Dermal fillers for Cellulite; At A Glance
- Best Results2-4 sessions
- Treatment Recovery1-2 weeks
- Procedure Time30 min
- Skin SpecialistDavin Lim, nurse injector
- Duration of Results2-5 years
- AnaestheticLocal, gas, sedation
- Back to Work1-4 days
Dermal Fillers for Cellulite
Dermal fillers are now mainstream treatment for cellulite. I deliver a class of fillers known as collagen stimulating fillers. These are different from the usual volumetric fillers such as hyaluronic acid. Collagen stimulating fillers strengthen the dermal layer, reducing out pocketing of adipose tissue or fat from the lower hypodermal layer.
FactsFacts on Dermal Fillers for Cellulite
- An important cause of cellulite is a weak dermal layer
- Extrusion forces in the layer below pushes fat upwards
- Herniation of fat pockets gives rise to visible waves of cellulite
- Collagen stimulating fillers reinforces the dermal layer
- Fillers include calcium hydroxylapatite & poly-L-lactic acid
- Fillers last 2-5 years, however their role is to increase your skin’s collagen production
- Fillers are best combined with radiofrequency devices & subcision
What is the cause of cellulite & how do I approach this problem?
3 main factors are implicated in cellulite.
- Prominent bands or septae that connect to the underside of the dermis. This gives depression & divots.
- Prominent pocket of adipose tissue or fat. These lobules are larger in females compared to males.
- Weakened dermal layer of skin. This allows herniation of fat pockets. This gives rise to the wavy & undulating cellulite.
By analytically addressing each factor, we can effectively target cellulite. Hence treatments include surgical release (bands & prominent pockets), RF stimulation of collagen & RF reduction of fat, and strengthening of the dermal layer (dermal filler).
How do dermal fillers treat cellulite?
Concept: dermal fillers strengthen the dermis by producing collagen. This is a different concept compared to hyaluronic acid fillers used primarily for volumetric correction of the face.
Strengthening of the dermis combats the high extrusion forces generated by the hypodermis. The hypodermis contains lobules of adipose tissue or fat. One of the main causes of cellulite is herniation of fat pockets, giving a wavy appearance to the area.
As it takes 2-6 months for your body’s immune system to produce collagen, results from dermal fillers will reflect this timeline.
I employ ways of collagen stimulation. Firstly, with fillers including poly-l-lactic acid, & calcium hydroxyapatite. Secondly with energy devices including radiofrequency & electromagnetic energy.
What types of cellulite respond best to dermal fillers & surgery?
Cellulite can be classed as localised (depressions and bandings), generalised (wavy areas) or mixed.
Localised cellulite with bands & discrete divots do best with dermal fillers & subcision.
Generalised cellulite characterised by wavy areas can also improve with dermal fillers combined with radiofrequency devices. This form of cellulite is harder to treat. Cellulite located on the inner thighs falls in this category.
What types of dermal fillers do I use?
I use collagen stimulating fillers, namely poly-L-Lactic acid as well as calcium hydroxylapatite. Both of these fillers are TGA approved with a very long safety record.
As a guide PLLA fillers last between 3 to 5 years, whilst calcium hydroxylapatite lasts 2+ years.
When will I notice the results?
2-4 months. Remember, the aim of collagen stimulating fillers is to stimulate your body’s immune system to produce collagen (as opposed to hyaluronic acid dermal fillers for volume correction).
Collagen stimulation is maximal at 6 months. This is compounded by the use of energy devices including radiofrequency or RF.
How long do dermal fillers last?
My preference is to use collagen stimulating fillers over hyaluronic acid fillers due to the longevity of the former. As a guide, collagen stimulating fillers will last between 2-5 years.
It is important to understand that these fillers are designed to stimulate collagen production, very different from hyaluronic acid fillers that are primarily designed for volumetric correction with secondary collagen stimulation.
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What are permanent solutions to fix cellulite?
To date, the longest studies & follow ups are just past the 5 -year mark. This applies to surgical procedures such as subcision. A realistic guide is as follows-
- Subcision: Probably permanent, or at least 3-5 years. More data to come.
- Dermal fillers: 2-5 years, however they do stimulate your own cells to produce collagen. How fast your body degrades collagen is part of your genetic make-up / DNA.
- RF/ Shock Wave/ Electromagnetic devices: work by thickening the dermis, reducing the effects of extrusion forces. How fast you degrade collagen varies from person to person. Possibly ‘top ups’ required annually.
Much like life itself, there are no permanent solutions to stop aging. However, effective treatments are available & the future looks bright.
Why combine dermal fillers with other treatments?
Cellulite is multifactorial. Dermal fillers support the junction between the lower dermal zone & the fat. Other factors that contribute to dimpling include fibrous bands & septae that pull the overlying skin down. Subcision can release these bands, in turn reducing the look of cellulite.
Devices including multipolar radiofrequency stimulates more collagen production & improves circulation, further improving cellulite. Suction devices deliver pulses, in turn improving lymphatic circulation. This can further decrease cellulite.
What are other injection methods to treat cellulite?
In 2021 the first FDA-sanctioned injectable treatment for cellulite was launched in the United States. The name is Qwo & is made up of two types of collagen-degrading enzymes that dissolve the fibrous bands (or fibrous septae) connecting skin to the deeper fat & muscle layer.
Septae are regarded as the root cause of cellulite, since they tug the skin down, causing surrounding fat to visibly bulge under the surface. These injections are non- invasive and consist of three rounds of injections, spaced 3 weeks apart. Studies have shown that results have lasted over 12 months (not great).
Patient selection is critical for optimal outcomes. Ideal candidates for the new treatment have distinct “tight” cellulite divots, directly caused by fibrous bands of connective tissue; the same type that responds well to subcision & dermal fillers.
Unsuitable patterns include generalized cellulite & laxity. It is important to note that this injection is not designed to treat laxity or sagging.
What is Cellfina & can it be combined with dermal fillers?
Cellfina is basically subcision for people who don’t know how to subcise. This treatment uses a vacuum to lift the underlying skin & fibrous bands closer to the surface. A knife is then used to cut the bands in 2 levels.
I prefer to manually subcise as I can feel the bands much better (much like acne scar subcision). I am more precise with my hands. I also combine dermal fillers with subcision in suitable cases.
Note: Patient selection is paramount – best results are seen with divots & depressions. Generalised cellulite, characterised by waves are poor candidates for subcision & or dermal fillers – injectables. This includes Qwo.
What is RF or radiofrequency & how does it help with cellulite?
As we age, our bodies produce less collagen by conversely stores more fat. As a guide we lose 1% of collagen per year after the age of 25. This leads to visible signs of ageing, including wrinkles, sagging, cellulite & fine lines.
Multi polar radiofrequency body contouring techniques employ handheld systems that emit RF & electromagnetic energy below the surface of the skin. This gently heats the under-surface, in turn shrinking fat deposits whilst boosting collagen production. These devices target 2 out of 3 causes of cellulite, namely providing support to the dermal-epidermal junction (collagen stimulation), & reducing adipocyte-fat volume. RF & electromagnetic energy can also improve lymphatic circulation.
The results? Smoothing of cellulite, with better elastic recoil, & improved skin tone.
Can devices work on their own to treat cellulite?
Here’s the truth about devices & cellulite. Radiofrequency devices including Venus Legacy, Velashape, Genius RFM, Profound RFM, Tempsure, NuEra & many others can give good results in about 20-30% of patients if used as a standalone modality. Generalised or wavy cellulite cases respond best to devices.
Devices should ideally be combined with dermal fillers & surgical techniques as this gives the best results.
How many sessions will I need?
1-4, depending on the extent of cellulite. For small areas you can expect a good outcome with one treatment.
For multiple sessions, I normally space the treatments between 6 to 12 weeks apart. The type of dermal filler I use takes several months before collagen stimulation is maximal- timing is important.
How long does it take to perform the procedure?
This depends on the complexity & extent of cellulite.
- Surgical procedures & dermal fillers take approximately 30 to 60 minutes to perform.
- RF devices take between 60 to 120 min to perform.
Is the procedure painful?
No. I mix the fillers with local anaesthetic. For large areas I typically give patients mild sedation or anesthetic gas.
How much does it cost?
As a guide (includes 2 sides, includes dermal fillers)-
Small area- $1900 to $2990
Medium area – $ 2900 – $4990
Large areas – $4990 to $7990
Cellulite treatment includes planning, photography, marking and post procedure care.
The costs are compounded with large volumes of dermal fillers (approximately 4-8 times the volume required for facial rejuvenation). Additionally we use the very latest technology & devices to ensure that you have the best possible results.
What are the potential side effects when treating cellulite?
As with any procedure, side effects can occur. An accurate breakdown to potential side effects are-
- Bruising, often up to 2 weeks. Seen in the majority of cases.
- Iron staining due to hemosiderin, seen in 10-15% of cases. May last 6+ months.
- Lumps & nodules, seen in 5% of cases. May last 3-7 months.
- Persistent lumps, seen in less than 2% of cases.
- Transient numbness (common)
- Persistent cases of numbness (rare, less than 3% of cases)
- Partial response
- No response (rare)
- infection – very rare.
Davin’s Viewpoint on dermal fillers for cellulite
In the past 3 years we have understood the anatomical & histological features of cellulite. We have an understanding of the different patterns of this condition, & in the majority of cases we can improve the appearance of cellulite.
Dermal fillers play an important role in strengthening the dermal-hypodermal junction. This layer of skin is where the herniated pockets of fat push upwards with powerful extrusion forces. Todate, there are only two effective methods to strengthen this area, firstly with dermal fillers. Fillers stimulate type 1 & 3 collagen. This acts as scaffolding to this layer. Secondly, with RF devices. These work by stimulation of innate collagen, hence why it is essential to combine fillers with devices.
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