Percussive therapy can fight cellulite as liposuction alternative
Cellulite has been an enigma for decades, and scientific explanations are just now emerging, said W. Gregory Chernoff, M.D. With increased understanding of cellulite, some very different approaches to its treatment are expected soon.
Although randomized prospective studies of cellulite are few -- especially biopsy studies that evaluate improvement after treatment -- most experts agree that cellulite is caused by multiple factors. Genetics and hormones have been identified as the key culprits. Women in some families do not develop cellulite while, in other families, 7- and 8-year-old girls show marked cellulite on the legs. "With the ongoing mapping of human genome, I think we're going to see some very interesting therapies coming out for the treatment of cellulite," said Dr. Chernoff, clinical associate professor, facial plastic surgery, Indiana University, Indianapolis.
The role of estrogen is clear: It affects collagenase, an enzyme that weakens the fiberseptaid that connect the fascia to the epidermal surface. As fat cells grow bigger, the weakened septa don't move, causing the skin to dimple. A way of bypassing this effect of estrogen without interfering with its necessary effects is not yet known.
Another factor contributing to cellulite is the impedance of microcirculation. "Anything we can do to improve circulation in the area, to decrease pooling of lymphatic fluids, has been shown to increase metabolism over time and to have some positive effect on cellulite" said Dr. Chernoff, who has private practices in Indianapolis and Santa Rosa, California. "Packs and wraps, suction rolling devices, and topical agents, such as xanthinas, flavonoids, and collagenase inhibitors have some scientific credibility, but long-term prospective studies have not been performed."
Lymphatic drainage
Dr. Chernoff, certified in otolaryngology and facial plastic surgery, has been exploring the benefits of percussive therapy, based on the concept of lymphatic drainage, that has been used by aestheticians and massage therapists for years.
Lymphatic drainage helps decrease the amount of edema in postrhytidectomy patients and can help with "the little lumps and bumps that all of us see with our liposculpture patients," he said.
"This is where the science backup falls into place." It also soothes the patients emotionally, helping the physician from the standpoint of postoperative "handholding."
Equipment specifics
Dr. Chernoff's chosen percussive therapy system, the Symedex MD-2000, has more applications than competitive systems at about one-third of the cost, he said. Instead of working through simple suction, the machine oscillates in and out, has an up and down feature, and also moves in a circular motion. Directional mobilization vectors allow for adjustment of oscillation speed and vibratory frequency.
"There are various theories behind what the machine does, but by-and-large it is really mimicking manual massage," he said.
The idea of driving lipophilic substances deeper into the dermis by means of percussive therapy or external ultrasound devices is a hot area in skin research.
To validate these approaches, Dr. Chernoff is entering patients into a prospective, randomized clinical trial. An ionic electron microscope will measure the penetration depth and concentration of ions in a skin product applied on the body, showing whether the product is actually getting absorbed and working.
"In the next few years, you will hear a lot about the idea of patients purchasing kits containing products as well as devices that will increase absorption of that product," he said.
Many of Dr. Chernoff's percussion therapy patients originally came into his office requesting liposuction. But, under his care, they are first enrolled in an anti-aging program and undergo screening of their blood, urine, and saliva.
Based on the values obtained, a computer program recommends a diet and exercise program to be used along with the percussion therapy.
"We educate patients about the alternatives to liposculpture," said Dr. Chernoff. "However, many patients are able to trim and tone themselves to the point that they do not need liposuction. Yes, we lose the liposuction fee, but we build a tremendous amount of loyalty with that patient."
Do-it-yourself therapy
A purchased percussion therapy system comes with 10 "take home" hand-held vibratory units. These are very popular with patients.
"They contribute significantly to the bottom line since the rental fee is $250 a month or $100 a week. "In our two centers, all 10 that come with the system are always out and we ordered another 10 take-home units"
Patients also purchase a package of therapies within the office that range from $100 to $250 per treatment.
One of his patients, a pilot, had trouble taking off at the required pitch -- the stick was hitting his belly -- when his airline changed to a different type of plane. After entering the wellness program, he lost 30 pounds, mostly around his abdomen and love handles. He uses his percussion therapy, take-home vibratory unit in the cockpit when he has a chance. And loves it.
In conjunction with aesthetics
Percussion treatment also works very well in the aesthetics department of Dr. Chernoff's two centers. He has two full-time massage therapists in each center who do the percussion treatments in addition to their massage duties.
"We have many patients who come in and sign on for a package of massage, but then they also convert to a package of this type of treatment as well," he said.
Dr. Chernoff believes his anti-aging wellness and longevity program, incorporating percussion therapy, when indicated, helps set his practice apart from others.
"It allows you to offer something patients cannot get from other centers and makes patients active participants in their own health and well-being."
However, he is continuing his research to scientifically validate various treatments and the benefits that come from the various components of his program.
"There's still lots of work to do in a good prospective randomized trial," he said.
Although randomized prospective studies of cellulite are few -- especially biopsy studies that evaluate improvement after treatment -- most experts agree that cellulite is caused by multiple factors. Genetics and hormones have been identified as the key culprits. Women in some families do not develop cellulite while, in other families, 7- and 8-year-old girls show marked cellulite on the legs. "With the ongoing mapping of human genome, I think we're going to see some very interesting therapies coming out for the treatment of cellulite," said Dr. Chernoff, clinical associate professor, facial plastic surgery, Indiana University, Indianapolis.
The role of estrogen is clear: It affects collagenase, an enzyme that weakens the fiberseptaid that connect the fascia to the epidermal surface. As fat cells grow bigger, the weakened septa don't move, causing the skin to dimple. A way of bypassing this effect of estrogen without interfering with its necessary effects is not yet known.
Another factor contributing to cellulite is the impedance of microcirculation. "Anything we can do to improve circulation in the area, to decrease pooling of lymphatic fluids, has been shown to increase metabolism over time and to have some positive effect on cellulite" said Dr. Chernoff, who has private practices in Indianapolis and Santa Rosa, California. "Packs and wraps, suction rolling devices, and topical agents, such as xanthinas, flavonoids, and collagenase inhibitors have some scientific credibility, but long-term prospective studies have not been performed."
Lymphatic drainage
Dr. Chernoff, certified in otolaryngology and facial plastic surgery, has been exploring the benefits of percussive therapy, based on the concept of lymphatic drainage, that has been used by aestheticians and massage therapists for years.
Lymphatic drainage helps decrease the amount of edema in postrhytidectomy patients and can help with "the little lumps and bumps that all of us see with our liposculpture patients," he said.
"This is where the science backup falls into place." It also soothes the patients emotionally, helping the physician from the standpoint of postoperative "handholding."
Equipment specifics
Dr. Chernoff's chosen percussive therapy system, the Symedex MD-2000, has more applications than competitive systems at about one-third of the cost, he said. Instead of working through simple suction, the machine oscillates in and out, has an up and down feature, and also moves in a circular motion. Directional mobilization vectors allow for adjustment of oscillation speed and vibratory frequency.
"There are various theories behind what the machine does, but by-and-large it is really mimicking manual massage," he said.
The idea of driving lipophilic substances deeper into the dermis by means of percussive therapy or external ultrasound devices is a hot area in skin research.
To validate these approaches, Dr. Chernoff is entering patients into a prospective, randomized clinical trial. An ionic electron microscope will measure the penetration depth and concentration of ions in a skin product applied on the body, showing whether the product is actually getting absorbed and working.
"In the next few years, you will hear a lot about the idea of patients purchasing kits containing products as well as devices that will increase absorption of that product," he said.
Many of Dr. Chernoff's percussion therapy patients originally came into his office requesting liposuction. But, under his care, they are first enrolled in an anti-aging program and undergo screening of their blood, urine, and saliva.
Based on the values obtained, a computer program recommends a diet and exercise program to be used along with the percussion therapy.
"We educate patients about the alternatives to liposculpture," said Dr. Chernoff. "However, many patients are able to trim and tone themselves to the point that they do not need liposuction. Yes, we lose the liposuction fee, but we build a tremendous amount of loyalty with that patient."
Do-it-yourself therapy
A purchased percussion therapy system comes with 10 "take home" hand-held vibratory units. These are very popular with patients.
"They contribute significantly to the bottom line since the rental fee is $250 a month or $100 a week. "In our two centers, all 10 that come with the system are always out and we ordered another 10 take-home units"
Patients also purchase a package of therapies within the office that range from $100 to $250 per treatment.
One of his patients, a pilot, had trouble taking off at the required pitch -- the stick was hitting his belly -- when his airline changed to a different type of plane. After entering the wellness program, he lost 30 pounds, mostly around his abdomen and love handles. He uses his percussion therapy, take-home vibratory unit in the cockpit when he has a chance. And loves it.
In conjunction with aesthetics
Percussion treatment also works very well in the aesthetics department of Dr. Chernoff's two centers. He has two full-time massage therapists in each center who do the percussion treatments in addition to their massage duties.
"We have many patients who come in and sign on for a package of massage, but then they also convert to a package of this type of treatment as well," he said.
Dr. Chernoff believes his anti-aging wellness and longevity program, incorporating percussion therapy, when indicated, helps set his practice apart from others.
"It allows you to offer something patients cannot get from other centers and makes patients active participants in their own health and well-being."
However, he is continuing his research to scientifically validate various treatments and the benefits that come from the various components of his program.
"There's still lots of work to do in a good prospective randomized trial," he said.