Cellulite is considered a disease of the subcutaneous fat layer that appears mostly in women and consists of changes in fat cell accumulation together with disturbed lymphatic drainage, affecting the external appearance of the skin [1]. Changes observed in the fibrotic septae between fat cells, reduction of the metabolic rate, and thus congesting tissue affect the external aspect of skin, with alteration of the skin surface that appears bumpy and uneven. Cellulite starts at puberty in almost all women, and when the deposition becomes excessive, it is a condition that is difficult to control and treat. Various treatment modalities with varying degrees of success have been proposed [2]. Reports suggest that radiofrequency (RF) electrical energy is effective when used on and absorbed by the affected tissue [3, 4]. RF current produces a heating effect that depends on current mode and intensity as well as on the natural resistance or impedance of the skin to the passage of electricity. Electrical impedance of the skin rises with increasing depth and coarser collagen elastin fibers. Impedance will decrease with an increase in blood content in the treated area due to continuous application of treatment. On the other hand, progressive heating of tissue leads to reduced impedance. The RF thermal effect is ‘‘blind’’ to the natural skin pigmentation and is transmitted deeper than light, thus exerting action on the subcutaneous layer. RF can be monopolar or bipolar. In most monopolar RF devices, a single electrode is applied to the skin while the other electrode is fixed to a remote part of the patient’s body. In bipolar RF, electricity passes along a well-defined arc through the target tissue from one electrode to the other. For bipolar RF, the depth reached by the electricity, according to physics, is one half the distance between the electrodes. The idea of combining RF with infrared (IR) light treatment for a more superficial heating, together with mechanical massage and suction, has gained support in the past few years [5]. Synergistic action on treating cellulite has been achieved with promising clinical results [6]. The product Vela Smooth (Syneron", Yokneam, Israel) incorporates mechanical massage and suction, IR light, and RF electrical current. The latter delivers up to 20 W at 1 MHz, and IR light is emitted over a waveband of 700–2000 nm. Both energies, electrical and optical, are applied simultaneously to the cellulite area. At the same time, mechanical massage is given together with suction action up to around 400 mbar of negative pressure. All these combined treatments are delivered through the handpiece which is manually applied to the skin by the person giving the treatment. The specific geometry of the electrodes and the vacuum impact upon inserting the skin between electrodes provide deep RF penetration when the handpiece is moved over the skin. The handpiece permits treatment at different intensities. Treatment in the trials of this report was given at the highest intensity. The purpose of our study was to check the histologic condition of cellulite in the buttock before and 2 h after a single treatment. The study was approved by the Ethics Committees of the Antoni de Gimbernat Foundation. All ten patients selected for the study had a similar cellulite condition in both buttocks, i.e., degree 3 according to the classification by Rossi [7]. Patients were informed of the purpose of the study and signed a consent form for biopsies. Sets of parameters for treatment were constant during the M. A. Trelles (&) ! S. R. Mordon Instituto Medico Vilafortuny, Antoni De Gimbernat Foundation, Av. Vilafortuny, 31, 43850 Cambrils, Spain e-mail: imv@laser-spain.com
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