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Focused Ultrasound for Noninvasive Body Contouring in Cellulite

2010; Lippincott Williams & Wilkins; Volume: 125; Issue: 2 Linguagem: Inglês

10.1097/prs.0b013e3181c831d1

1529-4242

Karsten Knobloch, Beatrice Joest, Peter M. Vogt,

Myofascial pain diagnosis and treatment

Sir: We read with great interest the recent report regarding the technical and preclinical assessment of nonthermal focused ultrasound for body contouring.1 Nonoperative alternatives to liposuction or surgical resection for body contouring appear attractive to the majority of patients. Thus, clear-cut prospective studies with appropriate power and outcome measures are mandatory in this field of body contouring, and we appreciate the comprehensive preclinical workup by the aforementioned group regarding nonthermal focused ultrasound. Based on their experimental results in a porcine model, they suggest that a cavitation-like effect is generated by each shock, with a treatment focus in the subcutaneous and not in the dermis, without any evident temperature change. Extracorporal shock wave therapy has been suggested as another ultrasound therapy in the treatment of lipedema and cellulite. One of the first reports of extracorporal shock wave therapy among 26 women showed improved skin properties with mitigation of oxidative stress.2 Another uncontrolled cohort study with 21 women using the low-energy ActiVitor-Derma (SwiTech Medical AG, Kreuzlingen, Switzerland) focused shock wave device with 0.018 mJ/mm2 at 5- to 25-mm depth two times per week over 6 weeks (96,000 shots per person) suggested a remodeling of the collagen of the dermis.3 Outcome was measured by high-frequency ultrasound. Recently, 59 women were analyzed in a nonrandomized clinical trial with two different dosages of focused extracorporal shock wave therapy.4 Outcome was determined by using the DermaScan C (Cortex Technology, Hadsund, Denmark) ultrasound system, skin elasticity measurement using the DermaLab System (Cortex Technology), and photographs. Over 4 weeks, skin elasticity increased by 73 percent, with a further improvement to 105 percent after 6 months' follow-up. A stimulation of microcirculation and altered cell permeability was hypothesized. However, to date, there has been no randomized controlled trial regarding the effectiveness of extracorporal shock wave therapy for the treatment of cellulite. As far as the Contour I (UltraShape Ltd., Tel Aviv, Israel) is concerned, the authors cite two clinical studies suggesting that the Contour I focused ultrasound device is a safe and effective technology for body contouring. The multicenter trial regarding the Contour I device was a nonrandomized, controlled clinical study with 164 subjects, with only 27 in the control group.5 Notably, a reduction of approximately 2 cm in the treatment area was achieved within 2 weeks after a single treatment, which lasted for 12 weeks. Given the aforementioned attractiveness of a noninvasive measure to improve body contour, further prospective, randomized, controlled trials are mandatory to elucidate the role of these novel applications. It would be interesting to learn more about the similarities and differences between extracorporal shock wave therapy and the Contour I focused ultrasound device. Furthermore, we wonder whether given differences in both device technologies might lead to a differential clinical outcome in noninvasive body contouring. Karsten Knobloch, M.D. Beatrice Joest, M.D. Peter M. Vogt, M.D., Ph.D. Plastic, Hand, and Reconstructive Surgery Hannover Medical School Hannover, Germany