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Ultherapy® and Radiesse® Combination Treatment to Improve
Skin Laxity and Cellulite Appearance on Buttocks and Thighs
Gabriela Casabona Private Practice, São Paulo, Brazil
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Disclosure
Dr Casabona has no financial interest in any of the products, devices, or drugs mentioned in this presentation
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Cellulite
Cellulite is estimated to affect 80–90% of post-pubertal women Changes in dermal and subdermal fibroelastic tissue
structure contribute to worsening of cellulite with age Treating skin laxity to improve the appearance of
cellulite requires stimulation of new collagen formation and dermal remodeling
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Luebberding S, et al. Am J Clin Dermatol. 2015;16:243–256.
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Typical cellulite appearance
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Rationale for combining MFU-V and CaHA
Microfocused ultrasound with visualization (MFU-V) delivered by
Ultherapy® System
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Radiesse®
calcium hydroxylapatite (CaHA)
Both have demonstrated collagen-stimulating properties and
improvements in skin laxity in a variety of aesthetic indications
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Study aims
To evaluate the effects of combined MFU-V/CaHA skin-tightening treatment on buttock and thigh cellulite appearance To determine whether MFU-V enhances CaHA-induced
neocollagenesis
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Study design
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Study type Retrospectively enrolled case series
Subjects 20 women (18-55 years) with moderate-to-severe cellulite who had undergone MFU-V and CaHA treatment for skin laxity on buttocks and thighs
Treatment MFU-V applied using 4 and 7 MHz transducers at focal depths of 4.5 and 3.0 mm (25 lines/transducer/site)
Immediately after, subdermal injections of CaHA diluted 1:1 with 2% lidocaine solution at same site using microdroplet fanning technique (1 ml/site)
One subject scheduled for thighplasty received treatment with six different CaHA:lidocaine dilutions (0.3 ml/5 cm2) followed by MFU-V
Tissue specimens from each dilution site were stained with picrosirius red solution and examined under polarized light microscopy for estimation of amounts of collagen type I, type III and total collagen
Study endpoints Photographs taken at baseline and at 90 days and graded by 2 independent, blinded evaluators using Hexsel Cellulite Severity Scale1
Patient satisfaction questionnaire
1. Hexsel DM et al. J Eur Acad Dermatol Venereol. 2009;23:523–528..
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Significant improvements observed for each item on cellulite severity scale
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CSS item Evaluator 1
Baseline 90 Days Between-group
difference
P value
No. of depressions 2.00 (0.73) 1.10 (0.79) -0.90 (0.31) <0.001
Depth of depressions 1.85 (0.81) 0.95 (0.69) -0.90 (0.72) <0.001
Appearance of skin
surface alterations
1.65 (0.99) 0.70 (0.86) -0.95 (0.60) <0.001
Grade of skin laxity,
flaccidity or sagging
1.65 (0.75) 0.70 (0.66) -0.95 (0.51) <0.001
Nürnberger and Müller
classification
2.30 (0.66) 1.50 (0.69) -0.80 (0.41) <0.001
Overall score 9.45 (2.98) 4.95 (3.02) -4.50 (1.00) <0.001
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Significant improvements observed for each item on cellulite severity scale
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CSS item Evaluator 1 Baseline 90 Days Between-group
difference
P value
No. of depressions 2.00 (0.73) 1.10 (0.79) -0.90 (0.31) <0.001
Depth of depressions 1.85 (0.81) 0.95 (0.69) -0.90 (0.72) <0.001
Appearance of skin
surface alterations
1.65 (0.99) 0.70 (0.86) -0.95 (0.60) <0.001
Grade of skin laxity,
flaccidity or sagging
1.65 (0.75) 0.70 (0.66) -0.95 (0.51) <0.001
Nürnberger and Müller
classification
2.30 (0.66) 1.50 (0.69) -0.80 (0.41) <0.001
Overall score 9.45 (2.98) 4.95 (3.02) -4.50 (1.00) <0.001
Improvement from moderate-to-severe to mild after only 1 treatment session
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Significant improvements observed for each item on cellulite severity scale
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CSS item Evaluator 2
Baseline 90 Days Between-group
difference
P value
No. of depressions 2.00 (0.73) 1.10 (0.79) -0.90 (0.31) <0.001
Depth of depressions 1.85 (0.81) 0.95 (0.69) -0.90 (0.72) <0.001
Appearance of skin
surface alterations
1.65 (0.99) 0.75 (0.97) -0.90 (0.64) <0.001
Grade of skin laxity,
flaccidity or sagging
1.70 (0.80) 0.75 (0.72) -0.95 (0.51) <0.001
Nürnberger and Müller
classification
2.30 (0.66) 1.50 (0.69) -0.80 (0.41) <0.001
Overall score 9.50 (3.07) 5.05 (3.25) -4.45 (1.10) <0.001
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Significant improvements observed for each item on cellulite severity scale
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CSS item Evaluator 2 Baseline 90 Days Between-group
difference
P value
No. of depressions 2.00 (0.73) 1.10 (0.79) -0.90 (0.31) <0.001
Depth of depressions 1.85 (0.81) 0.95 (0.69) -0.90 (0.72) <0.001
Appearance of skin
surface alterations
1.65 (0.99) 0.75 (0.97) -0.90 (0.64) <0.001
Grade of skin laxity,
flaccidity or sagging
1.70 (0.80) 0.75 (0.72) -0.95 (0.51) <0.001
Nürnberger and Müller
classification
2.30 (0.66) 1.50 (0.69) -0.80 (0.41) <0.001
Overall score 9.50 (3.07) 5.05 (3.25) -4.45 (1.10) <0.001
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A2
B2
C2
A1
B1
C1
Improvements in cellulite severity
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Improvements in cellulite severity
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A1 A2
B1 B2
A1
A2
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Peak total collagen gain with 1:1 CaHA:lidocaine dilution
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Dilutions: A1, B1 (1:0.16), A2, B2 (1:0.3), A3, B3 (1:0.6), A4, B4 (1:1), A5, B5 (1:2), A6, B6 (1:6.5).
CaHA alone (A1-A6) CaHA + MFU-V (B1-B6) Control (C)
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Picrosirius-red-stained histologic sections of dermis at 1:1 CaHA dilution
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A4, CaHA alone B4, CaHA+MFU-V
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Patient satisfaction and treatment tolerability
Satisfaction All women reported smoother skin 19/20 reported dimples less visible 19/20 (95%) were satisfied to very satisfied Tolerability MFU-V/CaHA was well tolerated with no severe bruising or
severe pain All women had mild pain with a mean duration of 2 days 18 women had mild bruising which resolved within 1 week
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Conclusions
MFU-V/CaHA treatment of skin laxity resulted in a significant improvement in cellulite appearance after one procedure Both treatments induce neocollagenesis and elastogenesis
resulting in remodeling of the dermis and collagen structures in the superficial fascia Conversion from collagen type III to type I at 90 days was
greater in tissue sections not subjected to MFU-V, suggesting that complete tissue remodeling may take longer with MFU-V Treatments were well tolerated; subject satisfaction was high MFU-V and CaHA at a 1:1 dilution ratio are an effective
combination for improving skin laxity and cellulite severity in the buttocks and upper thighs