In each edition, Modern Aesthetics® asks top aesthetic physicians about new devices. This month, Joel L. Cohen, MD talks about Cellfina. Dr. Cohen is Director of AboutSkin Dermatology and DermSurgery, Englewood and Lone Tree, CO.
What Is the Cellfina System?
The Cellfina System is an FDA cleared device from the company behind Ulthera that is intended for long-term improvement in the appearance of dimples of cellulite in the buttocks and posterior thigh areas of adult females. Dr. Cohen says it is used to treat specifically the dimple type of cellulite and not cellulit that involves confluent textural irregularities.
“This dimple type appearance of cellulite is something we tend to see in people who work out, eat healthy, and who have some troublesome areas despite the fact that they're in good shape,” says Dr. Cohen, adding that until now there hasn't been a reliable way to address this. There have been many types of devices marketed over the years for cellulite, he says, but results seen from treatment have been inconsistent and short-lived.
In the pivotal study for FDA clearance, assessment of cellulite severity by an independent physician panel showed that a single procedure significantly improved the appearance of cellulite. The minimally invasive procedure targets the tight connective-tissue bands in the underlying structure of cellulite known as fibrous septae. It uses a precision-guided, vacuum-assisted approach to release the restricting septae, improving the appearance of cellulite.
What Does Treatment Entail?
When a patient comes in for treatment with Cellfina, Dr. Cohen says he marks out individual dimples with a gentian violet marker. In general his patients have had anywhere from eight to 24 dimples so far, and most people have fallen in the middle with 16 to 18. The vacuum device with an anesthesia platform is then placed physically over those marked-out dimples, and they are anesthetized using a special 22g needle placed into the platform in the areas being lifted by the suction to introduce the tumescent anesthesia. Once all of the dimples are anesthetized, the same vacuum chamber is used for treatment, but this time with a release platform attached. Dr. Cohen says the principals of the specific treatment comes from subcision, but the Cellfina System offers much greater precision release of the fibrous bands because you are lifting the whole area up and introducing the small blade to release the dimple. A motor module is inserted into the release platform to guide a .45mm microblade—the needle goes in and swipes across the whole area. Dr. Cohen says there are two depths you can go to with the device. “I almost always use the 6mm depth unless there's an immediately adjacent dimple. You don't want to treat two immediately adjacent dimples both at 6mm because that same depth would potentially allow some fluid accumulation and potentially result in a seroma or even hemotoma,” he says. Using two different depths for immediately adjacent dimples has offered excellent results without these potential adverse events at this point.
“It's very precise, it's very controlled, it's very reproducible, and we're seeing very good results. The FDA study showed results at a year, but the follow up to that—after the FDA clearance—is that two-year patient satisfaction has been found to be 96 percent,” Dr. Cohen says. “We can control the exact area of the dimples by marking them out, vacuuming over them, anesthetizing them, and then releasing them, and patients are having very long-term, reproducible improvement with very minimal downtime.”
What Can Patients Expect?
Dr. Cohen says the patients he's treated typically have some bruising for five day to nine days. “We generally tell people to take it easy for a few days after these procedures—four or five days is a good number.” This means avoiding workouts, yoga, and strenuous activity. To help minimize downtime, Dr. Cohen says after the procedure, his nurses actually take their two thumbs over the released areas and massage out any remaining anesthesia or any bleeding and then cover the area with a bandage. Patients are told to bring really tight biking shorts or very tight workout spandex to the office to wear after the procedure.
“We like the compression of the bike shorts and I think it decreases some of the swelling and bruising patients can get, or any fluid accumulation,” Dr. Cohen explains. In addition, he offers specific instructions on post-treatment washing of the areas that were released. He instructs patients to prep their toilet seat with an antimicrobial wipe to avoid potential for infection through the very small entry points left from the procedure. Although, he explains, the risk of infection is low because the entry points are so small. n
What Kind of Feedback Have You Received from Patients?
Dr. Cohen says patients have been very happy with the results.
The competition from subcision alone or from other devices that may incorporate a needle or liposuction, do not offer results that are as precise or consistent in his opinion for dimpling. But it's important to convey that the Cellfina device is just for dimples and it can be difficult to explain to patients over the phone exactly what you're talking about. Dr. Cohen says when patients come in for a consult, he shows them before and after pictures and emphasize that the procedure is just for the dimples.
“If it's the dimples they really are concerned about, this is the treatment for them. But if they have other cellulite issues that concern them, there are other devices people are using, including lasers or radiofrequency devices, and I think it's exciting that we'll probably see something that's gives more long-term, more reproducible type of results for that type of classic cellulite (confluent textural irregularity) perhaps in the near future as well. But for the dimples, we're here with CellFina,” says Dr. Cohen.
Read what what Dr. Cohen's patients think about Cellfina. Download the Modern Aesthetics® App on iTunes.
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