■Thrombosis or post-thrombosis syndrome
■Known melanoma or chemotherapy
■Anti-coagulation therapy ■Cortisone-therapy ■Known metabolic disorder (e.g. diabetes mellitus, hypercholesterolaemia)
■Inflammation within treatment area
■Other simultaneous treatment of cellulite.
High-resolution ultrasound The high-resolution ultrasound was carried out at the beginning and at the end of the study. It is an image-producing and non-invasive diagnostic tool12
, which is able to
give an exact representation of the structure and quality of the subcutis, and therefore the result of cellulite therapy can be evaluated precisely13
.
Liquid crystal contact thermography LCCT measures minor differences in skin temperature14
. In this study,
LCCT was used to detect a change in micro-perfusion of the surrounding tissue treated with HERST.
Application technique and device parameters The low-energy defocused HERST was produced by electromagnetic means with the ZWave® device (Figure 2), with the energy flow density per shot set at 0.02 mJ/mm2
.
The treatment was applied to the right lateral thigh, once per week for a period of 10 weeks. Over a surface area of 120 cm2
reduction to the subcutaneous fat. In one study15
of skin, 3700 shots
where applied homogeneously at 16 Hz and 120 mJ. The control area was the left thigh. At the end of the treatment period (equivalent to 37 000 shots), a questionnaire was completed with regard to tolerance (pain and side-effects) and the subjective outcomes of cellulite.
Results and discussion Impact of HERST on remodelling subcutaneous fat In addition to tightening the skin and improving its quality, an ideal therapy of cellulite should ensure a
, the hypothesis was
stated that low-energy defocused HERST treatment (12 sessions) is effective in treating cellulite through the remodelling of subcutaneous adipose tissue. This effect can be corroborated by the subjective comments of the patient (in which improvement as a result of treatment may have a latent period of 2–6 months), as well as studying the superficial adipose tissue using high-frequency ultrasound (indirect signs of subcutaneous remodelling) and LCCT (indirect signs of increased perfusion). The present prospective design study (low-energy, HERST, 10
therapy sessions) supports this hypothesis. A remodelling in the subcutis can be seen using high-resolution ultrasound. In the pre-treatment echography it is possible to see typical macro-nodules of cellulite degree III, in both the areolar and lamellar layers of the subcutaneous adipose tissue (Figure 3). The superficial fascia is unfolded and hyperechogenicity of the subcutis is shown. In the post-treatment echography, an improvement to the area (without nodules), increased homogenisation of the echogenicity and linear superficial fascia can be seen, all of which are typical of
prime-journal.com | June 2012 ❚ 59
Figure 6 Liquid crystal contact thermography (LCCT), RW27ST with
colours corresponding to
temperature steps of 0.50 Celsius) of right lateral thigh, after 10th HERST treatment
Figure 5 Liquid crystal contact thermography (LCCT), RW28ST with
colours corresponding to
temperature steps of 0.50 Celsius) of right lateral thigh, before first HERST treatment
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