Cellulite - dr-ruemmelein

ACUSTIC WAVE THERAPY ONCELLULITEA method for keeping women‘s backsides looking better

Talking to you as a user

Curriculum vitae Born 1964 in Hamburg Education as Medical Specialist in dermatology and allergology at theUniversity of Hamburg from 1982 to 1993 Private practice for dermatology with an emphasis on cosmetology andlaser medicine in Kronberg near Frankfurt from 1998 to 2008 Since 2006 dermatological laser department at the University HospitalZürich 2007 to 2009 joint practice and cooperation with Dr. Christ and Dr.Steiger, Plastic Surgery Zurich Since October 2008 dermatology practice Zurich with an emphasis onaesthetic dermatology Married with four children

My patient is a customer Due to the Zurich accreditation memorial I have onlyself-pay patients This leads to a service oriented approach!

My personal experience with cellulitetreatments8 years Endermology2002 upgrade to Keymodule2008 sale of the device with the sale of the practice2008 Thermalipo RF-therapieSince January 2009 Cellactor SC1 by Storz (AWT)

What do my patients want from me? Time Professionality Answers to their questions

TALKING ABOUT CELLULITE -WHO ARE OUR CUSTOMERS?100% of the females could be patients of thepractice.

Who suffers from cellulite? 80% of all women have cellulite. The other 20% believe that have it. That means 100% potential patients.

... even she suffers from cellulite?

What`s the difference between man and woman? Special skin structure: standing fat cell chambers, vertical septa, fat cells canpush up Women: 40 billion fat cells – Men: 30 billion→ energy reserve during pregnancies Influenced by hormonal variations Weak connective tissue in many womenSubcutaneous fatlayerMale skinFemale skinSTORZ MEDICAL AG; 2007

The vicious circle of celluliteIf the fat cells enlargeThe pressure in the tissue increasesThis results in a reduction of the adipolysisCellulite increasesIf this continues, edema and local inflammation result.

Orange peel skin – Mattress phenomenonSTORZ MEDICAL AG; 2007

Limiting FactorsIn order of importance: Money Patience and consistency Time

WHAT SHOULD I EXPECT FROMTHE TREATMENT METHOD?1. The costs must be in relation to the results forthe patient2. The assistant must enjoy performing thetreatments

AWT has its origin in shock waves Shock waves in the nature Man made Shock waves

PhysicsContinuous acoustic wavelike UltrasoundAcoustic pulse wavelike Shock wave• High amplitude at the beginning• Very fast increase of pressure• Short asymmetric pulse

Energy release at accustic borders1 cm

PhysicsMaximal penetration depth and different intensity distribution30mm 55mm 125mmAWTRadialPlanarFocused

Biological effectsEnergy release at acoustic boundariesIncrease of cell wall permeability

Increase of cell wall permeabilityMolecular transfer trough cell membraneOhl et al, Biochemica et Biophysica Acta (2003) 131-138

Published Clinical TrialsCellulite: DermaSelectW.Siems, T.Grune, P.Voss, R. Brenke, “Anti-fibrosclerotic effects ofshock wave therapy in lipedema and cellulite”, BioFactors 24 (2005)275–282

Biological effectsMechanotransduction = transformation ofmechanic stimuli into biochemical signalsEnergy release at acoustic boundariesIncrease of cell wall permeabilityStimulation of Microcirculation (Blood, Lymph)Release of Substance PRelease of Nitrous oxide with increased cellmetabolism, increasedcirculation, neoangiogenesis

Release of Nitrous oxideMariotto et al, Nitric Oxide (2005) 89-960.03mJ/mm² increased cell metabolism anti-inflammatory effect vasodilation neoangiogenesis (VGEF)

Release of Nitrous oxideNeoangiogenesis (VGEF)0.09mJ/mm²Oi, Shimokawa et al, Tohuku J.Exp.Med. (2008) 151-158

Biological effectsEnergy release at acoustic boundariesIncrease of cell wall permeabilityStimulation of Microcirculation (Blood, Lymph)Release of Substance PRelease of Nitrous oxide (vasodilation, increased cell metabolism,neoangogenesis, anti-inflammatory effect)Antibacterial effectStimulation of Growth factors

Stimulation of Growth factorsNeogenesis of boneSchatz, Orthopädie (2002)

Biological effectsEnergy release at acoustic boundariesIncrease of cell wall permeabilityStimulation of Microcirculation (Blood, Lymph)Release of Substance PRelease of Nitrous oxide (vasodilation, increased cell metabolism,neoangiogenesis, anti-inflammatory effect)Antibacterial effectStimulation of Growth factors (neogenesis of vessels, bone, collagen)Stimulation of Stem cells

Stimulation of Stem cells Cell proliferation Cell migrationNeuland et al, ISMST Newsletter (2008)

Stimulation of Stem cellsSchaden, Journal of Surgical Research (2007) 1–12

Stimulation of woundhealing01.09.2009 08.09.2009

Resulting Treatment effectsShort termed increase in blood flow due to massage andvasodilationLong term increase in blood flow due to angioneogensisLymph drainage effect, removal of water and wasteproductsMechanical and biochemical lipolysisSoftening of fibrotic structures (scar tissue, septi)Strengthening of connective tissue (colagenoneogenesis)resulting in increased skin elasticity and firmnessCell regeneration process (Cell rejuvenation)

Published Clinical TrialsCellactor: Cellulite/Tissue tighteningC.Christ, R.Brenke, G.Sattler, S.Gabriel, W.Siems, A.Daser, “Steigerungder Hautelastizität und Revitalisierung der Dermis bei Cellulite undBindegewebsschwäche durch die Akust-Wellen-Therapie”, ÄsthetischeDermatologie 2 (2007)C.Christ, R.Brenke, G.Sattler, S.Gabriel, P.Novak, A.Daser, “Improvementin Skin Elasticity in the Treatment of Cellulite and Connective TissueWeakness by Means of Extracorporeal Pulse Activation Therapy”,Aesthetic Surg J (2008) 28:538–544

Tissue TighteningDerma-Lab (Cortex Technology)Dr. Christ et al

Tissue TighteningEpidermis: 0.03-2mmDermis: 0.5-1.5mmSubcutis: 0.5-30mmUltrasonic Derma Scan C(Cortex Technology)

Cellulite appearanceBefore treatment After 6 treatment sessions After 3 months Follow-upDr. Sattler et al

Acoustic Wave Therapy (AWT)Before TreatmentAfter Treatment

AWTBefore Treatment After Treatment 3-Months-Follow-up

11.05.2009 14.07.2009

AWT convinced me My patients pay CHF 1‘600 for 10 treatments. The results are obvious in before-and-after photos. The treatments are enjoyable for my assistant. The device is attractive.

Patient care Medical briefing Discuss photos at the PC Expectations must be realistic Accompanying weight control with disciplined diet Body measuring

Patient care Fat measurement Weight and fat content measured every two weeks Exercise Drinking Nutritional supplements Skin care

Treatment in my practice

Do we achieve satisfaction?Yes! With good patient information and agreementform Good service and patient care Objective results with photo documentation

My ConclusionThe Cellactor has become an integral part of mypractice.

Thank you for your attention.Dr. med. Bettina RümmeleinFachärztin für DermatologieMedical Center SanitasCH-8802 Kilchberg/Zürichwww.dr-ruemmelein.ch