A validated photonumeric cellulite severity scale for the area above the knees: the knee cellulite severity score

Abstract

Background Treatment for cellulite above the knees is increasingly requested. However, a classification of cellulite of this area has not yet been developed. Objective To validate the proposed knee cellulite severity score (KCSS) for the assessment of cellulite and skin laxity above the knee. Materials and methods Based on standardized photographs of cellulite and skin laxity above the knees of 57 females (114 knees), three key morphological aspects of cellulite were identified. A photonumeric KCSS was developed and validated by three independent assessors. Results The three key cellulite morphological features (number of depressions, depth of depressions and presence of laxity) are each graded from 0 to 3, producing a classification of no lesions (0), mild (1–3), moderate (4–6) and severe (7–9). Evaluators at different time points repeated similar classifications (intraclass correlation coefficient >0.9), which were also similar among the assessors (inter‐observer reliability >0.9). All three key morphological aspects were deemed necessary, and positively contributed, to the overall scale (item‐total correlation analysis values >0.89, P < 0.05). Conclusions The KCSS is a consistent, comprehensive, reliable, and reproducible tool for standardized and objective assessment of the severity of cellulite and skin laxity above the knees.

Hyperdiluted calcium hydroxylapatite for skin laxity and cellulite of the skin above the knee: A pilot study

“…This retrospective study enrolled women seeking improvement of skin laxity and depressions above the knees treated with the hyperdiluted CaHA 1:4 between Septermber 2017 and June 2019. Patient eligibility for study inclusion was ≥1 point according to the previously described and validated knee cellulite severity score (KCSS) 8 . Exclusion criteria for the study included the presence of any illness or use of medications that may affect wound healing, the presence of significant scarring, open wounds or lesions in the area to be treated, previous skin tightening procedure before the proposed treatment area within the past year, immunosuppression or autoimmune disease.…”

“…Patients were assessed according to the KCSS 8 at T0 and T1. Each knee was evaluated by three dermatologists (S.G., S.L., and V.D.M.)…”

“…Each of the three items (number and depth of depressions and skin laxity) was graded from 0 (absent) to 3 (severe); 0 corresponds to absence and 3 to the most severe condition. The overall scores (0‐9) were classified as absent (0), mild (1–3), moderate (4–6), and severe (7–9), as previously described 8 …”

“…Patient eligibility for study inclusion was ≥1 point according to the previously described and validated knee cellulite severity score (KCSS). 8 An adequate solution was obtained connecting a 10 mL LuerLock syringe, containing the diluent, to the original syringe of the CaHA product, through a transfer adaptor, as previously described. 9 According to guidelines, 10 at least 20 passes between the two syringes were performed, to ensure product homogeneity and the solution was used immediately after reconstitution to avoid the separation of each component.…”

“…, and severe (7-9), as previously described. 8 Further, efficacy was evaluated by a blinded, qualitative identification of T0 and T1 images by two investigators (initials). For each subject, the reviewers were asked to identify which was the posttreatment image.…”