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Tissue stabilized guided subcision: new technique for combatting orange peel skin

Tissue stabilized guided subcision: new technique for combatting orange peel skin

Written on 5th June 2018
by Dr. Stefania De Fazio


De Fazio Stefania

Plastic Surgeon




By Doctor Stefania de Fazio, Plastic, Reconstructive and Aesthetic Surgeon

The tissue stabilized guided subcision method revolutionises the long-term treatment of orange peel skin, one of the most hated cellulite symptoms in women.

The term cellulite commonly refers to all those blemishes ranging from orange peel skin to water retention which does not necessarily have to be accompanied by the accumulation of adipose tissue typically located in areas such as hips, buttocks or thighs. Scientifically speaking, cellulite is the inflammation of the adipose and connective tissue that evolves and then develops with all the consequent symptoms.

Cellulite, explains Dr. De Fazio, is the blemish that is most widespread among women. Every woman suffers from it sooner or later: in fact, statistics show that more than 1.4 billion women all over the world are affected by the disease and none are completely immune.

Its origins are multifactorial and can be traced back to genetic, hormonal and vascular factors, unbalanced diet, damage from tight clothing or living a sedentary lifestyle.

Women suffering from cellulite, says Dr. De Fazio, are strongly affected in their daily life: they feel vulnerable, different from others and certainly feel less attractive; they develop certain forms of behaviour through which, among others, they aim to hide the affected areas of their body with clothing.

As a consequence, there are also many social and sporting limitations: on the beach they stay covered up and are too shy to play games and sports on the beach if the affected areas are not properly covered; they never wear skimpy skirts in the gym and even if they love to swim, they feel they can no longer do so. The cause?  That embarrassment born from the physical confrontation with the rest of the world, both male and female; in the eyes of those suffering from cellulite, the latter will always appear better than them and look perfect.

“Nothing is worse,” says De Fazio. “Decades of confrontation with women and being a woman too, with the same problems and fragility, make me firmly reiterate that no woman in the world thinks that they are perfect, except for some moments in life that I dare to call rare and magical; the grass always seems greener on the other side.”

But why does cellulite form?
Cellulite, continues Dr. De Fazio, is caused by many different factors: genetic, hormonal, vascular, poor eating habits, clothing that is too tight, a sedentary lifestyle. In its initial phase, it is caused by a vascular defect in the adipose cells contained in the subcutaneous layer of the hypodermis, which is located between the skin and the muscle layer; it develops over time and can be classified into various stages, ranging from a lipoedema (in which the predominant issue is liquid retention) to lipodystrophy (in which damage to the connective tissue is associated with the localisation of accumulations of adipose and vascular tissue).

As the condition advances, and in the more advanced stages, we will then see lipodystrophy, that is to say localised occurrence of sclerotisation: a thickening of the tissues with a loss in the elasticity of the subcutaneous fibrous septae (the scaffolding that supports the fat cells) which traps the blood vessels inside and compresses the natural lymphatic drainage pathways, among others.

This is what causes the “orange-peel appearance” and it will only worsen with evolution of the disease.

There are many treatments for combating cellulite that can be considered more or less invasive depending on the type.

Examples are:

  • Lymphatic drainage massage or mechanical pressure therapy: which acts on the lymphatic stasis and the lymphatic circulation to remove swelling or localised oedema: the results are effective only if the disease is an initial stage and where lymphatic oedema is the predominant problem, but the effects obtained are temporary.
  • Mesotherapy with homeopathic or allopathic substances, injections of deoxycholic acid (local injections of substances aimed at emptying the adipose cell or destroying adipose tissue), cavitation, application of external medical equipment: the results are sometimes risky and are not always stable or predictable: either because there is no damage to the fat cells which therefore only temporarily empty the fat they contain and at the end of the therapy will then tend to reacquire the initial volume over time, or where instead the adipose tissue is destroyed but this is not accompanied by the disposal of any external fat. The fat must, therefore, be eliminated by reabsorption from the lymphatic and vascular circulation, which will lead to a very high increase in the level of triglycerides in the blood.
  • Surface liposculpture, liposuction, lipolaser: these are all aesthetic plastic surgery techniques, suitable for the elimination of localised adiposity through an aspiration system and the use of small cannulas. These are methodologies whose results are mostly definitive: the adipose tissue multiplies in the number of cells more or less until adolescence, then it no longer grows except in cases of hypertrophy: that is, the number of cells no longer multiplies and remains stable but those present will fill up to their maximum volume. Such interventions change the conformation of the body, modelling it and reducing local accumulations, making the silhouette more harmonic. It should be emphasised that these interventions will not prevent the patient from gaining weight, but if this occurs, it will be different from that prior to surgery, mainly in the areas where the fatty deposits form, but fat will be distributed about the body in a more uniform and harmonious manner.

Liposculpture will improve the orange peel effect a little, thanks to the reduction of the tension exerted by the subcutaneous fat on the supporting structures but without completely eliminating the so-called “dimples” of cellulite.

What should we do to eliminate these unsightly “dimples”?
With the aim of working directly on these blemishes and completing the surgical procedure, a new technological device has been developed that acts directly on the real cause: the thickened fibrous septae which cause local skin retraction.
Recently, we have been able to use a new treatment, known as tissue stabilized guided subcision, approved by the FDA as the first and only medical protocol for the long-term treatment of these effects caused by cellulite: a tissue stabilized guided subcision protocol makes it possible to sever the fibrous septae, one by one and in a precise and controlled manner.
Similar to the way in which an upholsterer cuts those threads that hold the buttons that “sink” the fabric of an armchair.

Who is the ideal patient for the tissue stabilized guided subcision procedure?
Before performing the tissue stabilized guided subcision procedure, it is essential that an expert doctor submits the patient to an accurate pre-operative check-up to assess the clinical condition and technical suitability of the patient: not all women are ideal patients for the tissue stabilized guided subcision procedure.
For this reason, indications and contraindications to this treatment are provided.
The tissue stabilized guided subcision procedure is not recommended in patients with:

  • Diabetes
  • Obesity
  • Coagulation problems
  • Pregnancy
  • Tumours
  • Varicose veins in the area to be treated

The ideal patient, explains Dr. de Fazio, must:

  • Be healthy
  • Be able to maintain a stable weight
  • Present moderate or severe cellulite

How tissue stabilized guided subcision treatment works

Before explaining surgical treatment using tissue stabilized guided subcision, it should be specified that it is carried out in full compliance with standards of hygiene and sterility, and single-use materials are used for all those parts where direct contact between the instrumentation and the cutaneous and subcutaneous tissue of the patient may occur during the procedure.

On average, tissue stabilized guided subcision treatment lasts roughly one hour, regardless of the number and size of the areas to be treated.

The patient, standing, is observed by the operator holding a light vertically in order to better highlight the blemishes present; pre-treatment photographs are taken and then the areas to be treated are marked with a special dermatological marker.

The patient is then laid down on a surgical bed and the areas to be treated are carefully disinfected, establishing a sterile area.
The initial step is to administer local anaesthesia to the first area to be treated, by positioning a special handpiece on the corresponding skin area.
There will, therefore, be two handpieces used: the first for administration of the local anaesthesia and the second containing a micro-blade that will sever the fibrous septae; both handpieces are connected to a suction system that creates a vacuum, which allows the underlying tissues to be lifted in order to maintain a stable and uniform surface for working on the tissue.

Once the local anaesthesia has been administered, the handpiece will be replaced with the second one and the micro-blade will proceed with severing of the fibrous septae and consequent elimination of skin retraction, therefore obtaining the desired smooth and harmonious appearance of the skin.
The tissue stabilized guided subcision treatment is a minimally invasive treatment and can be performed on an outpatient basis, but must comply with all parameters of sterility parameters, be carried out in a suitable environment and with all equipment adequate for the purpose.

After tissue stabilized guided subcision treatment, what to expect?
During the consultation phase and first visit, the operator will have provided the patient with clear and specific indications on the treatment to be carried out and on the obtainable results, also showing before and after photos that give a concrete demonstration of what can be obtained with the method; however, it is important to remember that each case is specific to itself.
Furthermore, notes Dr. De Fazio, in order for the patient to visualise the actual change that will take place gradually over the following months, it is crucial to produce an accurate photographic record before and after treatment to be viewed under the guidance of your doctor during the recovery period.
In the post-treatment period, turgor underlying the treated skin area and bruising or ecchymosis may be seen.

It is possible that in the 24 hours following treatment the very small incisions may have produced a reddish fluid.

Why is that? The local anaesthesia used is a cocktail of a physiological and anaesthetic solution: it is often administered in a considerable quantity in order to create fully hydrated local tissues and then allow the micro-blade to slide in more easily due to the additional liquid.

These liquids, mixed with a very small amount of blood, give rise to that rosy fluid which, under compression, can be expelled from the micro-incisions in the skin in the immediate post-therapy hours.

It is therefore important to apply dressings locally with a sufficient absorbent layer of gauzes in order to control leakage of the liquid and avoid stains and unwanted damage to objects.

Immediately after and in the days following the procedure, it would be advisable to apply local compression in order to facilitate the escape of fluids and contain inflammatory oedemas: this can be done by wearing a cincher or elastic tights.

In order to obtain the best results, the diligence of patients will be decisive in carefully following all the post-surgery indications given by the doctor.

The results are long-lasting and tissue stabilized guided subcision treatment is the only certified treatment for effects that last 3 years. However, it should be borne in mind  that this assessment was made by the Food and Drug Administration (FDA), the US body that supervises the safety of foodstuffs and medical devices, and was based on studies lasting a maximum of 3 years.
“If we assume that the metabolism of a scar lasts on average one year, I can calmly and personally claim that if after three years the correction is stable, cicatrisation will be settled and the results achieved will last forever, taking into account the natural processes of skin aging that time will have on those same anatomical areas.”

Where to perform the tissue stabilized guided subcision treatment?

Although tissue stabilized guided subcision treatment appears simple and able to be performed on an outpatient basis without the need for hospitalisation, this does not exempt the doctor from strict observance of all regulations to protect the health and safety of the patient. The equipment is unique: there are no alternatives to it. Only doctors who have undergone specific and adequate training can perform tissue stabilized guided subcision treatment.

Therefore, recommends Dr. De Fazio, it is important to apply exclusively to authorised medical centres and competent specialists who understand this method in order to avoid risks in terms of quality of results, effectiveness of technique and patient safety.

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