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Tissue Stabilized-Guided Subcision: A milestone for long-lasting cellulite treatment

Tissue Stabilized-Guided Subcision: A milestone for long-lasting cellulite treatment

Written on 8th November 2019
by Dr. Markus Klöppel


Klöppel Markus

Plastic Surgeon



Advantages of the innovative method and how it has developed

Experts estimate that up to 85 percent of women worldwide have cellulite – whether they are 25 or 60 years old. The skin manifestations referred to by those affected as troublesome dimples on the buttocks and thighs are not only annoying and unattractive, they can often also be painful, even if it’s more of a cosmetic problem.

But where does cellulite actually come from?

When we talk about cellulite in the conventional sense of the word, then for patients it often means a whole variety of unpleasant appearances on the buttocks and legs all brought under the banner of the term ‘cellulite’.

Whereas cellulite in the medical sense of the word refers only to the dimple-like, round or irregular indentations or depressions on the skin’s surface – and these occur very frequently, especially on the buttocks and thighs. However, they can also occur on the stomach and arms.

For a long time, a type of “clumping” or grape-like adherence of fat compartments was held responsible for these dimple-like indentations or depressions. However, pivotal, in-depth research conducted by Dr. Doris Hexsel shows that fibrous septae are responsible for these typical cellulite dimples. These septae extend from the epidermis through the subcutaneous fatty tissue and connect to the connective tissue fascias. The reason why it is mainly women who are affected by cellulite is in the course of these fibrous septae that in women run vertically between skin and deep fascia. Estrogen makes them shorten and thicken and they pull the skin into the deep subcutaneous fatty tissue, causing the visible dimples on the skin’s surface. In men, these connective tissue fibrous septae run diagonally and have a criss-cross structure. This diagonal course and the fact that men have lower levels of estrogen mean that it is technically not possible for them to develop dimple-like formations. On a practical level, the development of cellulite dimples can be compared with how the buttons of a Chesterfield sofa function. These buttons have threads that pull the leather cover inwards into the upholstery.

If we start from this assumption that cellulite is caused by connective tissue fibrous septae and their contraction, then it soon becomes clear that providing mere surface treatment or liposuction, neither of which treat the direct cause of these fibrous septae, can in the short-term only demonstrate unreliable or temporary success.

Previous treatment methods against cellulite

Cosmetics companies have been constantly developing new methods to treat cellulite for decades. Unfortunately, they have only met with moderate success, which also explains the new treatment approaches constantly being implemented. Most women start tackling the dimples on thighs, buttocks and stomach with specially developed creams, lymphatic drainage, contrast showers and brush massage or sea salt baths. Those who place themselves in the hands of specialists can experience more advanced treatments.

Tissue Stabilized-Guided Subcision as the latest technique against cellulite

“Tissue Stabilized-Guided Subcision”, TS-GS for short, is not only a revolutionary treatment technique. A world-leading aesthetics company has now adapted this technology for the long-term and sustainable treatment of cellulite. It is the only minimally invasive treatment concept CE-certified in Europe and FDA-approved in the USA that, as a clinically tested treatment method, has a direct effect on the primary cause of cellulite with visible results that last for three years and longer. This is so far unique, because other methods have, to date, not achieved the same impressive result or been as effective for the same length of time. Dr. Markus Klöppel – Specialist in Plastic and Aesthetic Surgery – and his team were the first practice in Germany to offer this treatment method in 2016 and they have been successfully carrying out this treatment in numerous patients to this day.

Only one single treatment with TS-GS technology for beautiful, smooth skin!

The treatment is carried out as an outpatient procedure and only one dose of local anesthetic is needed. As already indicated, the procedure primarily tackles the structural cause of cellulite. Fibrous connective tissue septae and fibers are assumed to be the cause of cellulite. These changes in the subcutaneous fatty tissue develop, among other things, as a result of hormonal fluctuations (menstruation cycle, menopause).

The full course of treatment includes, to begin with, a detailed medical consultation, including physical examination of the patient. Identifying cellulite dimples that are actually genuine is especially important for the course of treatment and the patient’s subsequent satisfaction. This is because only those will be successfully treated for the long-term with this subcision technology. Skin laxity following fluctuations in weight, striae in the dermis resulting from connective tissue giving way or unevenness in the skin’s surface as a result of previous liposuction, for example, cannot be treated with TS-GS.

Following detailed recording of medical history and conversations, the patient is marked in a standing position, which means that each individual cellulite dimple is marked.

The second step involves the patient being laid on the treatment couch initially in the prone position, later in the supine position. They are awake during this process and do not have to be fasting. The area to be treated is disinfected and then anesthetized. The skin is sucked in or lifted with a vacuum chamber, like the one used in the actual treatment, and infiltrated with local anesthetic with a special perforated cannula.

Once all the treatment areas have been anesthetized, the actual treatment can now begin for the patient without them feeling any pain. The skin is lifted in the same vacuum chamber with suction. A small oscillating blade inserted laterally can now be used to undermine each individual dimple in their precise location and at their precise tissue depth, carrying out a precise subcision of each individual cellulite dimple. This helps the skin in the affected areas to relax and recover its original smooth appearance.

Treatment over a small area of 10-20 dimples lasts approx. 30 minutes, treatments over a medium-sized area of approx. 40-60 dimples last approx. 1 hour and treatment for 80 or more dimples can sometimes last 90 minutes. The patient is awake at all times and only experiences the tumescence infiltration as slightly unpleasant. However, the rest of the procedure is pain-free for the patient.

Once the treatment is completed, the patient is given light sport leggings fitted with inner absorbent pads, as the small perforations in the skin can make the tumescence solution flow back within the subsequent 1-2 hours. These close up after about half a day and the patient can pursue sports activities after 3-4 days. It is possible for the patient to do office work and carry out their general daily routine the next day without any restrictions.

What are the risks and side effects of treatment with TS-GS?

Typical side effects and risks, as are usual with such treatments, are redness, bruises or feelings of tightness and temporary mild tenderness. They usually disappear a few days after the treatment.

Summary for cellulite treatment with TS-GS

Just one single treatment lasting approx. 60 minutes results in significant and lasting improvement in the appearance of the skin. The result is so convincing that 93 percent of the subjects of the clinical studies were still happy after 3 years.