 45% fat loss in the treated area, with no damage to the skin. OBJECTIVE To investigate the effects of contrast cryolipolysis compared to conventional cryolipolysis on localized adiposity. MATERIALS AND METHODS This is a case study was carried out with two volunteers. The cirtometry, ultrasonography, and the anthropometric characteristics' analyses of volunteers were performed before and after the intervention. The right flank region underwent conventional cryolipolysis, and the left flank underwent contrast cryolipolysis. RESULTS The procedures performed in both volunteers had positive results. However, the use of Contrast Cryolipolysis promoted greater loss of adipose tissue, reducing perimetry and cirtometry measurements, as well as the adipose tissue thickness, acknowledged via ultrasonography. CONCLUSION The contrast cryolipolysis promotes greater localized adiposity reduction than the conventional cryolipolysis.
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Affiliation(s)
- Patrícia Froes Meyer
- Federal University of Rio Grande do Norte, Natal, Brazil.,Potiguar University-UNP, Natal, Brazil
| | | | | | | | | | - Rodrigo Marcel Valentim da Silva
- Federal University of Rio Grande do Norte, Natal, Brazil.,Estácio de Sá University, Rio de Janeiro, Brazil.,Maurício de Nassau University, Natal, Brazil
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de Lima Morais TM, Meyer PF, de Vasconcellos LS, E Silva JC, E Andrade IF, de Farias VAF, da Silva IC, Araújo RMFG, da Silva RMV, Pacheco EF, Soares CD. Effects of the extracorporeal shock wave therapy on the skin: an experimental study. Lasers Med Sci 2018; 34:389-396. [PMID: 30109536 DOI: 10.1007/s10103-018-2612-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/07/2018] [Indexed: 12/17/2022]
Abstract
Extracorporeal shock wave therapy (ESWT) has been extensively studied for its multiple biological properties, and although it is widely applied in esthetical procedures, little is known about its effects on the epidermis and dermis. In this study, a histological and immunohistochemical study of the effects of ESWT was performed on rat skin. Forty-five female rats were treated with one or two sessions of ESWT and sacrificed on days 1, 7, 14, and 21 after treatment. The samples were histologically processed and then morphometric analyses were performed to assess the epidermis, dermis, and subcutaneous fat tissue thickness. Immunohistochemical reactions were also performed against the antibodies: basic fibroblastic growth factor (FGF2), its receptor (FGFR1), and α-smooth muscle actin. Slides were scanned and digitally assessed, to determine the microvessel density (MVD) and digital scoring of the immunohistochemical staining. The results showed that ESWT produced a significantly higher collagen content, MVD, and epidermis and dermis thickness than the control, non-treated group. Both in epidermis and dermis, FGF2 was overexpressed in the ESWT-treated groups, whereas FGFR1 was increased only in the group treated with two ESWT sessions at 21-days post-treatment. The ESWT-treated groups have also shown diminished thickness of subcutaneous fat tissue. In conclusion, ESWT induces neocollagenesis and neoangiogenesis, and upregulates the FGF2 expression, particularly in the groups treated with two sessions. Furthermore, it was demonstrated that overexpression of FGF2 on skins treated with ESWT seems to be a key role on its mechanism of action.
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Affiliation(s)
- Thayná Melo de Lima Morais
- Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira 901, Piracicaba, SP, 1314-903, Brazil
| | | | | | | | | | | | | | | | | | | | - Ciro Dantas Soares
- Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira 901, Piracicaba, SP, 1314-903, Brazil.
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Pérez Atamoros FM, Alcalá Pérez D, Asz Sigall D, Ávila Romay AA, Barba Gastelum JA, Peña Salcedo JA, Escalante Salgado PE, Gallardo Palacios GJ, Guerrero‐Gonzalez GA, Morales De la Cerda R, Ponce Olivera RM, Rossano Soriano F, Solís Tinoco E, Welsh Hernández EC. Evidence‐based treatment for gynoid lipodystrophy: A review of the recent literature. J Cosmet Dermatol 2018; 17:977-983. [DOI: 10.1111/jocd.12555] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 12/18/2022]
Affiliation(s)
| | | | | | | | - José A. Barba Gastelum
- Attached to Plastic Surgery at Centro Médico Nacional de Occidente IMSS Guadalajara Mexico
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Fritz K, Salavastru C, Gyurova M. Clinical evaluation of simultaneously applied monopolar radiofrequency and targeted pressure energy as a new method for noninvasive treatment of cellulite in postpubertal women. J Cosmet Dermatol 2018. [PMID: 29524305 DOI: 10.1111/jocd.12525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION This study investigates noninvasive cellulite treatments based on simultaneous application of monopolar radiofrequency (RF) and targeted pressure energy to evaluate efficacy and safety and to see whether simultaneous application has any benefits in noninvasive cellulite treatments. METHODS Thirty women with cellulite (fibrous/adipose/aqueous types) received 4 gluteofemoral treatments (~24 minutes; ~1000 cm2 ) using a simultaneous application of RF and targeted pressure energy. Clinical improvement was assessed using a pentile grading scale and satisfaction questionnaires. Hip/thigh circumference was measured. Ultrasonography and thermography observed changes in dermal/subcutaneous tissue composition and in gluteofemoral thermal profile. Evaluation at 3 months posttreatment was compared against the baseline. RESULTS The clinical improvement averaged 2.17 ± 0.95 (54% improvement). Cellulite was reduced in 93% of cases, while 73% of patients showed good/very good/excellent improvement, with most significant improvement seen in patients with moderately severe cellulite. Hips and thigh circumference decreased on average by 2.31 cm and 2.13 cm, respectively (P < .001). Patient satisfaction was very high, averaging 4.47 ± 0.57 points (1-5 scale). Ultrasonography revealed smoothing and thickening (+0.28 ± 0.15 mm) of the dermis and an average reduction of 1.96 ± 1.60 mm in fat thickness (P < .05). Subjects with significant cellulite reduction had a more homogenous thermal profile at follow-up as a result of therapy-induced diminution of topographic skin defects. No adverse events were recorded. CONCLUSION The application is effective and safe for treating cellulite. The level of clinical improvement after 4 sessions is comparable to results reported after 6-20 sessions in studies on stand-alone RF/laser/targeted pressure energy devices. The technology is promising and deserves further attention and research.
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Affiliation(s)
- Klaus Fritz
- Dermatology and Laser Center, Landau in der Pfalz, Germany.,Carol Davila University, Bucharest, Romania
| | - Carmen Salavastru
- Carol Davila University, Bucharest, Romania.,Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania
| | - Magdalina Gyurova
- Dermaplus Dermatology Laser & Aesthetic Medical Clinic, Plovdiv, Bulgaria.,Dermatology and Venereology Department, Medical University Plovdiv, Plovdiv, Bulgaria
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Kim H. The combination of extracorporeal shock wave therapy and noncontact apoptosis-inducing radiofrequency achieved significant waist circumferential reduction: a pilot study. Laser Ther 2017; 26:129-136. [PMID: 28785133 DOI: 10.5978/islsm.17-or-11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 05/09/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS A paradigm shift towards noninvasive body contouring has occurred over the past few years. Radiofrequency (RF) is one popular treatment method. Noncontact-type RF systems with frequencies in the tens of megahertz represent a novel approach. The current pilot study investigated the efficacy of an interesting combination of extracorporeal shock wave therapy (ESWT) and an apoptosis-inducing RF (AiRF) system for circumferential reduction. SUBJECTS AND METHODS Twenty-seven females, ages ranging from 13-69 years, (mean age 37.96 years) participated in the study. They were assigned to two treatment-based groups: Group A (n=19) and Group B (n=8). A voluntary daily dietary restriction plan of 500 kcal was put in place for all subjects. A combination of two different devices was used; an extracorporeal shock wave therapy (ESWT) system and a 27.12 MHz AiRF system. Either 4 (n=28) or 6 sessions (n=19) were given, one week apart. In Group A, the ESWT was applied before the RF with the reverse order of application in Group B. Weight and waist circumference were noted at baseline, then one week after the 4th and the 6th treatment sessions at which points clinical photography was also obtained. RESULTS All patients showed statistically significant waist circumferential loss in both the 4- and 6-week treated groups: Group A, 6.3 cm and 8.8 cm; Group B, 5.9 cm and 6.4 cm, respectively. Greater circumference loss tended to be seen in Group A in both groups, but without statistical significance. No patient complained of pain during or after the treatment sessions, and there were no adverse events. CONCLUSIONS This pilot study showed that the combination of ESWT and AiRF was safe and effective for significant waist circumferential reduction. The results tended to be better when ESWT was applied before AiRF, although the difference was not significant.
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Modena DAO, da Silva CN, Grecco C, Guidi RM, Moreira RG, Coelho AA, Sant’Ana E, de Souza JR. Extracorporeal shockwave: mechanisms of action and physiological aspects for cellulite, body shaping, and localized fat—Systematic review. J COSMET LASER THER 2017; 19:314-319. [DOI: 10.1080/14764172.2017.1334928] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Débora A. Oliveira Modena
- Department of Surgery, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil
- Ibramed Research Institute: Study Group in Technology Applied to Health, Amparo, Brazil
| | - Caroline Nogueira da Silva
- Human Development and Technologies, Universidade Estadual Paulista (UNESP), São Paulo, Brazil
- Ibramed Research Institute: Study Group in Technology Applied to Health, Amparo, Brazil
| | - Clovis Grecco
- Ibramed Research Institute: Study Group in Technology Applied to Health, Amparo, Brazil
| | - Renata Michelini Guidi
- Ibramed Research Institute: Study Group in Technology Applied to Health, Amparo, Brazil
- Biomedical Engineering Department, Faculty of Electrical Engineering and Computing, University of Campinas (Unicamp), Campinas, Brazil
- Centro de Estudos e Formação Avançada Ibramed (CEFAI), Amparo, Brazil
| | - Renata Gomes Moreira
- Ibramed Research Institute: Study Group in Technology Applied to Health, Amparo, Brazil
| | - Andresa A. Coelho
- Ibramed Research Institute: Study Group in Technology Applied to Health, Amparo, Brazil
| | - Estela Sant’Ana
- Ibramed Research Institute: Study Group in Technology Applied to Health, Amparo, Brazil
| | - José Ricardo de Souza
- Ibramed Research Institute: Study Group in Technology Applied to Health, Amparo, Brazil
- Centro de Estudos e Formação Avançada Ibramed (CEFAI), Amparo, Brazil
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Hexsel D, Camozzato FO, Silva AF, Siega C. Acoustic wave therapy for cellulite, body shaping and fat reduction. J COSMET LASER THER 2017; 19:165-173. [DOI: 10.1080/14764172.2016.1269928] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Doris Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
| | | | - Aline Flor Silva
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
| | - Carolina Siega
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
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Wilczyński S, Koprowski R, Deda A, Janiczek M, Kuleczka N, Błońska-Fajfrowska B. Thermographic mapping of the skin surface in biometric evaluation of cellulite treatment effectiveness. Skin Res Technol 2016; 23:61-69. [PMID: 27264715 DOI: 10.1111/srt.12301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cellulite is one of the worst tolerated aesthetic imperfections. Edema that accompanies cellulite causes disorders of blood flow what may be observed as changes in the skin surface temperature. The aim of this paper was to develop a new method based on the analysis and processing of thermal images of the skin for biometric evaluation of severity of cellulite and monitoring its treatment. METHODS The observations of the treatment effects were conducted on 10 females (33.4 ± 6.4 years). Thermal images of the volunteers' thighs were captured before starting the therapy (T0 ). In the following stages: T1 , T2 , and T3 , thermal images were captured 2 weeks after the first, second and third Alidya treatment administration, respectively. Profiled algorithms were developed to determine the mean Grey Level Co-occurrence Matrix (GLCM) contrast in the acquired thermograms. RESULTS The mean GLCM contrast for the phase T0 was 70.91, and for the stages T1 , T2 , and T3 : 57.78, 41.80, and 38.53, respectively. CONCLUSION The use of proposed method (GLCM contrast) enables biometric evaluation of the effectiveness of cellulite treatment. Traditionally used parameters of infrared analysis such as local points of the maximum and minimum temperature or the median temperatures are not useful in thermal, biometric evaluation of anti-cellulite preparations.
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Affiliation(s)
- S Wilczyński
- School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Department of Basic Biomedical Science, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - R Koprowski
- Department of Biomedical Computer Systems, Faculty of Computer Science and Materials Science, Institute of Computer Science, University of Silesia, Sosnowiec, Poland
| | - A Deda
- School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Department of Skin Structural Studies, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - M Janiczek
- Department of Medicine, Katowice School of Economics, Katowice, Poland
| | - N Kuleczka
- School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Department of Basic Biomedical Science, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - B Błońska-Fajfrowska
- School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Department of Basic Biomedical Science, Medical University of Silesia in Katowice, Sosnowiec, Poland
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