✚ Cellulite Risk factors:

• Smoking,

• Pregnancy,

• High Estrogen levels,

• Decreased blood flow

✚ Cellulite Types:

• Grade-I: is visible when skin in pinched, is cool;

• Grade-II: is visible when standing, but disappears when laying down.

• Grade-III: is visible with standing and laying both

• Grade-IV: is Nodular and linear, and always noticeable

• You can have different grades at different body parts

✚ Treatment that we offer are:

• Mesotherapy -which (improves by 1 grade )

• Caviation Ultrasound

• Vacum Rolling Radiofrequency- temporary reduction

• Microneedling with PRP / PRF (skin tightening)

✚ How many session of Mesotherapy do I need?

• It improves by 1 grade (exp: if you have Grade-3, it will become Grade-2),

• requires 10 treatment sessions once a week for best results, but initial result can be seen after 5 sessions.

• Then repeated again in 1 months; then every 3 months for maintenance.

• (We never inject below knees due to varicose veins; and Never if pregnant.

• Using 0.2ml per injection, in 1ml Syringe > will be enough for 5 injection.

• One arm or thigh gets 25 injection = 5ml total injection volume

• Both arms or thighs gets 50 injections = 10ml total injection volume.

✚ Medications used are:

• We use Phosphotidylcholine (PPC) stabilized in Deoxycholate (DCA), also knows as (PC/DC)

• Deoxycholic acid (conjugate base of deoxycholate), is the main ingredient of Kybella,

• Maximum dose per any treatment session, is 10ml per day or 50 injections.

• PC/DC can be mixed with 1% lidocaine to improve post injection discomfort (8ml+2ml mixture), but it reduces the effectivness of lipolysis or fat cell apoptosis.

✚ How do these medications break cellulite of fat cells.

• (PCDC), evolved from the initial intravenous use of to treat blood lipid disorders, containing phosphatidylcholine and bile salts, and later used to treat localized fat accumulation.

• Bile salts have been used to improve the aqueous solubility of phosphatidylcholine.

• Phosphatidylcholine is a glycerophospholipid extracted from soy bean lecithin. Chemically, it has 2 Fatty acids have and phosphoric choline attached to itself.

• PC in the body is the most important membrane lipid. It plays an important role in the biosynthesis of prostaglandins, leukotrienes, and thromboxanes, it is the major delivery form of choline which is a precursor in the synthesis of acetylcholine, it increases cholesterol solubility and inhibit plaque aggregation and plays a role in hepatic export of VLDL.

• In the subcutaneous tissue: The exact mechanism of PC action is not well understood yet. Several theories were mentioned in literature such as acting as an emulsifying/tenso active agent making lipids water soluble, may stimulate fat splitting lipases activity and release so that triglycerides are hydrolyzed into fatty acids and glycerol. Also, PC may act to stimulate β-receptors or inhibit α2-receptors, thus increasing lipolysis activity and accelerates fat elimination through the gastrointestinal and urinary System.

• Sodium deoxycholate is a bile salt that is also used as a laboratory detergent and is used to solubilize PC by forming mixed micelles composed of PC and DC [13].

• Deoxycholate seems to induce fat cell destruction in a non specific fashion due to its detergent action. Human fat injected with a compounded formulations (PC/DC) results acutely in vacuolization of adipocytes and in acute and chronic inflammation within the septae and lobules of the subcutaneous fat, the recruited inflammatory cells directly disrupt or indirectly destroy the adipocyte cell membranes via cytokine or lytic enzyme release resulting in fat necrosis eventually, the inflammatory response may abate with ingrowth of fibrocytes and collagen production.

✚ Which Medication is tolerated better?

• The occurrence of subcutaneous nodules was significantly higher in the DC group(70%) than in the PC/DC group (10%).

• The incidence of pain was significantly higher in the DC group (100%) than in PC/DC group (50%).

• Data based on Journal of Clinical & Experimental Dermatology Research, El Kamshoushy et al., J Clin Exp Dermatol Res 2012, 3:2, DOI: 10.4172/2155-9554.1000146

✚ Procedure Steps:

• Patient are recommended to Clean the skin with Hibiclins at home;

• We Numb the skin with BLT topical anesthetic x 30min at the office before injection, --After the injections use Arnica (gel or cream) 2-3 days TID;

• Avoid sun exposure during the 10 week course, and

• Avoid Ibuprofen type of Rx for pain during the course.

• For pain only TYLENOL is allowed, as it does not decrease the inflammation but is only a pain killer.

• You need the inflammation to treat cellulite.