Microwave Therapy for Cellulite: History
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Subjects: Dermatology
Contributor:
Luigi Bennardo

Microwave therapy has proven to be a safe treatment for improving cellulite appearance and reducing body circumferences. 

  • cellulite
  • microwaves
  • cellulite severity scale
  • non-invasive therapy

1. Introduction

Cellulite, also known as “Oedematous Fibrosclerotic Panniculopathy”, identifies aesthetic changes in the subcutaneous adipose panniculus [1]. The cause of cellulite is not clear; many authors think that it may be considered an endocrine-metabolic microcirculatory disorder that causes structural changes in subcutaneous adipose tissue and interstitial matrix alterations. The most affected areas are the buttocks and thighs [2]. Cellulite is clinically characterized by skin surface alterations, typically raised and depressed lesions (among which depressed lesions are the most frequent and varied in depth and shape), which give the affected areas an “orange peel” aspect [3][4]. The study published by Hexsel and colleagues showed that cellulite depressions are relevantly related to the underlying fibrous septa [5]. Large fibrous septae lead to adipose tissue lobulation determining the typical “orange peel” structure of cellulite.
Today, adiposity and cellulite treatments are two of the most frequent patient requests to the aesthetic doctor and plastic surgeon, especially in this particular historical period. One must also deal with reduced physical activity and lack of access to gyms and fitness centers. A forced sedentary lifestyle often results in a reduction in muscle tone and a lack of muscle stimulation. Nevertheless, if aspiration techniques (liposuction) remain the gold standard for localized fat deposits, skin laxity and cellulite require different techniques and treatments. The classic appearance with wavy or almost knotty skin, typical of the latter, does not disappear with surgical liposuction. This method molds the shapes and volumes, making them more regular but not modifying the skin surface. Numerous therapeutic modalities have been proposed for the treatment of cellulite; among these are cosmetics, therapeutic massage, radiofrequency, ultrasound, laser therapy, carboxytherapy, intense pulsed light, subcision vibration/oscillation platform therapy, and most recently, extracorporeal shockwave therapy (ESWT) or acoustic wave therapy (AWT) [6][7][8][9][10][11].
Unfortunately, the potential for cellulite improvement only in the short-term period despite the numerous treatment sessions limits their popularity. Since the demand for non-invasive and long-lasting treatments to reduce cellulite has grown, new medical devices have been developed as a result. Microwave technology is a non-invasive technique introduced to the market by the ONDA system (DEKA, Florence, Italy), based on microwave propagation into the tissues.
The system produces a connective matrix remodeling of adipose tissue with successive modification of the microenvironment that regulates adipocytes metabolism. Therefore, the homeostatic balance between connective interstitium and adipocytes, responsible for the vitality of the adipose tissue, is altered, inducing metabolic modifications due to thermal stress in the adipocytes themselves, which are stimulated to release several lipids into the environment that surrounds them in quantities much higher than their physiological capacities. As far as cellulite is concerned, however, the energy of the microwaves, absorbed by the fibrous connective septae, causes the solubilization of collagen with resulting debridement of the dense inelastic texture that strangles the adipose lobules [12]. The effect is the loss of the pockmarked appearance of the skin but also a reactivation of the fibroblasts to produce new collagen. Finally, on skin laxity, the heat produced by the microwaves, even rising from the subcutis, causes immediate shrinking (contraction) of the collagen in the dermis, inducing a consequent tightening (tension) [13][14].
It has been demonstrated in previous research that this technology raises cell metabolism and local blood circulation and induces self-regeneration processes increasing elastin fibers and collagen proliferation. From the literature, some studies reported an evident treatment efficacy in cellulite improvement and body contouring after eight sessions with the microwave technology system, allowing professionals to eliminate the “three stones” of the body sculpting procedure (fat, cellulite and wSkin Laxity) in a practical, quick and virtually painless manner without side effects for patients [15][16][17].
Indeed, it was already demonstrated in the study of Zerbinati and colleagues [14] that treatment with ONDA is effective for cellulite through the remodeling of collagen and for skin laxity, with a good tightening of collagen: data have shown that Picrosirius red staining in association with circularly polarized microscopy has had evidence of appreciable changes in the fibrous connective tissue forming the septa. It has been observed that there is a reorganization of the connective tissue; the MMPs (metal proteases, lytic enzymes) digest the old collagen (collagen I), and the fibroblasts, stimulated by this denatured collagen, begin to synthesize new collagen (collagen III), which is more elastic and contributes to the reduction in the orange peel aspect of cellulite. Histological results demonstrate that the treatment is safe (no epidermal–dermal damage was found, showing intact skin), both immediately after treatment and two months after (inflammatory process completely resolved).

2. Insightful Analysis

Over the latest 30 years, there has been a significant increase in the demand for non-invasive methods for use in the medical and aesthetics sectors to treat skin imperfections in general and in particular, to treat localized adiposity cellulite treatment and skin laxity. RF techniques are known to be one of the most common therapies for cellulite. Indeed, several companies suggest RF systems as valid and safe alternative technologies capable of achieving the same clinical results in improving cellulite [18]. Despite this evidence for RF devices in treating cellulite, no procedure has been successful in the long-term period [19]. Microwaves are part of the RF spectrum (frequency range between 1 and 300 GHz) [20], and this technology has become very popular in modern society and is not even a newcomer to medical applications. It has been used extensively in many branches of medicine until now, including Surgery, Oncology and Dermatology. The application of 2.45 GHz non-invasive, high-energy microwaves to the body directs a targeted action towards the subcutaneous adipose tissues to promote the heating of the adipocyte cells without affecting the dermal–epidermal layers. This process leads to a complete metabolic macrophage adipolysis compatible with subcutaneous adipose tissues reduction and a consequent circumference diminution. Additionally, cellulite is improved by the solubilization of collagen septae caused by subcutaneous adipose tissue heating, which causes dermal collagen fibers’ contraction and improves external skin architecture [21][22].
The solubilization of the deeper collagen fibers, the activation of fibroblasts and the collagen fibers’ remodeling could be caused by controlled hyperthermia [15]. On these bases, by evaluating ONDA’s safety and long-term efficacy in the treatment of cellulite, we have found and reported a significant amelioration of cellulite with a significant decrease in the number and depth of depressions in all subjects treated. The mean total CSS score improved from moderate-severe at baseline to mild at the 3MFU after the last protocol treatment with ONDA. Furthermore, patients’ cellulite appearance amelioration was confirmed by the improvement of grade scores obtained with the Nürnberger and Müller classification scale analysis. Additionally, the treatment’s effects on body circumference showed promising results, reducing buttocks and posterior thighs circumferences.
In addition, the evaluation of patient satisfaction levels through the five-point Likert scale questionnaire and the photographic assessment corroborates these results.
No side effects were observed, neither after the single treatment sessions nor after the entire follow-up period, demonstrating that the treatment is safe and well supported by all patients. The protocol was found to be safe and non-invasive for the patient, who can experience at most a slight tingling/sensation of contraction or a possible temporary redness of the skin, due to the passage of microwaves that cause subcutaneous heating.
The great advantage of ONDA is that this high degree of innovation has provided a revolutionary non-invasive, no-consumables platform with fast results in a highly controlled and safe way. The patented handpiece technology provides users with maximum control on the depth of penetration so that the vital organs are not affected and make the entire procedure extremely safe for both the patient and operator. With ONDA, unlike other therapies for body remodeling and cellulite, which require longer times and a higher number of sessions, and in comparison to the research of Di Pietro and colleagues [15] on the same device, in this study of 3–4 treatments, the results of cellulite improvement are visible, both regarding the reduction in skin laxity, =the typical “orange peel” aspect, and the decrease in body circumferences. ONDA represents, for this reason, a completely different universe in the body-shaping device market.

This entry is adapted from the peer-reviewed paper 10.3390/jcm11030515

References

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