Brief Experience in the Use of Combined Technologies
in the Treatment of Body Imperfections
Dr. Patrizia Giardino 1, Andrea Pelosi 2
1) Specialist in Reconstructive Plastic Surgery, European Dermatological Institute, Milan - Italy
2) Physiotherapist, Milan - Italy
Introduction Districtual or localised fat deposits, with
their typical “trochanter cushion” or
Over the last decade in the medical and “saddle bag” appearance, consist of
aesthetics sector there has been a gradual an increased accumulation of fat in the
increase in the demand by patients for regions where adipose depots are normally
non-invasive methods for treating skin present. In females these deposits,
imperfections in general, and in particular, prevalently found on the sides of the hips,
for treating “cellulite” or “F.E.P.”, areas of buttocks, thighs and medial face of the
localised fat and skin flabbiness. knee, can be considered as a secondary
sexual characteristic since influenced by
F.E.P. or Fibrosclerotic Edematous the female sex hormones. The adipocytes
Panniculopathy is the term used to identify in these areas are in fact very rich in
modifications in the subcutaneous adipose oestrogen receptors, hormones which
panniculum mainly of an aesthetic nature, exert an action favouring the accumulation
found prevalently, although not exclusively of fat inside these cells. This “hormone-
in females and located electively in the dependency” may therefore explain the
trochanter and superolateral areas of scarce effectiveness that nutritional diets
the thighs, inner parts of the knees and have in these areas.
Skin flabbiness is caused by the relaxation
It is evidence of a condition of suffering of the dermal-epidermal tissues and
in the fat cells due to haematic stasis subcutaneous layer that may derive from
followed by oedema, degeneration of two main factors:
the fundamental interstitial substances a) hypotrophy of the underlying muscular
and collagen fibres, fragmentation of the mass, meaning that the surface tissues
elastic fibres, an increase in the number lack their normal support;
(hyperplasia) and thickness (hypertrophy) b) a reduction in the elastic-collagen
of the reticular fibres, finally resulting in component of the derma or the supporting
sclerosis. In broad terms we are faced fatty tissue.
with a chronic degenerative process of the In the latter case, which may involve all body
derma-hyperdermic structures. areas including the face, with multifactorial
etiopathogenesis (aging, photoaging, and
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dietary imbalances), helping to restore the skin’s normal
the correct therapeutic proposal requires collagen-elastic tension.
surgical dermolipectomy /lifting in the more
severe cases, while in milder or moderate The two TriActive+ radiofrequency
cases, a mini-invasive or non-invasive handpieces exploit a multipolar technology
treatment is recommended in order to to treat imperfections caused by cellulite
stimulate the production of neocollagen and skin flabbiness (body and face), that
and extracellular matrix. implements a special electrical current
(extremely safe for the body) to induce a
molecular oscillation on the dermal and fat
Materials cells with a localised rise in temperature.
The radiofrequency therefore gives rise
Over a 6 month period we experimented to contraction of the collagen fibres (by
with the use of a new medical device, breaking the weak bonds inside the
the TriActive+, for the treatment of the molecules themselves) with subsequent
conditions described above. stimulation of the fibroblasts and
The TriActive+ is a platform that exploits neocollagenogenesis and reactivation of
six different handpieces (with Laser, the microcirculation.
Ultrasound and Radiofrequency), designed
to treat widespread lipodystrophy, localised Ultrasounds are mechanical sound waves
fat deposits and skin flabbiness. produced by special handpieces which,
on passing through the skin cause the
The synergic action of the six handpieces adipocytes to vibrate and exert a mechanical
allows for treating body imperfections in massage.
order to achieve: The special sound waves generated by
the platform act selectively on the cellulite
• toned, elastic skin; via specific mobilisation of the tissues
• harmonious remodelling of the body that partially ruptures the adipocyte
contours; membranes, releasing their triglyceridic
• a reduction in the oedema and painful content (eliminated via natural physiological
symptoms caused by venous-lymphatic pathways), and reducing compression
insufficiency of the lower limbs. on the blood vessels with subsequent
drainage of the oedema.
The laser handpiece, which combines three The ultrasounds produce a more effective
different synergic actions (laser stimulation, action on reducing the “mattress”
localised cooling and dermal massage), appearance, especially in more advanced
is characterised by an instrumental and stages of cellulite.
methodical approach to cellulite aimed at
restoring the skin’s normal homeostatic
The deep laser stimulation reactivates
the arterial, venous and lymphatic micro- A total of 22 patients were recruited for
circulations; the localised cooling reduces this trial with an average age of 45 years,
the effect and reabsorption of the oedema; suffering from:
the dermal massage mobilises the tissues,
• Cellulite trophism.
• Districtual adiposity (D.A.) The circumference of the area to be treated
• Moderately overweight was measured and the skin-fold technique
• Venous-lymphatic stasis applied.
• Fluid retention
• Flabby Skin Based on the assessment made, the
• Post-op oedema after laser lipolysis or indications were established for proceeding
liposuction surgery in a combination with the Triactive+ treatment and the type
of 2 or more of the indications listed of methods and protocols to be followed
above. were decided.
An accurate anamnesis was obtained Patients with skin pathologies, infectious
for identifying any previous or current diseases, phleblitis-thrombophlebitis-
pathologies, pharmacological therapies, phleobthrombosis, neoplasias, heart
risk factors, causes and concomitant and vascular failure, diabetes, renal
causes (hormonal imbalances, metabolic and hepatic impairment or dysfunction
alterations, pregnancies, diet, use and abuse were excluded, as well as patients with
of alcohol, smoking etc.) in the subject’s pacemakers and/or metal prostheses,
history that could be responsible for the transplants, osteoporosis, pregnant and
onset of blood and lymphatic circulation nursing mothers, patients under the age of
deficiencies, cellulite, fluid retention, 18 and those with anticoagulant therapies
obesity, etc. During this phase, detailed in progress (possibility of persistent
information was also collected in relation erythema).
to the symptomatology, motivations and In slightly-to-moderately overweight
goals that induced the subject to contact a patients, the treatments were associated
medical or aesthetics centre. with a sensible diet and moderate physical
A careful examination was also carried
out of the subject’s general physical Cycles consisting of a minimum of 3 to a
conditions: morphotype (gynoid or android), maximum of 8 sessions were carried out, each
overweight or obesity conditions, signs of lasting from 30 to 60 minutes (depending of the
venous insufficiency in the lower limbs, size of the area to be treated) with a frequency
identification of any asymmetries between of 1 session a week.
the body segments, and alterations in At the end of the cycle, 6 of the patients
posture, with photographic documentation treated continued the maintenance
of the body segments to be treated. sessions with a frequency of 1 session
every 15 days.
Information was also obtained regarding Two patients who began the cycle of
the texture and moisture content of the sessions for treating facial skin flabbiness
skin (presence or absence of oedema and had to discontinue for personal reasons
its characteristics), pain on palpation in the which were in no way related to the
areas most typically affected by cellulite treatment itself.
(inner thigh, front and external thigh areas), Four patients underwent a cycle of sessions
in order to provide a “staging” of it, and with Triactive+ (Laser + RF) within the
also in relation to skin and muscle tone and context of post-op treatment after laser
lipolysis, and as an aid to improving skin Face
tightening. It was possible to commence
the session one week after treatment
with the laser component for the first 3/4 Arms
sessions (thanks to the significant draining
component of the laser and its gentleness
in treating the tissues), followed by two or
more Laser+ RF sessions. Abdomen
After liposuction of the abdomen,
one patient who still showed signs of Graph 3: Body areas treated
oedema and persistent “induratio” of the
abdominal tissues after 2 months, had a
rapid resolution of the problem after only 3 Results
sessions of Laser + RF.
The patients underwent reassessment
Following are graphs illustrating the details of the treatment after 3-4 sessions,
of the treatment methods in the patients. during which it was decided if and how
Overweight Post-op Edema many sessions were still necessary for
Heavy-Leg Syndrome completing the treatment. Finally, the last
assessment was carried out at the end
Venous-Leg Syndrome of the scheduled sessions, during which
Flabby Skin control photographs and centimetric
measurements were taken, the skin-
Distrectual fold technique applied, and the texture,
Adiposity (D.A.) aesthetic aspect and painfulness of the
tissues reassessed. Moreover, patients
Cellulite 1-3 were invited to express their overall opinion
of the treatment according to a scale from
Graph 1: Pathologies treated
0 to 4 (results: 0-none, 1-poor, 2-average,
US + Laser
In photographic terms, an improvement
in the skin tissue quality, including a
reduction in cellulite imperfections and
US + Laser + RF Laser + RF
skin revitalisation (rosier skin colour due to
enhanced microcirculation) and remodelling
of the body contours, as observed in 90%
Graph 2: Combined use of the sources
Figure 1: Thermographs before and
The centimetric measurements of the there was an overall revitalisation of the
circumference of the lower limbs taken at tissues which enhanced the microcirculation
the level of the root of the thighs and knee (80%) and a slight improvement in skin
show a 0.5-cm to 3-cm reduction. flabbiness (20%). However there were
no follow-up assessments of the patients
In the treatment of the lower limbs it was treated capable of revealing the initial
possible to visually observe a significant effects of shrinkage of the collagen fibres
improvement in fluid retention, restoration by the RF or of the fibroblast stimulation
of tone and elasticity to the tissues treated, for neocollagen storage, a process that
a remodelling of the body contours, a usually takes about 6 months to be carried
reduction in the orange-peel aspect where out correctly.
present, and an overall revitalisation
of the tissues which enhanced the In patients who underwent laser lipolysis
microcirculation. or liposuction surgery, in whom treatments
with Triactive+ were applied for the
80% purpose of reducing post-op recovery times
(regression of the oedema, “sponginess”
and hardening of the tissues on palpation,
improvement of the ecchymosis), a more
rapid stabilising of the results of the surgery
50% was observed in approximately 50% more
cases than patients who not receiving
these treatments after surgery.
From an analysis of the questionnaire filled
out by the patients, it is evident that 77%
10% of patients judged the results as good while
the remaining 22% judged the results as
excellent, as confirmed in the following graph.
Toning & Elasticity
of the skin
Graph 4: Improvement observed 60%
100% of patients who complained of pain
and heaviness of the lower limbs at the end 40%
of the day (heavy-leg syndrome) before
receiving treatment, showed an 80 to 90% 30%
improvement in the symptoms. 20%
In the treatment of abdomen and thighs, 10%
an improvement in tone and elasticity of the
Excellent Good Medium Poor None
treated tissues (75%) was observed as well as
good remodelling of the body contours (70%). Graph 5: Assessment of patients depending
In the treatment of upper arms and face, on the result
Tolerance of the treatment was excellent
and no patients were forced to interrupt or
discontinue the sessions due to the onset
of pain or side effects.
The only side effect observed was the
appearance of mild ecchymosis after
use of the ultrasounds that cleared up
spontaneously within 5-6 days. There
were no reports of persistent erythema or
burning of the treated tissues.
Figure 2: Distrectual adiposity
In our opinion it was interesting to observe
that in some cases the expected results
were obtained after only 3-4 sessions,
while in more difficult cases an additional
3-4 sessions were sufficient for completing
the treatment with both operator and
patient satisfaction. Therefore, with cycles
of only 1 session a week for a maximum
of 8 sessions, it is possible to observe
considerable visual and symptomatological
improvements in the problems treated,
with hardly any side effects.
Moreover, the possibility of combining
Figure 3: 3rd stage cellulite
different methods and different protocols
in the same session depending on the
elective requirements and problems in the
individual patient is the most significant
factor of the Triactive+ that makes it
possible to obtain good and rapid results
in the treatment of skin imperfections that
are usually hard to resolve.
Patient compliance is also excellent since
Triactive+ is well tolerated and the initial
benefits in terms of visible results can already
be appreciated after the first 2 to 3 sessions.
Figure 4: Districtual adiposity
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