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There are currently numerous medical technologies, both minimally invasive and non-invasive, marketed for the treatment of cellulite. The first modality for the treatment of cellulite was developed in the 1970’s known as Endermologie (LPG Systems, Valence, France).
Additionally, biopsies revealed that Endermologie increases elastin or oxytalan fiber diameter and density, and collagen fibers show a more compact appearance with increased density in the papillary and upper reticular dermis (although the collagen effect is weaker than the elastic fiber effect). Additionally, Endermologie demonstrated softening of superficial skin surface irregularities and cellulite with a 50% improvement by objective blind photographic grading and a 92% patient satisfaction rate.
Technology using a mechanical roller, infrared light at 700 nm and bipolar radiofrequency was developed and underwent two alterations, known as Velasmooth, Velashape I and the newest model, Velashape II (Syneron Medical Inc., Irvine, California). A non-focused ultrasound device, Vasershape, manufactured by General Projects (Florence, Italy) and distributed in the United States by Sound Surgical Technologies (Louisville, Colorado) was FDA approved as a non-invasive device for the temporary treatment of cellulite in 2010. The action of the low-frequency ultrasound (ultrasound diathermy) must always be followed with lymphatic drainage.
Due to the less than optimal outcomes for cellulite treatment using any of the non-invasive medical technologies, minimally invasive techniques used for the treatment of cellulite have been brought to market. The minimally invasive medical technologies to be investigated in this study are the laser and ultrasound energy based devices. Minimally invasive laser cellulite treatment was recently evaluated for efficacy, safety and duration of clinical benefit in ten patients using Cellulaze (Cyanosure, Westford, Massachusetts), a pulsed laser that delivers energy at 1440 nm using a side firing light fiber.13 The study revealed with a single treatment observed for at least one year produced a “good” rating by survey. Palomar Medical Technologies has no published data on their new minimally invasive side firing 924 nm laser cellulite device.

The goal is to determine the efficacy and the side effects observed of each device in a direct comparison.
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However, if one current technology is superior to all the others, this study would be unnecessary.
Despite these histological changes, there was no change in skin elasticity as measured by a Cutometer.
However, objective measures of body contouring were minimal and proportional to weight loss.
Heat generated by the infrared light and radiofrequency is theorized to increase the dissociation of oxygen from oxyhemoglobin and diffusion into adipose tissue. The Vasershape system delivers a non-invasive treatment that uses therapeutic massage and ultrasound diathermy using the combined action of two low-frequency ultrasound heads cross-sectioned onto the area being treated. The two laser technologies to be investigated are Cellulaze (Cyanosure, Westford, Massachusetts) side light fiber at 1440 nm and the Slim Lipo Cellulite device (Palomar Medical Technologies, Burlington, Massachusetts) side light fiber at 924 nm. Sound Surgical Technologies has no published data on their new minimally invasive Vasersmooth side cutting ultrasound probe device. An additional non-invasive investigation will combine two recognized cellulite treatments, non-focused ultrasound (Vasershape) and mechanical massage (Endermologie) to improve the outcome of each used separately.
Some refer to this as “painful cellulite”, any type of cellulite, which is characterized by significant tenderness during the pinch test. Thus, Endermologie alone should not be considered an effective body contouring method.10 Endermologie is approved by the Food and Drug Administration for the temporary improvement in the appearance of cellulite. As with Endermologie, the mechanical massage improves circulation and may stretch the connective tissue bands in the fat layer.11 Velashape II is approved by the Food and Drug Administration for the temporary improvement in the appearance of cellulite.
This membrane operates in an undulating motion, which gently lifts, folds and compresses the tissue following a sequence of movements specific to each area being treated.

The non-focused minimally invasive ultrasound device at 36 kHz to be studied is known as Vasersmooth (Sound Surgical Technologies, Louisville, Colorado).
Objective measures revealed improved skin elasticity of 29%, by elastometry, and increased skin thickness of 25%, by diagnostic ultrasound. The universal cellulite grading system developed in 1972, the Nurenberger-Muller Grading Scale, was chosen to ensure uniformity in cellulite assessment.
The cellulite is visible when the subject contracts the buttocks or when the skin is pinched. Cellulite characterization by high-frequency ultrasound and high-resolution magnetic resonance imaging. A prospective clinical study to evaluate the efficacy and safety of cellulite treatment using the combination of optical and RF energies for subcutaneous tissue heating. There was a subjective observed reduction in adipose volume, however, this observation lasted only two weeks after treatment.7 A porcine study revealed accumulation of dense, longitudinal collagen bands in the mid and deep sub-dermis with distortion and disruption of adipocyte cell membranes. This manipulation of the cutaneous and subcutaneous tissues improves lymphatic, arterial and venous circulation.
Variants of the Vasersmooth device technique include the addition of autologous fat grafting, autologous stem cell grafting and a combination of the fat and stem cell grafting methods.
With the same hand piece, the lymph nodes are opened prior to drainage, thus allowing the elimination of potential toxins and lipids in the interstitial spaces caused by the action of the ultrasound.

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