Cellulite protocol

Principle
Stimulate blood flow and activate receptors involved in the natural lipolysis of the body. Improve skin tightening to reduce orange peel skin. Fibrous cellulite treatments will require mechanical disruption of fibrous septae with high CO2 flows.

Indication
All types of cellulite from grade I–II to grade III–IV. Subcutaneous irregularities after liposuction.
Complementary treatment to liposuction, which does not have any efficacy on cellulite.

Protocol
There are various protocols derived from the Royat Spa, the use of which depends on the patient’ availability for treatments. At least one session per week up to one session daily.

Cellulite grade I or II

• Combination of subcutaneous and intradermal injection
• One session per day to one per week
• Flow: 1–2 cc/kg/min – approximately 2 minutes per subcutaneous injection
• Punctures: 15–20 cm spaced, no overlapping
• Number of sessions: 10–20
• Progressive flow (automatic mode) available with some machines

Cellulite grade III or IV

• Combination of subcutaneous and intradermal injection
• One session per day to one per week
• Flow: >2 cc/kg/min
• Punctures: 15–20 cm spaced, no overlapping
• Number of sessions: 10–20
• Progressive flow (automatic mode) available with some machines

Technique
The operator’ hand movement should target both the subcutaneous layer and the intradermal layer as both lipolysis and collagen synthesis for skin toning need to be improved.

Intradermal injection photo                                               Subcutaneous

Start by injecting the dermis and, when done, push the needle further/deeper to inject the subcutaneous layers. This appears to be the easier approach, lthough injecting the subcutaneous layers first still appears to work.

Injection Points
Injections points should be made in the area where cellulite resides. It is almost always in the hips and thighs

Endpoint
Subcutaneous injection will let the gas diffuse and create a 15–20 cm diameter disk. The skin has a granite-like appearance and shows erythema. Move the needle 15–20 cm away from the previous injection point (no overlapping) to treat the entire cellulite surface. Note that the 15–20 cm circle occurs during the first sessions. After several sessions, typically five to six, the skin offers less resistance to the gas diffusion, one or tow injections point may then be enough to treat the all cellulite area.

Post-treatment Care
No post-injection care is necessary. Advise the patient not to take long warm baths during the following 24 hours, nor to perform active sports for 24–48 hours and to avoid new skin trauma or bleeding.

Pain Management
Pain can be reduced with a ‘piano’ massage during the injection. Pain is more frequent in the first sessions:
CO2 can be reduced in the first sessions and progressively increased from session to session. If too much pain is reported, change the injection point and reduce the treatment time, giving more, shorter injections. Some machines have a progressive flow mode which starts the injection at a low flow and increases it progressively during the course of the injection.

Results
Most patients report improvement after six to eight p1785 sessions. Treatment is usually delivered for up to a maximum of 20 sessions.

Maximizing Results
CDT may benefit from combination with such treatments as RF, Cellu-M6®, Velasmooth® and manual lymphatic massage. Dietetic advice should be given to help the patient maintain a stable weight.

Reinforcement Sessions
Patients are usually advised to renew the treatment at least once a year in order to maintain the effect.