SUNEKOS CELL 15 A NEW APPROACH TO THE TREATMENT OF CELLULITE

Dr Mark Holmes discusses the benefits of low weight hyaluronic acid and six amino acids to address cellulite

SUNEKOS CELL 15 IS A new injectable medical device for the noninvasive treatment of cellulite using a patented mix of low molecular weight hyaluronic acid (HA), six essential amino acids (AA) and bicarbonate salts.

It achieves this by optimising the protein turnover of the extracellular matrix (ECM), improving the micro-circulation and counteracting the ECM acidosis and inflammation reducing fibrosis in the process. This is a process of neocollagenesis rather than the typical collagenase1,2

Cellulite is a dimpled lumpy skin appearance mainly represented in the gluteo-femoral area occurring almost exclusively in females. This chronic skin condition is widespread and affects more than 85% of females over the age of 20.

The cellulite treatment market is rapidly expanding. In 2019, the global cellulite treatment market size was $1.35 billion. By 2026 it has been predicted to reach $2.8 billion.

Edemato-fibroscerotic panniculopathy (EFP) was named by S.B. Curri. Four stages were described. Stages I and II of cellulite present as an edemato–inflammatory condition of the tissue associated with hypo-oxygenation and acidosis3,4

Stages I and II can be treated with Sunekos Cell applying the Across Tension Lines needle (ATL-n) technique5

The pathogenetic mechanism of late stage cellulite is mostly related to the ageing of tissues

(inflammation/acidosis) already degenerated in fibrosis and subsequently in sclerosis. The sclerosis is irreversible. This condition is often related to menopause when the decrease of the hormones is worsening the process.

Stages III and IV can be treated with Sunekos Cell and Cannula and the Across Tension Lines cannula (ATL-c) technique5

For Crewe, there are three dominant contributors to the pathogenesis of dysfunctional adipose tissue6:

■ unresolved inflammation

■ inappropriate extracellular matrix (ECM) remodelling

■ insufficient angiogenic potential.

Sunekos Cell 15

Sunekos cell 15 is indicated for treating Cellulite types I-IV in the following areas1,5:

■ gluteal/trochanteric area

■ thighs

■ abdominal area

■ arms

■ other areas of the body affected by cellulite.

Sunekos Cell 15, produced by Professional Dietetics, consists of one ampoule of their patented formula of premixed HY6AA (low molecular weight hyaluronic acid, six essential amino acids) and one vial of carbonate and bicarbonate salts. When mixed they create an injectable volume of 15 ml.

Low molecular weight HA has a stimulating action on fibroblasts and neo-angiogenesis, through binding with specific receptors for HA fragments7

The HY6AA formula produces optimal neo-synthesis of collagen and elastin (glycine, L-proline, L-lysine MHC, L-leucine, L-valine, L-alanine).

The carbonate and bicarbonate salts help to regulate to regulate the physiological pH reducing the typical acidosis and latent inflammation that characterises both the early and late stages of the disease.

A recent study of Sunekos Cell involved 20 females with cellulite grade II–IV. Four treatments were carried out 2–3 weeks apart. 2.5 mls were injected with a cannula into three areas on each leg for a total of 15 mls per session1

Results were assessed using digital pictures, the GAIS scale and mean weight pre-treatment, and at 8 weeks and 12 weeks after the first treatment. A two point improvement was noted.

I have been using Sunekos Cell in my own clinic for 11 months, my patients have been very pleased with the results regardless of whether they have cellulite grade I, II, III or IV.

I do not treat patients with localised skin inflammation or infection, unrealistic expectations, soft tissue auto-immune disease or very advanced stage IV cellulite.

As part of a holistic approach patients are encouraged to improve any pre-disposing lifestyle factors:

■ smoking

■ poor diet

■ lack of exercise

■ tight fitting clothing.

Patients are assessed while standing.

Cellulite can be treated with just Sunekos Cell 15, however should there also skin laxity, I use injectable Sunekos Body once the Sunekos Cell treatment is completed.

The ampoule of HY6AA and the vial of bicarbonate salts are mixed together. The ampoule is then gently rolled between the fingers for a minimum of 30 seconds to ensure proper mixing.

Each ampoule contains a total of 15 ml, 7.5 ml for each leg.

I typically treat the trochanteric area and two out of five other possible areas with 2.5 ml to each area (Figure 1):

■ lateral thigh

■ anterior superior thigh

■ anterior inferior thigh

■ posterior superior thigh

■ posterior inferior thigh.

When the patient is standing, I mark each area as a 12 x 12 cm box and take a photo so I know exactly where to inject on subsequent visits. A 30 G needle or a 27 G cannula and 2.5 ml syringe are used depending on the technique for the specific stage. Injections are made perpendicular to the tension lines of the skin using the ATL-n or ATL-c technique (Across Tension Lines needle or cannula)5. For the needle, the volume injected at each point is 0.15 ml. After the treatment the injected area is massaged.

Three treatments are performed 2 to 3 weeks apart for cellulite types I and II and four treatments for types III and IV. It’s important to stress to the patient that the part of sclerosis in type IV is not reversible.

I use the Sunekos Cell 15 in conjunction with the Nutrakos pH7 oral supplement. Waste accumulates in the connective tissue, damaging collagen, impairing the efficiency of the microcirculation and promoting water retention.

Tissue acidosis is one of the main factors responsible for the appearance and worsening of cellulite. Nutrakos pH7, a specific combination of carbonates and bicarbonates, helps to restore the acid-base balance. I recommend they take one sachet a day for two months.

Results

Many patients have already noticed improvement when they come back for their second treatment. However, it is stressed that the optimal results will be 3 to 4 weeks after the last treatment. Typical results are an improvement in skin appearance with reduced dimpling. Results continue to improve after each treatment and have been maintained at the 6 month follow up (Figure 2). At this stage one or two treatments are performed as maintenance with a further follow up planned at 12 months to repeat the whole process.

Those treated commonly refer their friends, family and colleagues a good indicator of treatment satisfaction.

Sunekos Cell 15 is extremely well tolerated with no downtime and minimal pain. Some patients have had minimal bruising, but no adverse effects have been experienced.

References

1. A. Sparavigna. Injective treatment of the so-called cellulite: a new approach aimed at restructuring extracellular matrix of deeper layers of the skin. Efficacy and safety of a new specific formula (part 1 & 2) - JPD Vol 18 n2 2022

2. Fasola E, Kutera E. Pilot study evaluating the therapeutic effects of a new pre-mixed injectable product of low molecular weight (LMW) hyaluronic acid added to six amino acids (HY6AA +Formula) in facial skin aging. J Dermat Cosmetol. 2022;6(3):74-77

3. S.- Curri Localised Adiposity and oedematofibrosclerotic panniculopathy. Ed Sepem, Milan 1990 4.

4. Curri S.- Compendium of clinical and instrumental semy-semy of panniculopathy - Ed.Edra, Milan 1993.

5. Fasola E. Cellulite rebuild rather than destroy-Prime Vol 13 Issue 1 2023

6. Clair Crewe, Yu Aaron An, Philipp E. Scherer The ominous triad of adipose tissue dysfunction: inflammation, fibrosis, and impaired angiogenesis.

7. Tedesco L., Rossi F. Ruocco C., Ragni M., Carruba M.O., Valerio A., Nisoli E. A designer mixture of six amino acids promotes the extracellular matrix gene expression in cultured human fibroblasts. Bioscience, Biotechnology,