Written by: Dr Bill Johnson
1601 Lancaster #20 | Grapevine, Texas 76051 | Tel 817.410.2990 | Fax 817.410.2992 | www.preventionfirst.info
Use of Acoustic Wave Therapy (AWT) in the Treatment of Cellulite
Background:
Cellulite is defined as skin relief alterations that give the skin an orange peel or mattress appearance. Historically,
few treatments have been truly effective. Several studies have shown extracorporeal pressure waves, similar to
Acoustic Wave Therapy (AWT) to be effective in the treatment of cellulite.
Objectives:
To determine the effectiveness of Acoustic Wave Therapy (AWT) delivered using a ballistic pressure head (DActor)
in improving the appearance of cellulite.
Methods:
Patients were recruited from phone calls and inquires made at a one location medical practice office. Patients
were treated for cellulite based on their regions of complaint. An area was defined as a 20x30 cm area (typically
the front or back of one thigh). Each area received 6 treatments consisting of 1,000 vertical pulses and 1,000
horizontal pulses. Patients had photographs and circumference measurements taken before and after treatment.
Weight and electrical impedance measurements were taken before and after each treatment.
Results:
Adequate weight and body fat data was collected on 102 patients. Thigh circumference data was collected on 72
patients. Patient satisfaction surveys have been completed by 19 patients to date. All patients contributing data
had before and after pictures taken. Average weight loss was small, 0.19 lbs (0.08 kg), and fell short of statistical
significance, p=0.21. Similarly percentage body fat using lower body electrical impedance was small at 0.02% a
non-significant change with p=0.45. Thigh circumference decrease was significant at 0.45 cm, p=0.025. Patients
rated their posterior thigh treatment at 84% of perfect and anterior thigh treatment at 52% of perfect. Only 11% of
responders (2 patients) disagreed that they were more confident in revealing clothing. Sixty eight percent of
responders were more comfortable in revealing clothing and 74% were more comfortable with there body. Only
11% (2 patients) disagreed that they were more confident in their body. Seventy three percent of responders
stated the treated area was closer to the appearance they desired. Only 11% of responders (2 patients) responded
that the area was not closer to the appearance they desired. Before and after pictures reveal moderate to
substantial improvement in the appearance of cellulite. Continued improvement in cellulite appearance was seen
for up to 4 weeks past the end of treatment (maximum duration of follow-up).
Conclusions:
AWT delivered by a ballistic impulse method is effective for improving the appearance of cellulite in the majority
of patients. A small decrease in thigh diameter is also seen. No significant changes in weight or body fat
composition were seen, The optimum number and timing of treatments and the use of complimentary techniques
requires further study.
Cellulite is defined as changes in the surface contour of the skin that result in an orange peel or
“mattress†appearance of the skin.1 In is present in post-pubertal females of all race and ethnic
types, effecting 85-98% of this population. Cellulite is not defined as a pathologic condition, but
it is a substantial cosmetic concern for many adult females. It can cause significant psychological
and self-worth issues, and commonly affects clothing and activity choices. Several contributory
factors have been proposed for the formation of cellulite: altered connective tissue septae,
vascular changes, inflammatory changes,2 and protrusion of subcutaneous adipose tissue into the
reticular dermis. Body mass index, thigh circumference, and the percent of fat in the thigh
correlate with the severity of cellulite. Skin compliance (elasticity) has a negative correlation.3
Biopsy studies have pointed to sclerotic fibrous tissue strands to playing the predominant role in
the “mattress†appearance. Biopsy studies also confirm the role of fat protrusion into the reticular
1601 Lancaster #20 | Grapevine, Texas 76051 | Tel 817.410.2990 | Fax 817.410.2992 | www.preventionfirst.info
dermis in the severity of cellulite.4 Research has suggested pressure or acoustic waves are
effective in disrupting the sclerotic fibrous septae responsible for much of the uneven appearance
of cellulite.5 Acoustic wave therapy has also been demonstrated to increase the thickness of the
reticular dermis and decrease the protrusion of fat into the area.6 It appears that acoustic wave
therapy (AWT) is a promising new treatment for improving the appearance of cellulite. The
purpose of this study was to demonstrate the effectiveness of AWT using a 20 mm ballistic head
(D-Actor) in improving the appearance of cellulite.
Bibliography:
1: Dermatol Surg. 2005 Jul;31(7 Pt 2):866-72; discussion 872.
Botanical extracts used in the treatment of cellulite.
Hexsel D, Orlandi C, Zechmeister do Prado D.
Doris Hexsel Dermatologic Clinic, Brazil. d o hexsel@terra.com.br
2: J Cosmet Laser Ther. 2004 Dec;6(4):181-5.
Cellulite: a review of its physiology and treatment.
Avram MM.
Division of Dermatology, David Geffen School of Medicine, UCLA Medical Center,
Los Angeles, CA, USA. m a vram@mednet.ucla.edu
3: J Cosmet Sci. 2005 Mar-Apr;56(2):105-20.
Quantitative model of cellulite: three-dimensional skin surface topography,
biophysical characterization, and relationship to human perception.
Smalls LK, Lee CY, Whitestone J, Kitzmiller WJ, Wickett RR, Visscher MO.
The Skin Sciences Institute, Cincinnati Children's Hospital Research Foundation,
Cincinnati, OH 54267, USA.
4: P l ast R e constr S u rg . 1998 Jun;101(7):1934-9.
An exploratory investigation of the morphology and biochemistry of cellulite.
Rosenbaum M , P r ieto V , H e llmer J , B o schmann M , K r ueger J , L e ibel R L , S h ip A G .
Laboratory of Human Behavior and Metabolism, Rockefeller University, New York, NY, USA.
5: B i ofactors . 2005;24(1-4):275-82.
Anti-fibrosclerotic effects of shock wave therapy in lipedema and cellulite.
Siems W , G r une T , V o ss P , B r enke R .
Loges-School of Physiotherapy, Research Institute of Physiotherapy & Gerontology, D-38667 Bad Harzburg, Germany.
werner.siems@loges-schule.de
6: STORZ MEDICAL AG
Dermatoligic pulse activation therapy – new ways to healthy skin.
Schulz, M ·
Unterseestrasse 47 · 8280 Kreuzlingen · Switzerland
Tel. +41 - 71 677 45 23 Fax +41- 71 677 45 04 E-mail schulz.manfred@storzmedical.com