Cellulite is a problem familiar to many women. Its appearance is associated with changes in the subcutaneous fatty tissue: fat cells increase in size, forming bumps and indentations on the skin. These changes are caused by a complex interaction of various factors, including genetics, hormonal background, connective tissue structure, and microcirculation. As a result, fibrous septa are formed, which squeeze the fat lobes and worsen the appearance of the skin. There are various methods to fight cellulite — from cosmetic creams to invasive surgical procedures, but there is no ideal solution yet.

A group of dermatologists from Brazil has proposed a new approach that combines a minimally invasive subcision technique with hyaluronic acid (HA). The essence of subcision is the gentle rupture of the fibrous septa that compresses the adipose tissue. This allows the fat lobes to be released and improves the appearance of the skin. However, simply tearing the septae is not enough — a void is created in its place, which needs to be filled. This is where HA gel with large particles (800–1800 microns) comes to the rescue. Such gel has high viscosity and good ability to model tissues, which allows filling the spaces formed after subcision, providing a smoother and more even relief of the skin.

The study, conducted by a group of Brazilian doctors, involved 12 women with severe cellulite but without significant ptosis (sagging) of the skin. Before the procedure, 10 x 10 cm squares were marked on the problem areas (often the buttocks). An ultrasound determined a safe zone for the gel injection — subcutaneous fat tissue at a depth of about 8 mm. This eliminates the risk of damage to large vessels and nerve endings. Then, a subcision was performed with a special cannula (a thin needle with a blunted end) to rupture the septa within the square in five ray-like directions. 0.5 mL of HA gel was injected in each ray, totaling 2.5 mL for each quadrant corner. A total of 10 mL of gel was injected per buttock.

Following the procedure, a compression dressing was applied for two weeks. Antibiotics were prescribed to prevent infections. Patients experienced mild pain and redness for a few days after the procedure. 

The study's results were encouraging: most patients experienced a significant improvement in skin appearance and a reduction in the severity of cellulite. Side effects were minimal, mainly limited to minor bruises and short-term pain. Positive dynamics were maintained over a long period (up to 19 months of follow-up), and the patients were delighted with the results.

This new method combines the advantages of minimally invasive subcision and filling defects with HA. In the study, patients underwent a single procedure, which can be repeated after 15 days if necessary.

The method allows a pronounced cosmetic effect with minimal side effects. However, further studies on larger groups of patients are needed to confirm this method's long-term efficacy and safety.

Reference:

de Matos Lourenço L., Colla L.A., Ortiz de Noronha M.G. et al. Square technique-A treatment for cellulite with large size particle hyaluronic acid. Skin Health Dis 2023; 4(1): e290.