Viscoelasticity increased from the baseline value of 0.61 MPa (0.32; 1.29) to 0.90 MPa (0.18; 1.69) after the treatment sessions, and up to 0.99 MPa (0.71; 1.59) at the follow-up. Again, the data scatter strongly and the statistical evaluation showed no significant change.

Effect sizes using Cohen’s d were estimated for the contour line, Young’s Modulus and viscoelasticity. Results are summarised in Table 1. Young’s Modulus and viscoelasticity showed a nearly average size and the contour line an average-to-strong treatment effect.

Discussion

This clinical evaluation was designed to evaluate the efficacy and safety of AWT in anti-cellulite treatment. Treatment success was measured using a variety of methods.

The circumference of the thighs decreased from 55.8 cm to 53.1 cm. As the BMI remained constant, this reduction is a clear sign of an effective treatment with AWT. According to the evaluation of the results with the CSS scale, four experts using photo-documentation and the aesthetic practitioner evaluating the patients, found a consistent and clear treatment effect. The DermaScan device enabled the measurement of two parameters: skin thickness, which remained constant over the entire treatment process, and the length of the contour line, which showed a rather strong treatment effect and decreased significantly.

The DermaLab measurement strongly delivered scattered data and a nearly average treatment effect. There is no statistical significance as the number of patients was too small. The spatial high resolution of the DermaScan enabled detection of changes in the sub-millimetre range (Figure 5). The AWT treatment changes the substructure at the interface between the dermis tissue and the adipose tissue. Figure 4 shows that, on average, the dermis–hypodermis contour length decreases as a result of treatment. The ‘smoothing’ of the dermis–hypodermis interface indicates an improvement towards a cellulite-free appearance.

Figure 6

A study by Adatto et al5 showed a reduction of the fat layer thickness and of the cellulite appearance. The circumference of both legs had been reduced from 60 cm to 58.2 cm at 12-week follow-up. Measurements with the ultrasound system demonstrate a significant decrease of the subcutaneous fat layer thickness with an average of 2 mm (22.2%) at 12-week follow-up. The minor and temporary side-effects confirm the safety of AWT. Only minimal side-effects, such as redness and swelling, were apparent in this study. The authors are currently working on follow-up studies.

Conclusions

Figure 7 Photographic documentation. (A) Patient is shown at the initial screening and (B) at the follow-up visit.

Figure 7 Photographic documentation. (A) Patient is shown at the initial screening and (B) at the follow-up visit.

Anti-cellulite treatment with AWT significantly alters the structure of the dermis–hypodermis interface. High resolution ultrasound and the DermaLab suction apparatus provide valuable information with regard to the condition of the skin, and can be used as objective measures to monitor the progress achieved with AWT. AWT and the applied measurement devices are safe to use and showed minimal side-effects in this study.