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Dermatology Research and Practice
Volume , Article ID , pages
http://dx.doi.org/.//
Clinical Study
Effect of Capacitive Radiofrequency on the Fibrosis of
Patients with Cellulite
Rodrigo Marcel Valentim da Silva, Priscila Arend Barichello, Melyssa Lima Medeiros,
Waléria Cristina Miranda de Mendonça, Jung Siung Camel Dantas, Oscar Ariel Ronzio,
Patricia Meyer Froes, and Hassan Galadari
Potiguar University (UnP), Laureate International Universities, 59054-180 Natal, RN, Brazil
Correspondence should be addressed to Rodrigo Marcel Valentim da Silva; marcelvalentim@hotmail.com
Received July ; Revised September ; Accepted September
Academic Editor: Masutaka Furue
Copyright © Rodrigo Marcel Valentim da Silva et al. is is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Background. Cellulite is a type of lipodystrophy that develops primarily from an alteration in blood circulation or of the lymphatic
system that causes structural changes in subcutaneous adipose tissue, collagen, and adjacent proteoglycans. e radiofrequency
devices used for cutaneous applications have shown dierent physiological treatment eects, but there is controversy about the
suitable parameters for this type of treatment. Objectives. e aim of this study was to evaluate the eects of low-temperature
radiofrequency to conrm the thinning of the collagen tissue and interlobular septa and consequent improvement of cellulite.
Methods. A sample of eight women was used to collect ultrasonographic data with a MHz probe that measured collagen ber
thickness. e Vip Electromedicina (Argentina) device, frequency of . MHz and active electrode . cm in diameter (area =
. cm2), was applied to a cm2region of the gluteal region for minutes per area of active electrode, during biweekly sessions.
Results. e Wilcoxon matched paired test was applied using GraphPad InStat . for Win-NT soware. Pre- and posttreatment
mean collagen ber thickness showed a .% reduction from . to .mm. Statistical analysis using the Wilcoxon matched
paired test obtained a signicant two-tailed Pvalue of .. Conclusion. It was concluded that the use of more comfortable
temperatures favored a reduction in brous septum thickness and consequent cellulite improvement, evidenced by the lower degree
of severity and decrease in interlobular septal thickness.
1. Introduction
Cellulite is a type of lipodystrophy widely considered as an
esthetic disorder in dermal and hypodermal tissue, whose
alterationisbasedonamorphologicaldisorder.Itdevelops
primarily from an alteration in blood circulation and of the
lymphatic system, causing structural changes in subcuta-
neous adipose tissue, collagen, and adjacent proteoglycans
[,].
In cellulite, fat is stored in fat cells that lie between the skin
and muscle tissue. Fat cells are grouped together into large
conglomerates separated by brous strands (brous septae).
ese brous strands run between the muscle and the skin
andservetoholdthefatinplace(insmallcompartments).
e skin is tethered down by string-like tissues that pull
it inward, toward the interior of the body. As fat cells
expand with weight gain, the gap between the muscle tissue
and skin expands. e brous strands cannot stretch and
cannot support the skin. e tension of these septae pulls
sections of fat in along with them, causing the fat cells in the
subcutaneous layer to increase and stick together within the
connective tissue bers, resulting in dimpling (also described
as “mattress” or “cottage cheese”) [].
In the past decade, cellulite management has inspired
a new generation of innovative medical devices, such as
radiofrequency machines, which promise to correct cellulite
signs and symptoms []. Radiofrequency energy has been
usedformorethanacenturyinavarietyofmedical
applications. It is conducted electrically to the tissue, and
heat is produced when the inherent impedance of the tissue
converts the electrical current to thermal energy. RF devices,
whichhavebeenusedforcutaneousapplications,exhibit
dierent physiological eects: neocollagenesis, the liing
Dermatology Research and Practice
eect, decreased localized adiposity, reduced edema and
broses, and improved cellulite [–].
Several experimental in vivo and in vitro studies have
produced evidence about the thermal modication of col-
lagen tissue, but there is no consensus about the optimal
therapeutic algorithm []. At dierent temperaturas, it is
possible to increase or decrease the density of collagen
tissue, mainly of brous septa found in the cellulite process
[]. When heated, collagen, a very organized crystalline
protein structure, transforms into a disorganized gel. Its triple
helix shape is destroyed, since its intermolecular bonds are
sensitive to low heat. When this disorganized gel is subjected
to temperatures above degrees, its structure is transformed
into a thicker, rigid tissue, with little uid and no elasticity
[,].
Hence, there are a number of controversies about ideal
temperatures for treating cellulite. Some authors propose
high temperatures: Alster and Lupton []treatedcellulite,
obtaining immediate collagen contraction due to heat and
protein denaturation using high temperatures and del Pino et
al. [] observed a thickening and realignment of interlobular
septae using temperatures between and ∘Cwithradiofre-
quency. ese temperatures are considered high, but there is
another authors that uses low temperature, about degrees
or to degrees above the temperature of the skin [,].
e problem lies in the fact that most cellulite treatments
have proven to be ineective, since the assessment methods
usedaremostlysubjectiveordonotprovideenoughinfor-
mation for the study of subcutaneous tissue. e application
of dierent temperatures to treat cellulite are suggested by
several authors [,], as well as dierences between their
classication. According to Goldman et al. [], the hard
celluliteistypicalofyoungsubjectswithtonedtissues,
typically in Latin American people. Normally, the area is
rigid and presents adherences between supercial and deep
layers and the skin thickness is increased. In these cases,
according to some authors [,], the use of low temperatures
would be more interesting to rene brous septae. On the
other hand, so cellulite is common in older people and
sedentary, with characteristics of weak and white skin. In this
case, radiofrequency high temperature increases the collagen
thickness.
High-resolution ultrasound allows the observation of
subcutaneoustissue,thefatlocatedbetweenskinandmuscle,
and the anatomic vie ws of the layer between the subcutaneous
tissue and the adipose layer, as well as the integrity of the
brous bands (brous septa) that divide them [].
Because of the aforementioned problem, the aim of
this study was to evaluate the eects of low-temperature
radiofrequency ( to degrees above skin temperature)
in hard cellulite, to conrm the thinning of the collagen
tissue and interlobular septa and consequent improvement of
cellulite.
2. Material and Methods
e study was approved by the Human Research Ethics Com-
mittee of Universidade Potiguar. e sample was composed
of eight women volunteers selected according to the following
inclusion criteria: age between and years and complaint
of grade and cellulite (according to Curri’s classication)
[], located in the gluteal region, and willingness to submit
to the treatment. Pregnant and diabetic women undergoing
drug or hormone treatment were excluded. e participants
were not submitted to any food restriction and were asked
to maintain their usual daily activities. Aer being informed
aboutthepurposeofthestudyandtheproceduresthatwould
befollowed,thewomengavetheirwritteninformedconsent.
e following data collection instruments were used:
Fibro Edema Geloid Assessment Protocol (PAFEG), pro-
posed by Meyer et al. [] A Sony digital camera, . megapix-
els; GE Vivid ultrasound machine, with multifrequency
(.– MHz) probe; radiofrequency device and infrared
digital thermometer were also used.
An evaluation was conducted based on PAFEG, which
is composed of three items: identication, anamnesis, phys-
ical examination containing inspection and palpation, topo-
graphic location, severity classication, tactile sensitivity test,
and complementary examinations associated with general
patient information. An ultrasonographic examination was
performed by a medical specialist using a MHz probe
to measure collagen bers before and aer radiofrequency
treatment. is examination is a simple, nonintrusive, and
reliable method that enables measuring the thickness of
interlobular septae present in more advanced cellulite. ree
dierent septae located at the center of the demarcated area
were measured pre- and posttreatment with a pendulum
probe to avoid inuencing the measures, and the resulting
values of these parameters were used for statistical analysis.
e demarcated area remained during the entire treatment
and adipose layer thickness was also measured both brfore-
and aer treatment. GraphPad InStat . for Win-NT
soware and the Wilcoxon matched paired test were used for
the analyses.
Radiofrequency was applied to the gluteal region with
thevolunteersintheventraldecubituspositionandthe
lower extremities extended and relaxed. Aer delimitating
an area of cm2and performing asepsis (% alcohol)
of the area to be treated, we applied the Tecartherap-Vip,
Vip Electromedicina (Argentina) radiofrequency capacitive
device, with frequency of . MHz, active electrode . cm
in diameter (area = . cm2), and passive metal electrode
with an area of cm2, placed in the lower abdominal region
with Carbopol gel for coupling. e application zone was
divided by the measure of the active electrode, obtaining the
measure of electrodes. Aer the patient’s skin temperature
was measured, the application was initiated, continuing until
the temperature was degrees above the initial value. Once
this level was reached, linear movements (back and forth)
were performed for minutes on the area, relative to the size
of two electrodes, during biweekly sessions.
Statistical analysis of collagen ber thickness before and
aer treatment was based on the PAFEG data and ultrasono-
graphic examination results obtained.
Dermatology Research and Practice
(a) (b)
F : Ultrasonography before and aer sessions.
(a) (b)
F : Ultrasonography before and aer sessions.
3. Results
Figures ,,,andcorrespond to the organization and
deposition of brous septae in cellulite areas before and aer
radiofrequency treatment.
e mean thickness values obtained for brous septae
are shown in Tabl e .
e mean pre- and posttreatment collagen brous thick-
ness was . mm and . mm, respectively, a reduction
of .%. Statistical analysis using the nonparametric test
for paired data (Wilcoxon matched paired test) showed a
signicant two-tailed 𝑃value of ..
Adipose layer thickness results are shown in Tab l e .
e mean pre- and posttreatment adipose tissue layer
thickness was . mm and . mm, respectively, an
increase of . mm (.%). Statistical analysis using the
nonparametric test for paired data (Wilcoxon matched paired
test) obtained a nonsignicant two-tailed 𝑃-value of ..
isndingiscorrelatedwiththeincreasedweightofmost
of the patients (mean of . Kg) (Table ).
ecelluliteshowedalteredconjunctiveandadipose
tissue disposition, with adipose and cell hyperplasia and
hypertrophy, as well as polymerization of the fundamental
amorphous substance, resulting in proliferation of intra-
adipocyte and interlobular collagen bers. ese alterations
provoke reduced circulation in tissues, reduced drainage
and broblast incarceration, and enrichment and rupture of
elastic bers [].
Figures to show the ultrasonographic results of
collagen ber thickness aer radiofrequency treatment at
comfortable temperatures ( to degrees above skin temper-
ature), demonstrating a decrease in interstitial brosis. Two
temperatureobservationparameterscanbeusedtoapply
radiofrequency: the rst is based on infrared thermometer
values and the second based on the subjective scale of heat
applied to each patient. It is suggested that G, a moderate
and pleasant heat level, be reached to achieve an increase in
the distensibility of collagen tissue [].
Figure shows the presence of an adipose tissue gra
performed years before following lipoaspiration. e tissue
is surrounded by interstitial brosis in Figure (a),butaer
treatment (Figure (b)) there is no visible brosis in this
area. e reorganization of brous tissue, as well as the
reduction in ber thickness observed aer ultrasonographic
examination, may be associated with the eects of radiofre-
quency. According to Verrico et al. [], radiofrequency
thermotherapy favors the absorption of type I collagen by
activating protein metabolism activators. is corroborates
the results and biological eects obtained for brous septum
thickness as well as the improvement in cellulite.
Dermatology Research and Practice
(a) (b)
F : Ultrasonography before and aer sessions.
(a) (b)
F : Ultrasonography before and aer sessions. ese gures shows the presence of an adipose tissue gra performed years before
following lipoaspiration. e tissue is surrounded by interstitial brosis in (a), but aer treatment (b) there is no visible brosis in this area.
4. Discussion
e radiofrequency eects on the conjunctive tissue evalu-
ated by ultrasonography have been documented in a number
of studies [,]. In research using high temperatures, the
changes observed reect the increased echodensity of con-
junctivetissuestructures,evidencedbyanincreaseinthe
amount of bers and compactness of existing bers. is
allows us to assume that high-temperature RF worsens the
clinical picture of cellulite.
According to the literature, radiofrequency also favors
a decrease in lipolysis and thickness and fat accumulation
in adipocytes, consequently reducing venous and lymphatic
uid retention caused by hypodermal tissue compressing
vessels and nerve endings []. Ta b l e shows that the temper-
ature conditions of this study did not satisfactorily alter adi-
pose tissue measures, evidenced by oscillating increases and
decreases in these values. According to PAFEG assessment,
the anthropometric data of the patients changed considerably
during the study, inuencing the reduction of adipose tissue.
It should be pointed out that no changes in patient diet were
indicated.
It was demonstrated that ultrasonography can be used as
a diagnostic method to evaluate the characteristics of subcu-
taneous tissue and to observe the eects of radiofrequency
in cellulite treatment. is methodology could be applied to
evaluate other treatments related to cellulitis and localized fat.
A diculty of this study was a small sample because of the
cost of the ultrasonography exam, so we suggest the repetition
of this research with a greater number of patients.
e use of more comfortable temperatures favored both a
reductioninbrousseptumthicknessandanimprovement
in the clinical appearance of cellulite, demonstrated by the
reduced degree of severity and decreased interlobular septal
thickening. Radiofrequency has been little studied in the
area of esthetic medicine; therefore, more studies are needed
to ascertain its real eects, since temperature variations
signicantly aect collagen tissue.
Authors’ Contribution
e authors declare that they participated in the design,
analysis of results and contributed eectively in carrying out
Dermatology Research and Practice
T : Average thickness of collagen bers.
Patient Grade of cellulitis Average thickness of collagen bers (measures/)
Before treatment (mm) Aer treatment (mm) Dierence (mm) Dierence Porcentual (%)
Grau . . −. −.
Grau . . −. −.
Grau . . −. −.
Grau . . −. −.
Grau . . −. −.
Grau . . −. −.
Grau . . . .
Grau . . −. −.
Media 1.01 0.67 −0.34 −24.66
T : Average of adipose tissue layer.
Patient Grade of cellulitis Average of adipose tissue layer
Before treatment (mm) Aer treatment (mm) Dierence (mm) Dierence Porcentual (%)
Grau . . −. −.
Grau . . . .
Grau . . . .
Grau . . . .
Grau . . . .
Grau . . . .
Grau . . −. −.
Grau . . −. −.
Media 29.7 30.3 0.5 5.5
T : Mean body weight alterations aer radiofrequency treat-
ment.
Patient Alterations in weight (Kg)
−.
.
.
.
.
.
−.
.
Media 0.51
this paper and make public responsibility for its contents,
in which any aliations or nancial agreements between
authors and companies that may be interested in publishing
this paper were not omitted.
Conflict of Interests
e authors state that they do not have any conict of
interests with the subject discussed in the paper or to the
products/items mentioned. We declare that the paper quoted
is unique and that the work, in part or in full, or any
other work with substantially similar content has not been
submitted to another journal.
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