Treatment of Cellulite with the
Swiss Dolorclast
Preface
•
•
•
The application settings outlined herein (handpiece, applicator, number of treatments, number of impulses per
treatment, frequency, air pressure) are non-binding recommendations. They are based on reports by experts in the
field.
Patients should not experience dyscomfort, or feel pain, when treated for cellulite. This is because treatment for this
indication with radial shock waves does not aim at activating the peripheral nervous system.
The Swiss Dolorclast Smart is approved for the treatment for cellulite. The corresponding approval of the Swiss
Dolorclast Classic and Master is pending.
Cellulite – brief introduction
Clinical picture
Picture taken from http://en.wikipedia.org/wiki/File:Cellulite-2.jpg
Histology
Cellulite
Smooth skin
Picture taken from www.istockphoto.com/stock-photo-2643756-cellulite-cross-section.php
© www.istockphoto.com
Definition, Epidemiology, Etiology
 Topographic skin change, evident by skin dimpling and
nodularity
 Occurence mainly in women on the
– pelvic region
– lower limbs
– abdomen
 Presentation as herniation of subcutaneous fat with fibrous
connective tissue
 Occurence in 80-90% of the postpubertal females
 Rarely seen in males
Cause
 Poorly understood
 Potential contribution:
– Changes in metabolism and physiology
– Alterations of
• connective tissue structure
• hormonal factors
• genetic factors
• the microcirculatory system
• the extracellular matrix
– Subtle inflammatory alterations
Predisposition





Gender (females > males)
Race (caucasians > african americans / hispanics)
Biotype
Distribution of subcutaneous fat
Predisposition to lymphatic and circulatory insufficiency
Grading




Grade 1: minimal dimples / surface inhomogeneities
Grade 2: orange peel appearance, thinned epi-/dermis
Grade 3: dimples / micronodules / striations
Grade 4: palpable macronodules / striations
 Note: other authors may use different gradings
Treatment options (1)
Khan et al., J Am Acad Dermatol 2010;62:373-384:
 Treatment modalities range from topical creams to invasive
procedures, such as laser-assisted lipolysis and liposuction
 There is no single treatment of cellulite that is completely effective
 Future treatment options for cellulite depend upon our understanding of
the molecular basis and hormonal influences of cellulite adipose tissue
Treatment options (2)
Levels in Evidence-Based Medicine
IA:
Meta-analysis of randomized clinical trials (RCTs) that had enough power to
demonstrate a statistically significant health outcome
IB:
II:
RCTs that had enough power to demonstrate a statistically significant health outcome
III:
IV:
Nonrandomized concurrent cohort comparisons between contemporaneous patients
V:
Case series without control subjects
RCTs trials with results that were not statistically significant but where a larger trial
might have shown a clinically important difference
Nonrandomized historical cohort comparisons between current patients and former
patients (from the same institution or from the literature)
Treatment options (3)
Treament options and corresponding Evidence levels












Weight loss (Level II)
Endemology (Level II)
Liposuction (Level III)
Subcision (Level IV)
Mesotherapy (Level II)
Topical phospotidylcholine and LED (Level IA)
Radiofrequency devices (Level II)
Ultrasound (Level II)
Laser-assisted lipolysis (Level IA)
Topical herbs and retinol (Level II)
Carboxy therapy (Level II)
Cryolipolysis (Level IV)
Why treatment for cellulite with shock waves?
Preliminary reports in the literature, describing treatment
for cellulite with extracorporeal shock waves (single
case studies and case series)





Angehrn et al., Clin Interv Aging 2007;2:623-630 (Level V)
Christ et al., Aesthet Dermatol 2008:1:6-14 (Level III)
Christ et al., Aesthet Surg J 2008;28:538-544 (Level III)
Kuhn et al., Clin Interv Aging 2008;3:201-210 (Level V)
Sattler et al., Aesthet Dermatol 2008;2:17-25 (Level III)
Recommended treatment protocol for
cellulite using the Swiss Dolorclast
Treatment protocol (1)
Application of coupling gel
(no need for palpation and labeling because
the treatment area is visually identified)
15
Treatment protocol (2)
Treatment with the Power+ handpiece
• Applicator: 36 mm Planar
• Number of treatments: 8 (two treatments per week)
• Number of impulses per treatment: 200 – 300 per cm2
cellulite skin (approximately 3,500 per skin region)
• Frequency: 8 - 20 Hz
• Air pressure: 3 - 4 bar
• Literature: EMS (ongoing clinical study)
16
Results achieved with the recommended
treatment protocol (pilot study)
Results
Patient
#
Age
Body
Mass
Index
(BMI)
Pain (VAS
score) (a)
Comfort
during
treatment (b)
Satisfaction
about
treatment (b)
Cellulite
Stage
before
treatment
Cellulite
Stage
after
treatment
Cellulite
Stage difference
1
34
21.8
3.5
7
5
2.5
1
1.5
2
35
20.8
3
5
6
2.5
1.5
1
3
38
24.6
9 (c)
-- (c)
-- (c)
-- (c)
-- (c)
-- (c)
4
55
20.3
1
7
7
2
1.5
0.5
5
48
21.9
4
5
7
2.5
1.5
1
6
51
22.9
3
5
8
2.5
0.5
2
7
29
32.9
2
5
5
3
1.5
1.5
8
23
31.6
3
8
3
2.75
2.75
0
9
57
19.7
3
5
7
3
2.5
0.5
10
51
22.2
5
5
6
2.75
1.5
1.25
11
29
20.8
2
5
1
2
1.5
0.5
12
43
20.4
3
5
7
2.5
1.5
1
13
51
24.2
3
7
7
2.5
1.5
1
14
4
19.6
3
8
6
2.5
1.5
1
15
43
18.7
4
6
1
2
1.75
0.25
Average
:
41.8
22.8
3.0
5.9
5.4
2.5
1.57
0.9
(a) 0 = no pain; 10 = maximum pain
(b) 0 = worst; 10 = best
(c) drop-out because of pain
Conclusions (from our pilot study – Level V)
Treatment for cellulite with the Swiss Dolorclast is
 safe
 efficient in patients with cellulite grades 2 and 3
 able to reduce the cellulite grade by one grade on average
Treatment outcome does not correlate with age, body height,
body weight, and BMI
Treatment outcome is not permanent but lasts for several
months