- Original article
- Open Access
Caffeine phonophoresis versus shock wave therapy for adult women with cellulite: a randomized controlled trial
Bulletin of Faculty of Physical Therapy volume 24, pages 66–71 (2019)
Cellulite is a widespread problem involving women’s buttocks and thighs (85% of postadolescent women). It is characterized by an irregular, dimpled skin surface with thinning of the epidermis/dermis and presence of nodular clusters of fat cells. Caffeine has anticellulite effect owing to its lipolytic activity in fatty cells. Moreover, shock wave therapy treats cellulite through improvement of cell permeability.
To compare between the effects of caffeine phonophoresis and shock wave therapy in the treatment of women with cellulite.
Participants and methods
A total of 41 women with bilateral cellulite grade 2 and 3 at their thighs (ages 30–45 years) were randomly assigned into two groups. The caffeine phonophoresis group received caffeine 5% gel phonophoresis with an intensity of 0.2 W/cm2 at a rate of 1 min/cm2, three times/week. The shock wave group received shock wave therapy for two times/week. The treatments were conducted to a randomly selected side (the contralateral side serving as an untreated control). The cellulite grade and skin fold thickness were measured before and after 4 weeks of intervention.
There was a significant decrease in the cellulite grade and skin fold thickness of the treated side of both groups (P=0.001). There was no significant difference between the pretreatment values of both groups (P=0.724 and 0.341, respectively), and no significant difference between the posttreatment values of cellulite grade and skin fold thickness of both groups (P=0.149 and 0.268, respectively).
Caffeine phonophoresis and shock wave therapy were equally effective in improving the cellulite grade and skin fold thickness in adult women with cellulite.
Khan MH, Victor F, Rao B, Sadick NS. Treatment of cellulite. Part I. Pathophysiology. J Am Acad Dermatol 2010; 62:361–370.
Turati F, Pelucchi C, Marzatico F, Ferraroni M, Decarli A, Gallus S. Efficacy of cosmetic products in cellulite reduction: systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2014; 28:1–15.
Emanuele E. Cellulite: advances in treatment: facts and controversies. Clin Dermatol 2013; 31:725–730.
Pavicic T, Borelli CKH. Cellulite − the greatest skin problem in healthy people? An approach. J Dtsch Dermatol Ges 2006; 4:861–870.
De la Casa Almeida M, Suarez Serrano C, Rebollo Roldán J, Jiménez Rejano JJ. Cellulite’s aetiology: a review. J Eur Acad Dermatol Venereol 2013; 27:273–278.
Omi T, Sato S, Kawana S. Ultrastructural assessment of cellulite morphology: clues to a therapeutic strategy? Laser Ther 2013; 22:131–136.
Soares JLM, Miot HA, Sanudo A, Bagatin E. Cellulite: poor correlation between instrumental methods and photograph evaluation for severity classification. Int J Cosmet Sci 2015; 37:134–140.
Khan MH, Victor F, Rao B, Sadick NS. Treatment of cellulite. Part II. Advances and controversies. J Am Acad Dermatol 2010; 62:373–384.
Grotting JC, Beckenstein MS. The solid-probe technique in ultrasound-assisted lipoplasty. Clin Plast Surg 1999; 26:245–254.
Hamishehkar H, Shokri J, Fallahi S, Jahangiri A, Ghanbarzadeh S, Kouhsoltani M. Histopathological evaluation of caffeine-loaded solid lipid nanoparticles in efficient treatment of cellulite. Drug Dev Ind Pharm 2015; 41:1640–1646.
Brandi C, Campana M, Russo F, Brafa A, Nisi G, Grimaldi L, D’Aniello C. Carbon dioxide: maybe not the only one but an efficient and secure gas for treating local adiposities. Aesthetic Plast Surg 2012; 36:218–219.
Herman A, Herman AP. Caffeine’s mechanisms of action and its cosmetic use. Skin Pharmacol Physiol 2012; 26:8–14.
Rossi AB, Vergnanini AL. Cellulite: a review. J Eur Acad Dermatol Venereol 2000; 14:251–262.
Tang H, Mitragotri S, Blankschtein D, Langer R. Theoretical description of transdermal transport of hydrophilic permeants: application to low-frequency sonophoresis. J Pharm Sci 2001; 90:545–568.
Cagnie B, Vinck E, Rimbaut S, Vanderstraeten G. Phonophoresis versus topical application of ketoprofen: comparison between tissue and plasma levels. Phys Ther 2003; 83:707–712.
Byl NN, McKenzie A, Halliday B, Wong T, O’Connell J. The effects of phonophoresis with corticosteroids: a controlled pilot study. J Orthop Sports Phys Ther 1993; 18:590–600.
Sattler G, Pohl URK. Pilot study acoustic wave therapy (AWT) for cellulite. Aesthet Dermatol 2008; 2:17–25.
Knobloch K, Joest B, Krämer R, Vogt PM. Cellulite and focused extracorporeal shockwave therapy for non-invasive body contouring: a randomized trial. Dermatol Ther (Heidelb) 2013; 3:143–155.
Russe-Wilflingseder K, Russe E, Vester JC, Haller G, Novak P, Krotz A. Placebo controlled, prospectively randomized, double-blinded study for the investigation of the effectiveness and safety of the acoustic wave therapy (AWT®) for cellulite treatment. J Cosmet Laser Ther 2013; 15:155–162.
Braun MT, Daser AWK. Effects of shock wave therapy on pathological changes in subcutaneous adipose tissue. A pilot study. Aesthet Dermatol 2005; 4:1–17.
Angehrn F, Kuhn C, Voss A. Can cellulite be treated with low-energy extracorporeal shock wave therapy? Clin Interv Aging 2007; 2:623–630.
Christ C, Brenke R, Sattler G, Gabriel S, Siems WDA. Increase of skin elasticity and revitalization of the dermis in cellulite and connective tissue weakness by extracorporeal acoustic wave therapy. Aesthet Dermatol 2008; 1:6–14.
Christ C, Brenke R, Sattler G, Siems W, Novak P, Daser A. Improvement in skin elasticity in the treatment of cellulite and connective tissue weakness by means of extracorporeal pulse activation therapy. Aesthet Surg J 2008; 28:538–544.
Adatto M, Adatto-Neilson R, Servant JJ, Vester J, Novak PKA. Controlled, randomized study evaluating the effects of treating cellulite with AWT/ EPAT. J Cosmet Laser Ther 2010; 12:176–182.
Kuhn C, Angehrn F, Sonnabend O, Voss A. Impact of extracorporeal shock waves on the human skin with cellulite: a case study of an unique instance. Clin Interv Aging 2008; 3:201–210.
Thiel M. Application of shock waves in medicine. Clin Orthop Relat Res 2001; 287:18–21.
Schmitz C, Császár NBM, Rompe JD, Chaves H, Furia JP. Treatment of chronic plantar fasciopathy with extracorporeal shock waves (review). J Orthop Surg Res 2013; 8:31.
Hexsel DM, Abreu M, Rodrigues TC, Soirefmann M, Do Prado DZ, Gamboa MML. Side-by-side comparison of areas with and without cellulite depressions using magnetic resonance imaging. Dermatol Surg 2009; 35:1471–1477.
Bae H, Kim HJ. Clinical outcomes of extracorporeal shock wave therapy in patients with secondary lymphedema: a pilot study. Ann Rehabil Med 2013; 37:229–234.
Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol Bed Bench 2013; 6:14–17.
Tyle P, Agrawala P. Drug delivery by phonophoresis. Pharm Res 1989; 6:355–361.
Barnett S. Mechanical vibrations − basic physics. In: Roy A, editor. Ultrasound: biologic effects and potential hazards. 2nd edition. New York, NY: Academic Press 1985. 13: pp. 73–73.
Oakley EM. Application of continuous beam ultrasound at therapeutic levels. Physiotherapy 1978; 64:169–172.
Schlaudraff KU, Kiessling MC, Császár NBM, Schmitz C. Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite. Clin Cosmet Investig Dermatol 2014; 7:171–183.
Müller G. So-called cellulite: an invented disease. J Dermatol Surg Oncol 1978; 4:221–229.
Mirrashed F, Sharp JC, Krause V, Morgan J, Tomanek B. Pilot study of dermal and subcutaneous fat structures by MRI in individuals who differ gender, BMI, and cellulite grading. Ski Res Technol 2004; 10:161–168.
Schmelzle HR, Fusch C. Body fat in neonates and young infants: validation of skinfold thickness versus dual-energy X-ray absorptiometry. Am J Clin Nutr 2002; 76:1096–1100.
Velasco MVR, Tano CTN, Machado-Santelli GM, Consiglieri VO, Kaneko TM, Baby AR. Effects of caffeine and siloxanetriol alginate caffeine, as anticellulite agents, on fatty tissue: histological evaluation. J Cosmet Dermatol 2008; 7:23–29.
Lupi O, Semenovitch IJ, Treu C, Bottino D, Bouskela E. Evaluation of the effects of caffeine in the microcirculation and edema on thighs and buttocks using the orthogonal polarization spectral imaging and clinical parameters. J Cosmet Dermatol 2007; 6:102–107.
Lesser T, Ritvo E, Moy LS. Modification of subcutaneous adipose tissue by a methylxanthine formulation: a double-blind controlled study. Dermatol Surg 1999; 25:455–462.
Boucaud A, Machet L, Arbeille B, Machet MC, Sournac M, Mavon A. In vitro study of low-frequency ultrasound-enhanced transdermal transport of fentanyl and caffeine across human and hairless rat skin. Int J Pharm 2001; 228:69–77.
Monti D, Giannelli R, Chetoni P, Burgalassi S. Comparison of the effect of ultrasound and of chemical enhancers on transdermal permeation of caffeine and morphine through hairless mouse skin invitro. Int J Pharm 2001; 229:131–137.
Pires-de-Campos MSM, Leonardi GR, Chorilli M, Spadari-Bratfisch RC, Polacow MLO, Grassi-Kassisse DM. The effect of topical caffeine on the morphology of swine hypodermis as measured by ultrasound. J Cosmet Dermatol 2008; 7:232–237.
Russe-Wilflingseder K, Russe E. Acoustic wave treatment for cellulite-a new approach. In: AIP Conference Proceedings 1226, 25 (2010); 6–7 November 2009. p. 25–30. Firenze (Italy), https://doi.org/10.1063/1.3453782.
Hexsel D, Camozzato FO, Silva AF, Siega C. Acoustic wave therapy for cellulite, body shaping and fat reduction. J Cosmet Laser Ther 2017; 19:165–173.
Knobloch K, Joest BVP, Knobloch K, Joest B, Vogt PM. Cellulite and extracorporeal Shockwave therapy (CelluShock-2009) − a randomized trial. BMC Womens Health 2010; 10.
Modena DAO, da Silva CN, Grecco C, Guidi RM, Moreira RG, Coelho AA. Extracorporeal shockwave: mechanisms of action and physiological aspects for cellulite, body shaping, and localized fat − systematic review. J Cosmet Laser Ther 2017; 19:314–319.
Knobloch K, Kraemer R. Extracorporeal shock wave therapy (ESWT) for the treatment of cellulite − a current metaanalysis. Int J Surg 2015; 24:210–217.
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
About this article
Cite this article
Ashem, H., Draz, A. & Abdel-Aziem, A. Caffeine phonophoresis versus shock wave therapy for adult women with cellulite: a randomized controlled trial. Bull Fac Phys Ther 24, 66–71 (2019). https://doi.org/10.4103/bfpt.bfpt_27_18
- caffeine phonophoresis
- shock wave therapy
- skin fold caliper