Resumen

Objectives: To present clinical results of a three-session outpatient hybrid protocol combining subcision for fibrous septa release, calcium hydroxyapatite, and microneedle radiofrequency in the treatment of Edematous Fibrosclerotic Panniculopathy (cellulite), effectively addressing its varying severities, from mild and localized to more severe and diffuse presentations. Introduction: Edematous Fibrosclerotic Panniculopathy (EFP) involves contraction of fibrous septa, causing skin irregularities and dermal laxity. Guided subcision mechanically releases these septa, while calcium hydroxylapatite (CaHA) stimulates neocollagenesis and dermal remodeling. Microneedle radiofrequency (RFMA) delivers fractional thermal coagulation, promoting collagen remodeling, dermal contraction, and tissue repair. Its thermal effect penetrates up to 8 mm, aiding hemostasis and accelerating hematoma resorption post-subcision. The combination synergistically enhances skin quality and recovery. Materials / method: Retrospective observational study with 22 female patients aged 28–49, Fitzpatrick II–IV, diagnosed with EFP in gluteal/posterior thigh areas. Guided subcision was performed with patients standing to allow better septa visualization and precise mechanical release of fibrous septa. CaHA injection followed. Microneedle RF applied same day or within 24h, with adjustable depth 2–7 mm and thermal effect up to 8 mm. High density, multiple passes. Three monthly sessions. Evaluations: photos, satisfaction survey, adverse events. Results: Progressive improvement was observed from the first session, with visible dermal contraction, skin texture enhancement, and surface regularization on photographic follow-up. Patient satisfaction was high. Hematoma resolution averaged 5–7 days, accelerated by RFMA’s thermal coagulation promoting local hemostasis and vascular remodeling. Edema and inflammation decreased rapidly. Skin firmness improved, potentiating CaHA bio-stimulation. Mild transient erythema and edema resolved spontaneously within 48 hours. No severe adverse events or infections were reported. Conclusion: The combined protocol of guided subcision, CaHA injection, and microneedle radiofrequency proved safe and effective for treating EFP regardless of clinical severity. The integrated mechanical release, bio-stimulatory effects, and thermal action provide a comprehensive approach. RFMA significantly contributes to tissue repair, inflammation modulation, skin quality improvement, and hematoma resorption, enhancing CaHA effects and optimizing recovery. This represents a personalized, versatile therapeutic option in aesthetic medicine for EFP.