Cellulite: Subcision

Abstract

In 1997, Hexsel and Mazzuco reported the use of Subcision^® for the specific efficacious treatment of cellulite depressed lesions by severing the underlying fibrous septa that accompany these lesions (Hexsel D, Hexsel CL, Subcision: cellulite reduction. In: Dover J, Alam M, Orringer JS (eds). Body shaping, skin fat and cellulite, 3rd ed. Elsevier, London, 2015, pp 133–139; Hexsel D et al., Dermatol Surg 42(5):693–696, 2016; Hexsel DM, Mazzuco R An Bras Dermatol 72:27–32, 1997; Hexsel DM and Mazzuco R Int J Dermatol 39(7):539–544, 2000; Hexsel D, Mazzuco R. Subcision. In: Goldman MP, Bacci PA, Leibaschoff G, Hexsel D, Angelini F (eds). Cellulite: pathophysiology and treatment. Taylor & Francis, New York, 2006, pp 251–261). To perform the technique, tissue is pierced using an 18-gauge Nokor needle (BD), introduced to a depth of 1.5 to 2 cm into the subcutaneous tissue and then directed parallel to the skin surface. The sectioning of the fibrous septa is achieved by pressing the needle against the septa that pulls the skin down while withdrawing the needle. Only those septa that exert traction on the skin should be sectioned. Subcision performed too superficially and oversectioning of all the septa, especially in the lower buttocks and upper, can lead to the occurrence of protrusion of subcutaneous fat as a complication and thus should be avoided. It is important that the patient wears compressive clothing immediately after treatment, initially night and day for 7 days and during the day for 30 days to control the amount of bruising after the procedure (Hexsel D, Hexsel CL, Subcision: cellulite reduction. In: Dover J, Alam M, Orringer JS (eds). Body shaping, skin fat and cellulite, 3rd ed. Elsevier, London, 2015, pp 133–139).