Cellulite Treatment (VASERsmooth)

Comprehensive Minimally Invasive Technique to Reduce or Eliminate Unwanted Cellulite at the Masterpiece Aesthetics & Surgical Arts

The skin surface dimpling, known as cellulite, along the outer thighs, abdomen and buttocks can now be effectively treated by a new minimally invasive modality using ultrasound known as VASERsmooth.

Cellulite Treatment Options

Dr Troell's Expertise in Cellulite Treatment:

  1. first surgeon in Nevada and second in California to offer this innovative cellulite technology
  2. Western United States teaching center for minimally invasive cellulite treatment and liposuction surgery to include SlimLipo laser lipolysis and VASER liposuction as well as High Definition VASER liposuction
  3. first physician to buy VASER Shape, the best non-invasive body contouring device as proven by his crossover randomized comparable study with CoolSculpt, Endermologie and Velashape. Dr. Troell was on The Doctors show and received the Best Noninvasive Body Contouring Result award at the Aesthetic Show in 2011.
  4. Completed the first study comparing VASERsmooth alone, VASERsmooth with autologous fat transfer, VASERsmooth with autologous fat transfer and platelet rich plasma and VASERsmooth with autologous fat transfer and stem cell therapy. The later two methods yielded the best outcomes.

Dr. Troell offers physicians and surgeons Continuing Medical Education (CME) courses on body contouring topics through Touro University Nevada, Osteopathic School of Medicine. Dr Troell was clinical professor at Stanford University Medical Center for seven years and is currently Adjunct Professor at Touro University Nevada.

VASERsmooth™ method?

This unique safe and effective technique works through the use of high frequency ultrasound (36,000 Hz) known as VASER technology. VASERsmooth™ is a specifically designed ultrasound powered probe that has either a cutting edge about 2 cm’s from the blunt tip or a "V" shaped probed which cut the fibrous bands of cellulite or other subcutaneous scar tissue.

VASERsmooth works by:

  • excises the vertically oriented fibrous bands
  • the ultrasound probe delivers ultrasound energy to mobilize fat, smoothing out adjacent areas.

Areas of excess bulging fat are smoothed out by liposculption and areas of persistent indentations can be filled in by using one’s own fat, stem cells and/or platelet rich plasma (PRP). The “cobblestone” or “orange peel” appearance of cellulite, which is causing skin dimpling and contour irregularities, is more efficiently and effectively treated than ever before by VASERsmooth™ and fat transfer or fat grafting.

VASERsmooth Advantage over Laser Technologies:

  • Laser technologies, such as Cellulaze (Cynosure) or Cellusmooth (Sciton) is that the procedure duration of cutting the fibers takes less than 5 minutes in most instances compared to 45-60 minutes with laser technologies.
  • Better safety profile wit ha significantly less risk of buring the skin since the ultrasound cuts the fibers and the lasers need an elevated temperature to work, risking burning the adjacent thin skin. The laser needs to achieve about 42° C to achieve the optimal effect, however, skin burns occur at 47° C. Thus, the range of treatment target temperature and tissue safety is narrow.
  • Fat removed using VASER or ultrasound technology is alive with 85% of fat cells alive and 87% of stem cells alive. This fat and stem cells can be used to fill indentations. Laser technologies results in nonviable fat cells. Limitation of any form of cellulite treatment using lasers is the lack of repair of the areas of indentations using fat.

VASERsmooth™ reduces cellulite through tissue tightening, cutting those fibrous bands and by promoting your body’s creation of new collagen and alterations of the current collagen fibers and viable for fat and stem cell graft into the areas of indentations as well as under the entire skin areas treated to further promote collagen synthesis.


Cellulite affects an estimated 85% of post-pubescent women. The association with woman is linked to the effect of estrogen hormone on the skin and soft tissues, which we do not fully understand. The cellulite results in dimpled, uneven skin with a cobblestone or orange peel appearance.

The tissue changes in cellulite include: fibrous septae attachments of the skin extending into the underlying fat and even connecting to the underlying muscle, a thickened fat layer, fat lobules herniating up into the skin-fat interface as well as reduced skin blood circulation.

Cellulite most common areas:

  • Buttocks
  • Anterior Thigh
  • Lateral Thigh
  • Posterior Thigh

In order to optimize the treatment result, it is important to grade the severity of cellulite prior to commencing treatment. The Universal Cellulite Grading System developed in 1972, the Nurenberger-Muller Grading Scale, was chosen to ensure uniformity in cellulite assessment. There are four grades of cellulite ranging from grade 0-3:

Grade 0: “No cellulite”. There is no visible cellulite while standing. With pinching the skin, there is no appearance of cellulite. This grade of cellulite is rare and very desirable.

Grade 1: “Tight cellulite”. There is no cellulite when standing, however, when one pinches the skin of the thigh/buttock or when the thigh/buttock muscles are contracted, one will see the appearance of orange peel or mattress appearance of the skin. The pinch test should be painless and the skin-fold small.

Grade 2: “Loose cellulite”. There is visible cellulite while standing, but it is not visible when lying. The cellulite is visible when the subject contracts the buttocks or when the skin is pinched. The skin is generally loose and has a painless skin pinch.

Grade 3: There is visible cellulite while standing and in the supine position. Some refer to this as “painful cellulite”, any type of cellulite, which is characterized by significant tenderness during the pinch test.

VASERsmooth™ Treatment Technique?

Photographs & Patient Marking:

Probably the most important part of the procedure is after the photographs are performed, marking the areas of fullness and areas of indentations. Two different colored pens are used for marking the indentations, one for more superficial areas and one for deeper areas. The same is done for the areas of fullness. Side or down lighting is essential during this process. This “down lighting” highlights the surface contour asymmetries and indentations to optimize the treatment strategies.


Eventhough this is a minimally invasive procedure, to optimize safety, we use comprehensive cardiac monitoring and intravenous line placement. The entire procedure usually takes less than one hour from monitoring patient, preparation, anesthetic administration, ultrasound delivery, fat harvesting and liposuction fat processing, VASERsmooth fibrous bands excised and placement of fat into the areas of indentations.


When you undergo the minimally invasive VASERsmooth™ treatment, you will be given oral sedation to make you sleepy, make you relax and treat discomfort. You lie down on a comfortable procedure table after being prepared with warmed antibacterial solution and sterile drapes are applied. Monitors are placed for your safety. Some patients prefer to be more sedated and intravenous sedating or pain medications can be administered.

The procedure begins with the administration of a small amount of local anesthesia. Thereafter, one or more small incisions (about 1/8 inch) are made near the treatment site. A very narrow cannula will then be inserted through this incision and water with numbing medication (lidocaine) in a wetting solution and a medication to stop bleeding (adrenalin) is infiltrated into the targeted cellulite area.

Liposuction & Fat Harvesting:

After adequate anesthesia, controlled ultrasound energy is delivered through small ultrasound probe to the treatment site. If needed, small amounts of liposuction can be performed. The goal is a smooth skin contour that may be permanent. The fat removed can be processed to place purify the fat to optimize fat survival during transfer to the areas of indentation.

VASERsmooth Subcision of Fibrous Bands:

The VASERsmooth™ probe disrupts the fibrous attachments noted by the markings until smooth unabated movement of the probe under the skin at these areas is again appreciated by the surgeon. Areas of excess fat fullness can be suctioned with a small liposuction cannula.

If there are persistent areas of indentations in the area of cellulite, unresolved by cutting sub-dermal fibers by the VASERsmooth™ ultrasound probe, they may be treated by the the addition of your fat to produce a smooth outcome:

Fat Transfer (Administration) to Cellulite Indentations:

  1. Fat transfer, thin coat of one’s own fat immediately under the skin.
  2. Fat transfer a homogeneous, thin coat of one’s own fat under the skin and into the areas of indentations
  3. Fat Transfer a homogeneous, thin coat of one’s own fat mixed with stem cells in a thin layer under the skin
  4. Fat Transfer a homogeneous, thin coat of one’s own f fat mixed with platelet rich plasma (PRP) in a homogeneous thin layer under the skin.


Patients can walk immediately after the procedure. The need for narcotics medications after the procedure s less than three days, swelling peaks at two days and persists for one week, skin erythema or redness persists for about one week to ten days, skin peeling begins 1-2 days after the procedure and persists for 3-5 days. Thus, most woman can place makeup at 4-5 days post-procedure. Light exercise can resume at one week with regular exercise at two weeks post-treatment. A compression garment is recommended to wear fro a three week duration.

Additionally, a study investigating the optimal technique to harvest and process fat as well as stem and regenerative cells is ongoing. The study will be performed with the association of the Associate Dean of Research, Dr Mahboob Qureshi, MD, PhD through Touro University Nevada.

Please feel free to call us at Beauty By Design in Irvine, CA (949) 220-0532.

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