Surgeons give Cellfina a thumbs up

Canadian plastic surgeons who retrospectively evaluated 25 women who had tissue stabilized-guided subcision (Cellfina, Merz North America) to treat cellulite found Cellfina was safe and worked to manage grades 1 to 3 cellulite in patients’ thighs and buttocks.

Those findings, published August 2019 in the Aesthetic Surgery Journal,¹ help to confirm the device works in plastic surgery practice, according to a commentary by U.S. plastic surgeons in the same issue.²

Plastic surgeons’ experience is important because while Cellfina has been on the market for several years and studies suggest tissue stabilized-guided subcision is relatively safe and efficacious, the data has been limited to the dermatology literature, according to the commentary by Simeon Wall, Jr, M.D., assistant clinical professor of Plastic Surgery, Louisiana State University (LSU) Health Sciences Center at Shreveport and aesthetic surgery fellow Rachel Walker, M.D.

“In properly selected patients, [tissue stabilized-guided subcision] does work and may provide superior outcomes to imprecise and varied surgical subcision attempts,” the commentary authors write. “We have found this device to be of value in our practice not only in the hands of MD extenders but also in select operative cases, mainly improving contour deformities.”

While the new study is smaller, was shorter term and lacked standardized reporting compared to the pivotal Cellfina research by Kaminer et al.,^3,4 its results are worth discussion, according to the commentary. For example, the Canadian researchers’ 3-month patient satisfaction rates were higher than those from the pivotal research, which could be the result of better patient section, according to the commentary.

The ideal Cellfina candidate has stable weight with no or minimal skin laxity and true dimple-type cellulite, which usually occurs on the buttocks. While patients often think skin laxity is cellulite, providers treating these patients should know that treating skin laxity with Cellfina could make the skin laxity worse, the U.S. plastic surgeons write.

The Canadian and U.S. plastic surgeon authors note that using Cellfina to treat cellulite in areas like the gluteal/thigh crease, or banana roll, is risky because it increases the risk that the buttock will collapse from the increased skin laxity.

There are important structural differences between skin laxity and cellulite. Volume loss and aging result in skin laxity, while thick fibrous septae perpendicular to skin most likely cause cellulite, according to the commentary.

“In the [tissue stabilized-guided subcision] literature, providers are cautioned to avoid treatment of cellulite in the setting of laxity, large releases and treatment in the banana roll area due to concern for creating iatrogenic gluteal collapse,” the commentary authors write. “However, as plastic surgeons, we are uniquely positioned to treat these complex areas by surgically treating the gluteal collapse…. [Tissue stabilized-guided subcision] has proven to be a powerful tool for the plastic surgeon specifically because it can be used in a broader spectrum of patients.”

Dr. Wall writes that he was the first plastic surgeon to use the Cellfina device. He and his practice colleagues have found tissue stabilized-guided subcision is a safe, quick and effective intervention in appropriate patients, with best results when used as a stand-alone procedure for cellulite in the buttock.

References:

• Nikolis A, Enright KM, Sapra S, Khanna J. A Multicenter, Retrospective Evaluation of Tissue Stabilized-Guided Subcision in the Management of Cellulite. Aesthet Surg J. 2019 Jul 12;39(8):884-892. doi: 10.1093/asj/sjy274.

• Wall S, Walker R. Commentary on: A Multicenter, Retrospective Evaluation of Tissue Stabilized-Guided Subcision in the Management of Cellulite. Aesthet Surg J. 2019 Jul 12;39(8):893-897. doi: 10.1093/asj/sjz091.

• Kaminer MS, Coleman WP 3rd, Weiss RA, Robinson DM, Coleman WP 4th, Hornfeldt C. Multicenter pivotal study of vacuum-assisted precise tissue release for the treatment of cellulite. Dermatol Surg. 2015 Mar;41(3):336-47. doi: 10.1097/DSS.

• Kaminer MS, Coleman WP 3rd, Weiss RA, Robinson DM, Grossman J. A Multicenter Pivotal Study to Evaluate Tissue Stabilized-Guided Subcision Using the Cellfina Device for the Treatment of Cellulite With 3-Year Follow-Up. Dermatol Surg. 2017 Oct;43(10):1240-1248. doi: 10.1097/DSS.