New option for treatment of skin retraction

Doctors know that they must be able to offer the most advanced and up-to-date treatments and procedures to keep their patients satisfied and to keep themselves on the cutting edge.

Cellulite is just one reason why patients will seek out their dermatologist, hoping to discover a new and better way to renew their aging skin and restoring it to what it once was.

Cellulite or "peau d'orange" is a dimpling or puckering of the skin. It is estimated that more than 90 percent of women over the age of 20 have some degree of cellulite and the remaining percentage think they do. It is not usually seen in men because males have a different connective tissue fiber structure in the subcutaneous fat.

"Cellulite mainly involves the buttocks and the upper part of the thighs, but can also be seen in other parts of the body such as the abdomen and arms, coincidentally areas where an increase in subcutaneous fat deposits may be found," Dr. Hexsel explains. "The subcutaneous septa that pull the skin down seem to play an important role not only in cellulite but also in other skin depressed lesions."

Contrary to popular belief, cellulite formation is a normal physiologic state in post-adolescent women where adipose tissue retention is maximized to ensure adequate caloric availability for pregnancy and lactation. Aside from gender, other predisposing factors include heredity, race (Caucasians are more likely to develop this condition as compared to Asian or black women) and age (cellulite increases in severity with aging as a reflection of the thinning of the epidermis and loose skin).

Subcision

Dr. Hexsel advocates Subcision, a surgical technique that is especially useful in treating advanced degree cellulite.

She says that Subcision can also be used in the treatment of any conditions where subcutaneous septa are pulling the skin surface, including depressed scars and wrinkles, as well as cellulite. And, according to Dr. Hexsel, who developed this technique with her assistant Rosemari Mazzuco, M.D., other skin relief alterations, such as lumpiness or an uneven look that may appear following a liposuction procedure, or tissue loss due to trauma or inflammatory diseases, as well as the donor sites of fat grafts on the face or on the body can all benefit from the Subcision technique.

"There are three mechanisms of action in the Subcision technique," Dr. Hexsel tells Dermatology Times. "The first is a sectioning of the subcutaneous septa that pull down the skin, effectively separating the skin from the fat with cellulite that has traction forces. The second is new connective tissue formation, and the third mechanism of action is the redistribution of the tension and traction forces exerted by the fat and subcutaneous septa on the depressed lesions."

Explanation of procedure

The outpatient procedure is done under local anaesthesia using a special micro lancet.

Working from the depressed lesions, the cosmetic surgeon separates the skin that is adhered to the fat tissue with cellulite, repeating this procedure at each depression. Each site takes approximately two minutes to treat and correct. The full procedure takes approximately 45 minutes to perform.

Dr. Hexsel notes that in the post-operative period some of her patients reported pain, bruising and hemosiderosis. She observed significant improvements in the surface depressions in most of the 1,800 patients she has treated over the last 10 years. Most patients reported a high degree of satisfaction.

Dr. Hexsel says, "The Subcision method is simple, safe, efficient and reproducible. This technique can result in significant improvement in the skin depressions and cosmetic appearance, yielding few complications and persistent and positive cosmetic outcomes."