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Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite.

Schlaudraff KU, Kiessling MC, Császár NB, Schmitz C - Clin Cosmet Investig Dermatol (2014)

Bottom Line: Impulses were homogeneously distributed over the posterior thigh and buttock area (resulting in 7,500 impulses per area).No statistically significant (ie, P<0.05) correlation was found between individual values for δ-1 and δ-2 and cellulite grade at baseline, BMI, weight, height, or age.The individual clinical outcome cannot be predicted by the patient's individual cellulite grade at baseline, BMI, weight, height, or age.

View Article: PubMed Central - PubMed

Affiliation: Concept Clinic, Geneva, Switzerland.

ABSTRACT

Background: Extracorporeal shock wave therapy has been successfully introduced for the treatment of cellulite in recent years. However, it is still unknown whether the individual clinical outcome of cellulite treatment with extracorporeal shock wave therapy can be predicted by the patient's individual cellulite grade at baseline, individual patient age, body mass index (BMI), weight, and/or height.

Methods: Fourteen Caucasian females with cellulite were enrolled in a prospective, single-center, randomized, open-label Phase II study. The mean (± standard error of the mean) cellulite grade at baseline was 2.5±0.09 and mean BMI was 22.8±1.17. All patients were treated with radial extracorporeal shock waves using the Swiss DolorClast(®) device (Electro Medical Systems, S.A., Nyon, Switzerland). Patients were treated unilaterally with 2 weekly treatments for 4 weeks on a randomly selected side (left or right), totaling eight treatments on the selected side. Treatment was performed at 3.5-4.0 bar, with 15,000 impulses per session applied at 15 Hz. Impulses were homogeneously distributed over the posterior thigh and buttock area (resulting in 7,500 impulses per area). Treatment success was evaluated after the last treatment and 4 weeks later by clinical examination, photographic documentation, contact thermography, and patient satisfaction questionnaires.

Results: The mean cellulite grade improved from 2.5±0.09 at baseline to 1.57±0.18 after the last treatment (ie, mean δ-1 was 0.93 cellulite grades) and 1.68±0.16 at follow-up (ie, mean δ-2 was 0.82 cellulite grades). Compared with baseline, no patient's condition worsened, the treatment was well tolerated, and no unwanted side effects were observed. No statistically significant (ie, P<0.05) correlation was found between individual values for δ-1 and δ-2 and cellulite grade at baseline, BMI, weight, height, or age.

Conclusion: Radial shock wave therapy is a safe and effective treatment option for cellulite. The individual clinical outcome cannot be predicted by the patient's individual cellulite grade at baseline, BMI, weight, height, or age.

No MeSH data available.


Related in: MedlinePlus

Principles of radial shock wave technology.Notes: (A) DolorClast® device (Electro Medical Systems SA, Nyon, Switzerland) used in the present study. (B) Power+ hand piece of the Swiss DolorClast device with the 36 mm applicator used in the present study. Compressed air (1) is used to fire a projectile within a guiding tube (2) that strikes a 36 mm diameter metal applicator (3) placed on the skin. The projectile generates stress waves in the applicator that transmit pressure waves noninvasively into tissue. (C) Pressure wave generated with the Swiss DolorClast device, measured at a distance of 1 mm from the applicator (Power+ hand piece, 36 mm applicator, device operated at 4 bar air pressure and 15 Hz impulse frequency as used in the present study). After a delay of approximately 2 μseconds, the pressure wave shows an increase in (positive) pressure (i), followed by a decrease in pressure (ii) with reaching zero at approximately 8 μseconds, a subsequent period of negative pressure (iii) interrupted by a period of positive pressure (iv). (D–O) Cavitation bubbles (black dots) in degassed water generated during the phase of negative pressure of radial shock waves generated with the Power+ hand piece and the 36 mm applicator of the Swiss DolorClast device operated at 4 bar air pressure at 15 Hz (D–I) as used in the present study or at 1 Hz (J–O) either at the center of the applicator (D, E, F, J, K and L) or the edge of the applicator (G, H, I, M, N and O). Note that the arrows point to the center of the applicator. Maximum cavitation is shown in (E, H, K and N). The images shown in (D, G, J and M) were taken approximately 1.5 mseconds before the cavitation maximum, and images shown in (F, I, L and O) were taken approximately 1.5 mseconds after the cavitation maximum. Cavitation lasted for approximately one mseconds. The pictures were taken with a high-speed CCD camera (Photron Ultima APX; Photron, Tokyo, Japan) with a framing rate of 300,000 frames per second and an exposure time of 1/2,700,000 seconds. The scale bar in (O) represents 10 mm. Note that the cavitation field (and thus the pressure field below the applicator) is broader when generating radial shock waves at 15 Hz (D–I) than at 1 Hz (J–O). This phenomenon is observed for many radial shock wave devices (Császár et al, submitted for publication).
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f1-ccid-7-171: Principles of radial shock wave technology.Notes: (A) DolorClast® device (Electro Medical Systems SA, Nyon, Switzerland) used in the present study. (B) Power+ hand piece of the Swiss DolorClast device with the 36 mm applicator used in the present study. Compressed air (1) is used to fire a projectile within a guiding tube (2) that strikes a 36 mm diameter metal applicator (3) placed on the skin. The projectile generates stress waves in the applicator that transmit pressure waves noninvasively into tissue. (C) Pressure wave generated with the Swiss DolorClast device, measured at a distance of 1 mm from the applicator (Power+ hand piece, 36 mm applicator, device operated at 4 bar air pressure and 15 Hz impulse frequency as used in the present study). After a delay of approximately 2 μseconds, the pressure wave shows an increase in (positive) pressure (i), followed by a decrease in pressure (ii) with reaching zero at approximately 8 μseconds, a subsequent period of negative pressure (iii) interrupted by a period of positive pressure (iv). (D–O) Cavitation bubbles (black dots) in degassed water generated during the phase of negative pressure of radial shock waves generated with the Power+ hand piece and the 36 mm applicator of the Swiss DolorClast device operated at 4 bar air pressure at 15 Hz (D–I) as used in the present study or at 1 Hz (J–O) either at the center of the applicator (D, E, F, J, K and L) or the edge of the applicator (G, H, I, M, N and O). Note that the arrows point to the center of the applicator. Maximum cavitation is shown in (E, H, K and N). The images shown in (D, G, J and M) were taken approximately 1.5 mseconds before the cavitation maximum, and images shown in (F, I, L and O) were taken approximately 1.5 mseconds after the cavitation maximum. Cavitation lasted for approximately one mseconds. The pictures were taken with a high-speed CCD camera (Photron Ultima APX; Photron, Tokyo, Japan) with a framing rate of 300,000 frames per second and an exposure time of 1/2,700,000 seconds. The scale bar in (O) represents 10 mm. Note that the cavitation field (and thus the pressure field below the applicator) is broader when generating radial shock waves at 15 Hz (D–I) than at 1 Hz (J–O). This phenomenon is observed for many radial shock wave devices (Császár et al, submitted for publication).

Mentions: Extracorporeal shock wave therapy (ESWT) and radial shock wave therapy (RSWT) have been introduced as safe and effective treatment options for cellulite.15–23 A shock wave is an acoustic pressure wave that is produced in any elastic medium, such as air, water, or even a solid substance.24,25 Shock waves differ from sound waves in that the wave front, where compression takes place, is a region of sudden change in stress and density.24,25 Both focused shock waves (ESWT) and radial shock waves (RSWT) are characterized by a high positive peak pressure (in mPa), a fast initial rise in pressure (approximately a few microseconds or less), a diffraction-induced tensile wave following the positive pressure amplitude that can generate cavitation, and a short life cycle of approximately 10–20 μseconds (Figure 1).24–29 Extracorporeal shock wave lithotripsy is widely used for stone management in urology.30 ESWT and RSWT are byproducts of lithotripter technology. Since the late 1980s, they have been introduced into treatment for various diseases of the musculoskeletal system, such as plantar fasciopathy, Achilles tendinopathy, medial tibial stress syndrome, greater trochanteric pain syndrome, lateral and medial epicondylitis, and calcifying tendonitis of the shoulder.27–29,31,32 Shock waves have both a direct and indirect effect on treated tissues. The direct effect is the result of the energy of the shock wave being transferred to the targeted tissues. The indirect effect is the result of the creation of cavitation bubbles in the treated tissue.24,25,29 It has been hypothesized that both the direct and indirect effects produce a biological response in the treated tissues.24,25,29


Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite.

Schlaudraff KU, Kiessling MC, Császár NB, Schmitz C - Clin Cosmet Investig Dermatol (2014)

Principles of radial shock wave technology.Notes: (A) DolorClast® device (Electro Medical Systems SA, Nyon, Switzerland) used in the present study. (B) Power+ hand piece of the Swiss DolorClast device with the 36 mm applicator used in the present study. Compressed air (1) is used to fire a projectile within a guiding tube (2) that strikes a 36 mm diameter metal applicator (3) placed on the skin. The projectile generates stress waves in the applicator that transmit pressure waves noninvasively into tissue. (C) Pressure wave generated with the Swiss DolorClast device, measured at a distance of 1 mm from the applicator (Power+ hand piece, 36 mm applicator, device operated at 4 bar air pressure and 15 Hz impulse frequency as used in the present study). After a delay of approximately 2 μseconds, the pressure wave shows an increase in (positive) pressure (i), followed by a decrease in pressure (ii) with reaching zero at approximately 8 μseconds, a subsequent period of negative pressure (iii) interrupted by a period of positive pressure (iv). (D–O) Cavitation bubbles (black dots) in degassed water generated during the phase of negative pressure of radial shock waves generated with the Power+ hand piece and the 36 mm applicator of the Swiss DolorClast device operated at 4 bar air pressure at 15 Hz (D–I) as used in the present study or at 1 Hz (J–O) either at the center of the applicator (D, E, F, J, K and L) or the edge of the applicator (G, H, I, M, N and O). Note that the arrows point to the center of the applicator. Maximum cavitation is shown in (E, H, K and N). The images shown in (D, G, J and M) were taken approximately 1.5 mseconds before the cavitation maximum, and images shown in (F, I, L and O) were taken approximately 1.5 mseconds after the cavitation maximum. Cavitation lasted for approximately one mseconds. The pictures were taken with a high-speed CCD camera (Photron Ultima APX; Photron, Tokyo, Japan) with a framing rate of 300,000 frames per second and an exposure time of 1/2,700,000 seconds. The scale bar in (O) represents 10 mm. Note that the cavitation field (and thus the pressure field below the applicator) is broader when generating radial shock waves at 15 Hz (D–I) than at 1 Hz (J–O). This phenomenon is observed for many radial shock wave devices (Császár et al, submitted for publication).
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Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4043818&req=5

f1-ccid-7-171: Principles of radial shock wave technology.Notes: (A) DolorClast® device (Electro Medical Systems SA, Nyon, Switzerland) used in the present study. (B) Power+ hand piece of the Swiss DolorClast device with the 36 mm applicator used in the present study. Compressed air (1) is used to fire a projectile within a guiding tube (2) that strikes a 36 mm diameter metal applicator (3) placed on the skin. The projectile generates stress waves in the applicator that transmit pressure waves noninvasively into tissue. (C) Pressure wave generated with the Swiss DolorClast device, measured at a distance of 1 mm from the applicator (Power+ hand piece, 36 mm applicator, device operated at 4 bar air pressure and 15 Hz impulse frequency as used in the present study). After a delay of approximately 2 μseconds, the pressure wave shows an increase in (positive) pressure (i), followed by a decrease in pressure (ii) with reaching zero at approximately 8 μseconds, a subsequent period of negative pressure (iii) interrupted by a period of positive pressure (iv). (D–O) Cavitation bubbles (black dots) in degassed water generated during the phase of negative pressure of radial shock waves generated with the Power+ hand piece and the 36 mm applicator of the Swiss DolorClast device operated at 4 bar air pressure at 15 Hz (D–I) as used in the present study or at 1 Hz (J–O) either at the center of the applicator (D, E, F, J, K and L) or the edge of the applicator (G, H, I, M, N and O). Note that the arrows point to the center of the applicator. Maximum cavitation is shown in (E, H, K and N). The images shown in (D, G, J and M) were taken approximately 1.5 mseconds before the cavitation maximum, and images shown in (F, I, L and O) were taken approximately 1.5 mseconds after the cavitation maximum. Cavitation lasted for approximately one mseconds. The pictures were taken with a high-speed CCD camera (Photron Ultima APX; Photron, Tokyo, Japan) with a framing rate of 300,000 frames per second and an exposure time of 1/2,700,000 seconds. The scale bar in (O) represents 10 mm. Note that the cavitation field (and thus the pressure field below the applicator) is broader when generating radial shock waves at 15 Hz (D–I) than at 1 Hz (J–O). This phenomenon is observed for many radial shock wave devices (Császár et al, submitted for publication).
Mentions: Extracorporeal shock wave therapy (ESWT) and radial shock wave therapy (RSWT) have been introduced as safe and effective treatment options for cellulite.15–23 A shock wave is an acoustic pressure wave that is produced in any elastic medium, such as air, water, or even a solid substance.24,25 Shock waves differ from sound waves in that the wave front, where compression takes place, is a region of sudden change in stress and density.24,25 Both focused shock waves (ESWT) and radial shock waves (RSWT) are characterized by a high positive peak pressure (in mPa), a fast initial rise in pressure (approximately a few microseconds or less), a diffraction-induced tensile wave following the positive pressure amplitude that can generate cavitation, and a short life cycle of approximately 10–20 μseconds (Figure 1).24–29 Extracorporeal shock wave lithotripsy is widely used for stone management in urology.30 ESWT and RSWT are byproducts of lithotripter technology. Since the late 1980s, they have been introduced into treatment for various diseases of the musculoskeletal system, such as plantar fasciopathy, Achilles tendinopathy, medial tibial stress syndrome, greater trochanteric pain syndrome, lateral and medial epicondylitis, and calcifying tendonitis of the shoulder.27–29,31,32 Shock waves have both a direct and indirect effect on treated tissues. The direct effect is the result of the energy of the shock wave being transferred to the targeted tissues. The indirect effect is the result of the creation of cavitation bubbles in the treated tissue.24,25,29 It has been hypothesized that both the direct and indirect effects produce a biological response in the treated tissues.24,25,29

Bottom Line: Impulses were homogeneously distributed over the posterior thigh and buttock area (resulting in 7,500 impulses per area).No statistically significant (ie, P<0.05) correlation was found between individual values for δ-1 and δ-2 and cellulite grade at baseline, BMI, weight, height, or age.The individual clinical outcome cannot be predicted by the patient's individual cellulite grade at baseline, BMI, weight, height, or age.

View Article: PubMed Central - PubMed

Affiliation: Concept Clinic, Geneva, Switzerland.

ABSTRACT

Background: Extracorporeal shock wave therapy has been successfully introduced for the treatment of cellulite in recent years. However, it is still unknown whether the individual clinical outcome of cellulite treatment with extracorporeal shock wave therapy can be predicted by the patient's individual cellulite grade at baseline, individual patient age, body mass index (BMI), weight, and/or height.

Methods: Fourteen Caucasian females with cellulite were enrolled in a prospective, single-center, randomized, open-label Phase II study. The mean (± standard error of the mean) cellulite grade at baseline was 2.5±0.09 and mean BMI was 22.8±1.17. All patients were treated with radial extracorporeal shock waves using the Swiss DolorClast(®) device (Electro Medical Systems, S.A., Nyon, Switzerland). Patients were treated unilaterally with 2 weekly treatments for 4 weeks on a randomly selected side (left or right), totaling eight treatments on the selected side. Treatment was performed at 3.5-4.0 bar, with 15,000 impulses per session applied at 15 Hz. Impulses were homogeneously distributed over the posterior thigh and buttock area (resulting in 7,500 impulses per area). Treatment success was evaluated after the last treatment and 4 weeks later by clinical examination, photographic documentation, contact thermography, and patient satisfaction questionnaires.

Results: The mean cellulite grade improved from 2.5±0.09 at baseline to 1.57±0.18 after the last treatment (ie, mean δ-1 was 0.93 cellulite grades) and 1.68±0.16 at follow-up (ie, mean δ-2 was 0.82 cellulite grades). Compared with baseline, no patient's condition worsened, the treatment was well tolerated, and no unwanted side effects were observed. No statistically significant (ie, P<0.05) correlation was found between individual values for δ-1 and δ-2 and cellulite grade at baseline, BMI, weight, height, or age.

Conclusion: Radial shock wave therapy is a safe and effective treatment option for cellulite. The individual clinical outcome cannot be predicted by the patient's individual cellulite grade at baseline, BMI, weight, height, or age.

No MeSH data available.


Related in: MedlinePlus