24-year-old woman with Curri grade IV cellulite before and 13 months following a single treatment combining deep and subdermal Nd:YAG laser lipolysis and autologous fat transplantation. (PHOTO CREDIT: ROBERT GOTKIN, M.D., F.A.C.S. )

SEARCHING FOR A SOLUTION "There is no cure for cellulite," states Robert Gotkin, M.D., F.A.C.S., at Cosmetique Dermatology, Laser & Plastic Surgery, LLP, in New York, N.Y. "What we can do as aesthetic surgeons is try to improve the orange peel-like skin seen in cellulite. However, these improvements will be only temporary as skin laxity worsens with age. In my experience though, more invasive surgical procedures and devices can achieve longer lasting cosmetic results."

Dr. Gotkin co-authored a recent study in which a combination treatment of laser energy and fat transplantation was used to improve the signs of cellulite. In the trial, 52 female patients with grades 3 and 4 cellulite were treated with a 1064 nm Nd:YAG laser, followed by autologous fat transplantation in fat-depleted target areas. The laser technique was first used in the deep fat layers for actual lipolysis, and then superficially to break the fibrous bands causing cellulite. The autologous fat was selectively transplanted to the areas with the most severe concave contour deformities to try to fill those areas out and give a smoother, more even contour to the target skin's surface.

According to Dr. Gotkin, the technique allows the surgeon to work very superficially because the cannula carrying the laser fiber has a very small external diameter that essentially does not leave a footprint. This is different from traditional liposuction in which larger cannulas, used superficially at the dermal-fat junction, may contribute to a worsening of the appearance of cellulite by causing tunneling and dimpling. In addition, traditional liposuction also uses higher vacuum pressures (one atmosphere) to aspirate the fat, whereas this technique uses very low negative pressures for lipid aspiration.

"As a woman gets older and continues to develop skin laxity, cellulite will likely return," Dr. Gotkin says. "However, in the 12- to 30-month follow-up that we had in our study patients, we could significantly improve the cellulite long-term. Most of the approaches currently used in aesthetic surgery are noninvasive and therefore also achieve minimal results. Our goal was to give some permanent improvement in the appearance of cellulite and we were able to achieve that using this surgical technique."