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Non-Invasive Mechanical Body Contouring:

A One-Year Clinical Outcome Study Update

Peter Chang B.S.

Jeremy Wiseman B.S.

A.V. Salisbury M.D.

Robert A. Ersek, M.D., F.A.C.S.

 

Non-Invasive Mechanical Body Contouring:

A One-Year Clinical Outcome Study Update

Summary:

LPG Endermologie® is a machine-assisted massage system that allows positive pressure rolling, in conjunction with applied negative pressure to the skin and subcutaneous tissues.¹ Endermologie was originally developed in the late 1970s in France to soften scars and standardize physical therapy. However, patients treated with the LPG machine also showed improvement in body contour and skin texture. Since then, Endermologie machines have been used in France, the United States, and many other nations as an alternative method to altering fat distribution in the subcutaneous plane.

The authors have continued their study of determining the safety and efficacy of this machine. Since our last report in March 1997,² we have compiled records of 85 additional patients. With this larger patient pool, we can expect more statistically accurate results. This study is composed of 85 women between the ages of 21 to 61. The study group exhibited a wide range of body habitus, initial weights, and final results. Out of 85 patients, 46 patients completed seven sessions of treatment and showed a mean index reduction* in body circumference of 1.34 cm, while 39 patients who completed 14 sessions of treatments showed a mean index reduction in body circumference of 1.83 cm. A decrease in mean body circumference index was seen regardless of loss or gain in patientsí weight in most cases.
 
 History:

In the late 1970ís, Louis Paul Guitay (LPG) suffered muscle and skin damage as a result of a motor vehicle accident. The scarring that resulted was treated by therapeutic massage to soften this tissue and to restore muscle function. These massage sessions, which lasted three to four hours a day, consisted of rigorous routines of manually rolling the skin in order to regain elasticity. Guitay was unsatisfied with these massages because the therapy was time consuming, labor intensive, and the outcome varied widely based on the skill of the individual therapist. As a result, Guitay designed the Endermologie system, which used a mechanical method to produce the same effect as the manual massages. This mechanical system allowed the therapy to be performed quicker and in a more consistent fashion.

Soon after, these machines were used to treat trauma and burn scars similar to those suffered by Guitay. During this therapeutic use, physicians quickly noticed its ability to reduce the appearance of cellulite and alter fat distribution in patients. The manner which this is accomplished is theorized to be by the stretching of the vertical connective tissues and stimulation of lymphatic flow as a result of the extreme pressure difference and the rolling motion as dictated by the technique.

This positive pressure from rollers combined with the negative pressure from suction is believed to cause sublethal damage to the subcutaneous fat cells. As these damaged fat cells heal, they rebuild in such a way that results in an improved contour of the skin and better distribution of subcutaneous fat . Though the fat layer is altered, this mechanical force does not affect the overlying skin, bones, or muscles.

The cosmetic use of LPG Endermologie has been widespread in Europe, Japan and South American for the past decade.³ Recent approval of the system and the machine in the United States has allowed for the use of LPG Endermologie system in helping to reduce the appearance of cellulite and distribution of fat in the subcutaneous plane.⁴ Other physicians have also found the Endermologie system to produce a measurable difference in circumference measurements regardless of weight change in the same time frame.⁵

This body contouring system has also been used by others in conjunction with liposuction. This combination of techniques may help to shorten the recovery period of liposuction, and allow the results of liposuction to be more predictable.6
 
 Materials and Means:

Included in this report are 85 of our LPG Endermologie patients who fulfilled the requirements for the study. Of the 85 patients, 46 underwent the treatment for seven weeks while 39 patients completed the entire 14 week treatment.

Each patient included in our study had 45 minute LPG Endermologie® sessions with a trained LPG technician. These treatments were conducted once or twice every one to two weeks. Treatments varied only in intensity of the negative pressure applied, which was determined by patient tolerance. We have included all of our patients who conformed to the protocol and had completed seven or fourteen sessions (figures 1-4). Patients whose treatments were at irregular intervals or who did not complete at least seven sessions were not included.

Patients were encouraged to drink eight to ten glasses of water per day and to maintain a low-fat diet. However, no specific diet plans were recommended to our patients.

Before the initial LPG treatment, patients were weighed and circumference measurements were taken of the patientís waist, hips, thighs, knees, and calves. Identical weight and circumference measurements were collected at the seventh and the fourteenth visit.

The circumference losses of each of the locations were calculated by taking the difference between the initial circumference and the same measurement taken after seven and fourteen sessions. This data is then compiled into a mean body circumference loss by taking the average of the difference at each of the five locations. All measurements were included in the calculations regardless of whether the patient exhibited a positive (loss), negative (gain), or zero (neither loss nor gain) change in circumference.

Two index categories were established. The first index represents the mean body circumference loss of 46 patients who had undergone seven sessions as well as 6 patients who completed all 14 sessions and had recorded results after the seventh session (33 patients did not have recorded results at the seven session mark). The second index represents the mean body circumference loss of 39 patients who had completed all 14 sessions. These two indices indicate the average loss or gain in body circumference of the patients represented in this study.

Two other index categories were established to track the weight fluctuation in the same manner as for the body circumference. The first mean index was established by taking the average weight loss between the first and seventh session of 41 patients who had undergone only seven sessions (weights of five patients were not recorded). The second mean index was established by taking the average weight loss of the 37 patients who had completed all 14 sessions (weights of two patients were not recorded).
 
 Results (Table 1)

From these analyses, we discovered that after seven consecutive sessions, patients showed an overall decrease in body circumference and body weight (Chart 1, Table 2). Patients lost an average of 1.34 cm from each location (a 2.17% reduction). More specifically patients lost an average of 1.34 cm from the waist, 1.85 cm from the hip, 1.95 cm from the thigh, 0.97 cm from the knee, and 0.58 cm from the calf. However, 7 out of these 46 patients (15.22%) had gains in their mean body circumference with a mean body circumference gain of 1.4 cm. If we do not include the patients with gains in our analysis, the mean body circumference loss of our patients was 1.78 cm (2.88% reduction). The median circumference loss was 1.29 cm. Within this same period of time, our patients lost an average of 0.99 kg (a 1.5% reduction). However, 12 out of 42 patients (28.57%) reported an average gain in weight of 0.84 kg. Excluding patients with weight gains, the average weight loss was 1.84 kg. The median weight loss was 0.68 kg. 50% of patients who gained weight still showed a loss in mean body circumference.

After 14 consecutive sessions, we again discover an overall decrease in body circumference and body weight (Chart 2, Table 3). Patients lost an average of 1.83 cm from each location (a 2.65% reduction). The 39 patients lost an average of 2.05 cm from the waist, 3.19 cm from the hip, 1.93 cm from the thigh, 1.28 cm from the knee, and 0.71 cm from the calf. 5 of these 39 patients (12.82%) averaged circumference gains of 1.61 cm. If the gains are not included in our calculations, the mean body circumference loss is 2.35 cm (3.47% reduction). The median circumference loss was 1.38 cm. After 14 sessions, our patients report an average weight loss of 1.29 kg (a 1.84% reduction). If we exclude the 12 out of 37 patients (32.43%) who gained weight, the average weight loss was 2.41 kg. The median weight loss was 0.90 kg. 75% of patients who gained weight still showed a loss in mean body circumference.
 
 Discussion:

Our studies indicate that there is a general correlation between body circumference loss and weight loss for patients who completed 7 and 14 sessions (Chart 3 and 4). Fourth order best-fit curves were plotted using MicrosoftÒ Excel 97 based on data from weight loss and circumference loss after the 7^th and 14^th session using the least-squares method. From these charts we can see that the best-fit curves for weight loss and circumference loss are nearly parallel indicating that weight loss and circumference loss are very closely interrelated. However, as our results shown, 50% of our patients who gained weight still showed a loss in mean body circumference at seven weeks, and 75% of patients who gained weight after 14 weeks also showed a loss in mean body circumference. The same can also be seen graphically in charts 1 and 2. This suggests that with the Endermologie system, body circumference loss can be accomplished without body weight loss; although most circumference losses accompany weight losses.

Even though 12.82% of our patients gained mean body circumference after 14 sessions, 75% of those who gained body circumference still were evaluated to have attained "good improvement" on their goal of treatment of either eliminating cellulite or localized bulges. Some of the patients who gained weight were treated over the holiday season and admitted that they developed bad eating habits during this same time period. Patients who have shown the greatest improvement with the Endermologie system were either participating in a diet program and/or exercise regime.
 
 Conclusion:

From these observations, we conclude that the LPG Endermologie system is an effective method for fat mobilization and body contouring. Nearly all of our patients who undergone this procedure wished to eliminate cellulite or localized bulge and 90% reported favorable improvements in those areas.

Although no specific diet program was recommended to our patients, it can be seen that there is a connection between body circumference reduction and weight loss. Thus, Endermologie should be advocated along with proper diet and exercise management to the patients in order to reap the maximum benefit.

The results from our study vary widely, but significant measurement loss was seen in most cases regardless of weight change. With this greater patient pool, our results are more statistically significant and more reliable than before. However, these results should still be regarded as preliminary figures and we encourage our colleges to develop a double-blind protocol in a controlled setting to better understand the effects and mechanism of action of this method.
 
 References:

1 LPG Endermologie U.S.A. 3101 North Federal Highway, Suite 301Fort Lauderdale, Florida 3306, (800) 222-3911

2. Ersek RA. Mann GE 2nd. Salisbury S. Salisbury AV. "Noninvasive mechanical body contouring: a preliminary clinical outcome study." Aesthetic Plastic Surgery. 21(2): 61-7, 1997 Mar-Apr.

3. LPG Endermologie USA Training Course. April 24-26, 1996.

4. LPG Endermologie U.S.A. Endermologie Journal: Plastic Surgery Edition 1: 3-4, 1996

5. Lamm S: Younger at Last. New York: Simon and Schuster (in press), 1997

6. Vergrav, R. "Use of Mechanical Skin Fold Rolling in Cosmetic Surgery." Journal of Cosmetic Medicine and Dermatological Surgery. March 1995. Vol. XXII, No. 85.
 
 

Figure 1A: Patient TE seen after the first session.

Figure 1B: Patient TE seen after the 14^th session. This patientís mean circumference loss was 4.62 cm,

with a corresponding weight loss of 7.68 kg.
 
 

Figure 2A: Patient FD seen before the first session.

Figure 2B: Patient FD seen after the 14^th session. This patientís mean circumference loss was 1.38 cm,

with a corresponding weight loss of 0.45 kg.

Figure 3A: Patient FD (frontal view) seen before the first session.

Figure 3B: Patient FD (frontal view) seen after the 14^th session.
 
 

Figure 4A: Patient FT seen before the first session.

Figure 4B: Patient FT seen after 14^th visit. This patientís mean circumference loss was 5.74 cm, with a corresponding weight loss of 6.37 kg.
 

Table 1: Summary of data collected from 85 patients in the past year. Average weight and circumference loss of each area as well as total body measurement calculations.

Table 1 continued: Summary of data collected from 85 patients in the past year. Average weight and circumference loss of each area as well as total body measurement calculations.

Table 2: Overall body circumference and body weight measurements of individual patients after seven consecutive sessions.

Table 3: Overall body circumference and body weight measurements of individual patients after 14 consecutive sessions.

Chart 1:

This chart depicts the weight and circumference changes of the 46 patients after 7 LPG Endermologie sessions. Negative values denote weight and circumference gain while positive values denote weight and circumference loss.

Chart 2:

This chart depicts the weight and circumference changes of the 33 patients after 14 Endermologie sessions. Negative values denote weight and circumference gain while positive values denote weight and circumference loss.

Chart 3:

This chart shows the general correlation between body circumference loss and weight loss for the 46 patients who underwent 7 Endermologie sessions. The solid and dotted trend lines are 4th order best-fit lines based on data points plotted from weight and circumference loss of each patient.

Chart 4:

This chart shows the general correlation between body circumference loss and weight loss for the 39 patients who underwent 14 Endermologie sessions. The solid and dotted trend lines are 4th order best-fit lines based on data points plotted from weight and circumference loss of each patient.

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