7. CelluTite

The CelluTite hand piece has a V-dissector shape plastic tip, rather than bullet shaped and is used to treat advanced, grade 3 nodulo-pitted cellulite of the buttock and thighs. The hand piece is 2.4 mm ˜ 17 cm long (Figure 22).

The CelluTite® is designed to treat the three anatomic pathologies of Cellulite


Cellulite patients tend to have a more vertically oriented FSN anatomy and, over many years there is a contraction of many of the vertically oriented fibroseptal bands and edema of the superficial fat which leads to the pits and nodules characteristic of more advance cellulite (Figure 23).

The CelluTite® patient is marked out in the standing position and all deep pits are marked for release, while the nodules are marked using a different color and are targeted for stamping and popping to reduce the nodules. The thinned dermis, that allows superficial fat herniation is then heated, thickened and minimizes the ability of superficial fat to herniate into the dermis.

Only superficial tumescent anesthesia is required (first 4–6 cm of soft tissue) and a tense tumescent infiltration is instilled. The entire treatment is performed at level 2 on the CelluTite® depth setting. The procedure is divided into releasing the

Figure 22.

The CelluTite® has a V-shaped tip, making the CelluTite® a thermal V dissector. The V-tip, traps the vertical, shortened, fibroseptal band that pulls down the dermis causing the deep skin pits. The band undergoes a thermolysis, release the pit and smoothening the skin.

#### Figure 23.

The anatomy of cellulite: the FSN tends to be more vertically oriented. The pits are caused by shortened fibroseptal bands. Nodules result from edematous, swelling of superficial fat from the microcirculatory compromise. The dermis is thin, leading to fat herniating into the reticular dermis.

## BodyTite®: The Science and Art of Radiofrequency Assisted Lipocoagulation (RFAL)… DOI: http://dx.doi.org/10.5772/intechopen.83446

pits, followed by coagulation and reduction of the nodules. To release the pits, CelluTite tip is advanced the slowly at several levels across each pit. The thermal V-dissector captures the contracted FSN which is causing the dimple at the apex of the V (Figure 24) and bends the FSN over the RF emitting internal electrode, result in a thermoseptolysis and release, which allows the pitted skin to "pop back up" and smoothen the pitted appearance to the skin.

Additional smoothening is then achieved by moving the internal electrode up under a pre-marked nodule and performing a stationary stamping technique under each nodule and heating until the cutoff of 69° is achieved (USA) or, for International physicians, for 2 s, until there is a "popping" sound, both of which coagulate the edematous herniated fat, flattening the area and smoothening the contour (Figure 25).

Once all the pits and nodules have been successful performed, slow back and forth passes are made under the soft tissue until there is no FSN resistance with each pass and the external skin temperature reaches the pre-set cut off of 38–40°C. This will provide additional dermal thickening, minimizing herniated dermal fat (Figure 26).

Excellent long term CelluTite® results can be achieved with a single treatment, often 50–70% reduction (Figure 27) which can last for many years (22). Recurrent nodulo-pitted irregularity is prevented by the creation of more multi-directional FSN, than the vertically oriented anatomy that contributed to the deformity and this multi-directional, remodeled FSN is resistant to any single fibroseptal band to shortening and causing a deep pit (Figure 28).

CelluTite® can be performed at the same time as BodyTite® and aspiration liposuction. Generally, in combination cases, CelluTite® of the buttock, posteriorly

#### Figure 24.

The thermal V dissector captures the shortened vertical fibroseptal band(s) in the apex of the V and bends the band over the thermal electrode causing a thermoseptolysis and band division. This slow back and forth release is repeated a several vertical depth, providing a thorough release. This allows the pitted skin to "pop' back up smoothening the overlying skin.

#### Figure 25.

The CelluTite® applicator is placed under a nodule and a stationary stamping technique is performed causing coagulation of the nodule (70° cut off in the USA BodyTite® platforms and popping after 2 s in international BodyTite® systems). This coagulates the edematous fat and flattens the nodular skin.

#### Figure 26.

The skin and dermis are then heated to 38–40°C superficially and the subdermal space to 69° (US systems), thickening the dermis and reducing fat herniating into the dermis.

BodyTite®: The Science and Art of Radiofrequency Assisted Lipocoagulation (RFAL)… DOI: http://dx.doi.org/10.5772/intechopen.83446

and laterally is performed superficially first, follow immediately by BodyTite® RFAL liposuction of the outer and inner thighs second.

Non-invasive suction coupled RF devices such as the BodyFX®, Velashap. 3®, Venus Legacy® and others can be used after 6 weeks of garmenting to maintain the outcome and protect the patient's improvement.

#### Figure 27.

Long term, 36 month results of CelluTite of the buttock.

#### Figure 28.

With release of the pits, flattening of the nodules and thickening of the skin, the remodeling process leads to a more multi-directional FSN network, which is resistant to shortening of individual bands and nodular swelling of the fat.
