Introduction to the Definitive 3-Step Cellulite Treatment
In order to appreciate the definitive 3 step cellulite treatment we must first appreciate the real pathophysiology of cellulite. Until now, treatments have focused only a single pathophysiology for cellulite. Specifically, failed treatments have focused on global release of tethering ligaments, called fibroseptal networks and/or simultaneous tightening of loosened ligaments with external radiofrequency treatments.
The complexity of cellulite appearance is the pathophysiology of a cellulite dimple, which involves focal changes that must be independently addressed. Finally, there are focal fat distribution imbalances that must be acknowledged.
The Real Pathophysiology of Cellulite
The real pathophysiology of cellulite can only be appreciated after considering fat composition and distribution asymmetries, as well as connective tissue components of the skin and soft tissues. First, there are two layers of fat, the superficial and deep layers. The superficial layer possesses fat cells that are smaller in size and more compact as they are surrounded more by a high density of fibro septal network (FSN). The deep layer of fat possesses larger fat cells that are surrounded by less dense FSN. Interestingly, the superficial fat cells are more constant and less prone to size change with weight fluctuation.
In contrast, the deep fat cells are more dynamic and will preferentially grow and shrink in size with weight fluctuation. These observations are likely because the deeper fat cells preside in a roomier layer that possesses less dense and constricting FSN fibers. This differentiation is critical to the hypothesized pathophysiology of cellulite.
The next pertinent discussion regarding cellulite morphology pertains to the collagenous deposition and distribution in the skin and soft tissues. To rationalize the seemingly contrasting clinical observation of sporadic dimples caused by presumed tight fibrous bands, yet globally loose and sagging skin, we must take a closer look at the makeup of the fibro septal network matrix. It is hypothesized that the majority of FSN is oriented vertically with only sporadic diagonally oriented FSN fibers interspersed throughout.
With an initial weight gain, the deep fat cells tend to grow up, since they are constrained by their neighboring deep fat cells. As a result, when patients gain weight, the skin gets stretched up as it expands in the vertical direction more than the horizontal direction. This results in stretching out of the vertical FSN preferentially over the diagonal or oblique oriented FSN fibers.
The increased tension induced on the vertical fibers results in loss of vertical FSN fiber integrity and elasticity while the oblique fibers preserve their integrity and elasticity. Protective elements of the oblique bands follows the fact that the increased tension of growing fat cells is more gently distributed throughout the length of the fibers that are oriented horizontally more than strictly vertically.
If weight gain is followed by weight loss, then the vertical fibers become loose since they have lost their recoil ability, whereas the oblique vertical fibers retained their recoil potential and thus tighten back down. Similarly, when patients undergo liposuction to remove the deep fat after weight gain, the compromised vertical fibers become loose when compared to the oblique fibers. Following either weight loss or after liposuction, patients will observe the initial hints of cellulite.
Fat cells located in compromised vertical band areas will push the skin out, termed fat herniation, whereas areas where the skin is attached to oblique FSN fibers will resist fat bulging and dimple in. This effect becomes even more exaggerated with repeated weight gain because the frayed vertical fibers cannot resist the tension placed on them by growing deep fat cells. The net effect is that the majority of areas that maintain vertical FSN fibers will bulge out as previously characterized by herniated fat, whereas more sporadic areas adhered down by oblique fibers will create sporadic dimpling.
Cellulite appearance can be further exaggerated by poor lifestyle habits and natural aging. The FSN and dermal composition of collagen thin out when we exposed to prolonged radiation waves of the sun, if we consume diets low in protein composition, or are not physically active. Collagen production is similarly reduced with natural aging as fibroblasts gradually diminish their output capacity resulting in global thinning of the skin and superficial FSN matrix.
Thinning of the skin and superficial FSN matrix make older patients more prone to vertical band compromise and fat herniation while decreasing resistance to the dimpling of oblique fibers. Regardless of age, cellulite formation is still predicated by fluctuation of weight with an initial weight gain followed by weight loss or liposuction surgery. Cellulite is even more exaggerated following repeated weight gain.
The final consideration involves the fact that fat cells are depleted over the center of the dimple, whereas they are in higher density in the areas surrounding the dimple where fat herniation is occurring. This appreciation of fat density mismatch provides the premise requiring fat redistribution. Specifically, fat cells must be removed from the surrounding herniated sites where fibroseptal network tightening is being performed and replaced into the central dimples where ligament release is being completed.
Failed treatment options for Cellulite
The appearance of cellulite is primarily attributed to the structure of fat cells and connective tissues in the skin and subcutaneous layer. Fat cells, or adipocytes, are arranged vertically, and when these fat cells enlarge, they push upwards against the more rigid yet pliable skin and connective tissues. The appearance of sporadic dimples along saggy and loose skin is pathognomonic for cellulite. One of the most pervasive myths about cellulite is that it only affects overweight or individuals with hormone imbalances. In reality, cellulite can be present in people of all body types and health status, including those who are fit and lead an active lifestyle. However, as described above, the development of cellulite is predicated on weight fluctuation following an initial weight gain episode. Weight fluctuation leads to compromise of the majority of the FSN fibers since they are vertically oriented resulting in loose and saggy skin that is riddled with occasional oblique oriented FSN fibers attached to the center of the dimples.
To date, failed proposed treatments have been plentiful and ranged from topical treatments and non-invasive procedures to both minimally and more invasive surgeries which only address one of the three components and often address them poorly. This ineffective treatment of cellulite is the premise for the definitive 3 step cellulite treatment founded at SurgiSculpt.
Definitive 3 Step CelluliteTreatment
At Cellulite Treatment Centers we have delineated the real pathophysiology of cellulite formation that involves understanding the underlying skin and soft tissue anatomy. These proposed findings are based on a foundation of a static superficial soft tissue layer that possesses a compact fat layer that is not affected by weight fluctuation and a deep layer that is dynamic and affected by weight gain or loss. It is also the deep fat that is selectively removed during liposuction procedures.
Furthermore, the deep layer maintains a majority of vertical fibers that become frayed when exposed to the strain of weight gain and sporadic oblique fibers that maintain their elasticity even when exposed to moderate weight gain. Following weight gain and then either weight loss or even more dramatically after repeated weight gain, the classic appearance of cellulite can be appreciated. These undesirable changes include sporadic skin dimpling on a background of loosened and sagging skin that maintains herniated fat cells.
At Cellulite Treatment Centers we offer a bimodality treatment as the gold standard in cellulite reduction. These include the provisions of releasing the oblique fibers that attach to the center of the dimple and tightening of the vertical fibers throughout the field.
1st step. Aveli subcision of tethering ligaments
Aveli describes a sleek want that can be introduced through a small needle stick that maintains a retractable hook blade and light. This apparatus may be used to selectively identify and release the oblique fibers that attach to the central dimple region. An analogous tool, namely an endoscopic scissor can be used that has a controlled scissor head to selectively cut the oblique fibers identified as tethering the dimples down. By controlling the activation of the blade or scissors, it is possible to guide release of tethering FSN fibers without further releasing the frayed vertical fibers.
2nd Step. Attiva radiofrequency tightening of loosened ligaments
Attiva is a novel triphasic radiofrequency device that similarly utilizes sleek wands that are introduced into the subcutaneous tissues through a needle stick. The want may be guided by palpation both in the superficial plane as well as the deep planes of the soft tissues. The emitted proprietary energy allows for both immediate and delayed benefits to attenuated and loosened collagen fibers termed subdermal coagulation. The immediate effect of subdermal coagulation is the shrinkage of loosened vertical fibers when exposed to controlled, safe application of heat. The delayed secondary effect of subdermal coagulation is the stimulation of collagen production and remodeling of collagen fibers both along the deep dermal layer as well as the superficial soft tissue layers.
3rd Step. Fat Density Redistribution Asymmetry
Fat cell redistribution require reduction of fat from the areas surrounding the central dimple where fibroseptal network tightening is being completed. In return, the fat cells are replaced into the central dimple where the tethering fibroseptal network is being replaced. What makes this portion of the treatment tricky is that fat redistribution must be completed without disrupting the tightened fibroseptal network. This is why VASER ultrasound assisted liposuction is a critical tool that allows for teasing of the fat cells off of the ligaments so that they are not disrupted.
Conclusion: Definitive 3 Step Cellulite Treatment
In summary, we have reviewed the gold standard, definitive 3 step cellulite treatment protocol created at SurgiSculpt. In summary, the combined Aveli and Attiva treatments are considered the GOLD STANDARD in cellulite treatment today because they avoid disrupting the tethered ligaments while releasing the tethered ligaments. Finally, using VASER liposuction and fat transfer allows for fat cell redistribution without disrupting soft tissue structures. If you are concerned about the unsightly appearance of cellulite, we urge you to fill the form below or contact us today for a complimentary evaluation.