Cellulite: Clinical Challenges and Future Perspectives.
Journal
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
ISSN: 1524-4725
Titre abrégé: Dermatol Surg
Pays: United States
ID NLM: 9504371
Informations de publication
Date de publication:
01 04 2023
01 04 2023
Historique:
medline:
4
4
2023
entrez:
31
3
2023
pubmed:
1
4
2023
Statut:
ppublish
Résumé
Existing cellulite interventions pose various clinical challenges related mostly to ecchymosis and recovery time. To discuss the current treatment options for minimizing recovery time, efficacy of these options, and investigations into possible future approaches. A roundtable meeting was convened to discuss and share views on the clinical challenges seen in the present practice of cellulite treatments along with future approaches and mitigation strategies. The participants' views helped guide a narrative review on this topic. Cosmetic clinicians have a range of new interventions to choose from for cellulite improvement, each with different benefits and safety aspects. Bruising is a typical side effect that is seen with treatments targeting the fibrous septa, such as subcision and injectable treatments, and in some cases may produce long-lasting hyperpigmentation from postinflammatory hyperpigmentation or hemosiderin staining. Various strategies that could potentially mitigate bruising and other adverse effects of cellulite treatment are under clinical investigation, including, but not limited to, different injection techniques and dilutions, compression garments, cold packs, arnica gel, pulsed dye laser treatment, intralesional epinephrine, and tranexamic acid. Clinical challenges including varying treatment outcomes and certain treatment sequelae remain, and further research is needed to prevent side effects and improve treatment outcomes.
Sections du résumé
BACKGROUND
Existing cellulite interventions pose various clinical challenges related mostly to ecchymosis and recovery time.
OBJECTIVE
To discuss the current treatment options for minimizing recovery time, efficacy of these options, and investigations into possible future approaches.
METHODS
A roundtable meeting was convened to discuss and share views on the clinical challenges seen in the present practice of cellulite treatments along with future approaches and mitigation strategies. The participants' views helped guide a narrative review on this topic.
RESULTS
Cosmetic clinicians have a range of new interventions to choose from for cellulite improvement, each with different benefits and safety aspects. Bruising is a typical side effect that is seen with treatments targeting the fibrous septa, such as subcision and injectable treatments, and in some cases may produce long-lasting hyperpigmentation from postinflammatory hyperpigmentation or hemosiderin staining. Various strategies that could potentially mitigate bruising and other adverse effects of cellulite treatment are under clinical investigation, including, but not limited to, different injection techniques and dilutions, compression garments, cold packs, arnica gel, pulsed dye laser treatment, intralesional epinephrine, and tranexamic acid.
CONCLUSION
Clinical challenges including varying treatment outcomes and certain treatment sequelae remain, and further research is needed to prevent side effects and improve treatment outcomes.
Identifiants
pubmed: 37000914
doi: 10.1097/DSS.0000000000003746
pii: 00042728-202304001-00004
doi:
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
S15-S20Informations de copyright
Copyright © 2023 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
Références
Bass LS, Kaminer MS. Insights into the pathophysiology of cellulite: a review. Dermatol Surg 2020;46:S77–S85.
Davis DS, Boen M, Fabi SG. Cellulite: patient selection and combination treatments for optimal results—a review and our experience. Dermatol Surg 2019;45:1171–84.
Hexsel D, Dal Forno T, Hexsel C, Schilling-Souza J, et al. Magnetic resonance imaging of cellulite depressed lesions successfully treated by subcision. Dermatol Surg 2016;42:693–6.
Green JB, Cohen JL. Cellfina observations: pearls and pitfalls. Semin Cutan Med Surg 2015;34:144–6.
Kaminer MS, Coleman WP III, Weiss RA, Robinson DM, et al. Multicenter pivotal study of vacuum-assisted precise tissue release for the treatment of cellulite. Dermatol Surg 2015;41:336–47.
Kaminer MS, Coleman WP III, Weiss RA, Robinson DM, Grossman J. A multicenter pivotal study to evaluate tissue stabilized-guided subcision using the Cellfina device for the treatment of cellulite with 3-year follow-up. Dermatol Surg 2017;43:1240–8.
Layt C. A study of a novel controlled focal septa release method for improving cellulite. Plast Reconstr Surg Glob Open 2022;10:e4237.
Stevens WG, Kaminer MS, Fabi SG, Fan L. Study of a new controlled focal septa release cellulite reduction method. Aesthet Surg J 2022;42:937–45.
Goldie K, Peeters W, Alghoul M, Butterwick K, et al. Global consensus guidelines for the injection of diluted and hyperdiluted calcium hydroxylapatite for skin tightening. Dermatol Surg 2018;44:S32–S41.
Harper J, Avelar L, Haddad A, Novello J, et al. Expert recommendations on the use of injectable poly-l-lactic acid for contour deficiencies of the buttocks. J Drugs Dermatol 2022;21:21–6.
Kaufman-Janette JA, Bass LS, Xiang Q, McLane MP, et al. Efficacy, safety, and durability of response of collagenase clostridium histolyticum-aaes for treating cellulite. Plast Reconstr Surg Glob Open 2020;8:e3316.
Kaufman-Janette J, Joseph JH, Kaminer MS, Clark J, et al. Collagenase clostridium histolyticum-aaes for the treatment of cellulite in women: results from two phase 3 randomized, placebo-controlled trials. Dermatol Surg 2021;47:649–56.
Sadick NS, Goldman MP, Liu G, Shusterman NH, et al. Collagenase clostridium histolyticum for the treatment of edematous fibrosclerotic panniculopathy (cellulite): a randomized trial. Dermatol Surg 2019;45:1047–56.
Carson CC III, Sadeghi-Nejad H, Tursi JP, Smith TM, et al. Analysis of the clinical safety of intralesional injection of collagenase clostridium histolyticum (CCH) for adults with Peyronie's disease (PD). BJU Int 2015;116:815–22.
Peimer CA, Blazar P, Coleman S, Kaplan FTD, et al. Dupuytren contracture recurrence following treatment with collagenase clostridium histolyticum (CORDLESS [collagenase option for reduction of dupuytren long-term evaluation of safety study]): 5-year data. J Hand Surg Am 2015;40:1597–605.
Peimer CA, Wilbrand S, Gerber RA, Chapman D, Szczypa PP. Safety and tolerability of collagenase clostridium histolyticum and fasciectomy for Dupuytren's contracture. J Hand Surg Eur Vol 2015;40:141–9.
Kaufman-Janette J, Katz BE, Vijayan S, Xiang Q, Kaminer MS. Evaluation of five collagenase clostridium histolyticum-aaes injection techniques for the treatment of cellulite on the buttock or thigh. J Cosmet Dermatol 2022;21:1448–53.
ClinicalTrials.gov NCT04170296. A real world, multicenter, open-label, multiple dose study to assess the effectiveness of, and satisfaction with, CCH treatment of buttocks or thigh cellulite in adult females. Available from: https://clinicaltrials.gov/ct2/show/NCT04170296 . Accessed December 7, 2022.
ClinicalTrials.gov NCT04677712. A collaborative research, open-label study to assess effects of mitigation treatments on bruising of CCH-aaes treatment of buttock cellulite in adult females. Available from: https://clinicaltrials.gov/ct2/show/NCT04677712 . Accessed December 7, 2022.
ClinicalTrials.gov NCT05309525. Effect of oral TXA on buttock bruising post CCH injections in adult females. Available at: https://clinicaltrials.gov/ct2/show/NCT05309525 . Accessed December 7, 2022.
Ebrahimi B, Naeini FF. Topical tranexamic acid as a promising treatment for melasma. J Res Med Sci 2014;19:753–7.
Bala HR, Lee S, Wong C, Pandya AG, Rodrigues M. Oral tranexamic acid for the treatment of melasma: a review. Dermatol Surg 2018;44:814–25.
Tranexamic acid containing medicinal products. EU Summary of Product Characteristics. Available from: https://www.ema.europa.eu/en/documents/referral/antifibrinolytic-medicines-article-31-referral-annex-iii-tranexamic-acid_en.pdf . Accessed December 7, 2022.
Lysteda ® (tranexamic acid) tablets, for oral use. US Prescribing Information. Reference ID: 4712056; revised December 2020. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/022430s009lbl.pdf . Accessed December 7, 2022.
Murao S, Nakata H, Roberts I, Yamakawa K. Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis. Crit Care 2021;25:380.
Meaidi A, Mørch L, Torp-Pedersen C, Lidegaard O. Oral tranexamic acid and thrombosis risk in women. EClinicalMedicine 2021;35:100882.
Hurskainen T, Deng MX, Etherington C, Burns JK, et al. Tranexamic acid for prevention of bleeding in cesarean delivery: an overview of systematic reviews. Acta Anaesthesiol Scand 2022;66:3–16.
ClinicalTrials.gov NCT05419505. APHRODITE-1: a phase 2, open label, self-controlled study of different interventions to reduce bruising following CCH-aaes treatment for cellulite of the buttocks in adult females. Available from: https://clinicaltrials.gov/ct2/show/nct05419505 . accessed December 7, 2022.
Tanzi EL, Capelli CC, Robertson DW, LaTowsky B, et al. Improvement in the appearance of cellulite and skin laxity resulting from a single treatment with acoustic subcision: findings from a multicenter pivotal clinical trial. Lasers Surg Med 2022;54:121–8.
ClinicalTrials.gov NCT02427698. Comparison of the efficacy between cryolipolysis versus cryolipolysis plus subcision for treatment of cellulite: a prospective randomized control trial. Available from: https://clinicaltrials.gov/ct2/show/NCT02427698 . Accessed December 7, 2022.