Patent Publication Number: US-2005131439-A1

Title: Percutaneous cellulite removal system

Description:
The present application is a continuation of U.S. patent application Ser. No. 10/202,415, filed Jul. 22, 2002. U.S. patent application Ser. No. 10/202,415 claims the benefit under 35 USC Section 119(e) of U.S. Provisional Application Ser. No. 60/332,355, filed Nov. 15, 2001 and U.S. Provisional Application Ser. No. 60/356,891, filed Feb. 13, 2002. The present application is based on and claims priority from these applications, the disclosures of which are hereby expressly incorporated herein by reference.  
    
    
     BACKGROUND OF INVENTION  
      The present invention relates to an apparatus and method for making the appearance of cellulite less obvious by cutting the fibrous bridges that connect the skin to muscle and/or fascia (hereinafter referred to as “muscle,” “fascia,” or “muscle/fascia”) or by cutting the fibrous septae in subcutaneous fat in a minimally invasive manner, and specifically to a percutaneous cellulite removal needle with at least one lateral opening in its peripheral surface through which a surgical instrument and/or a cutting mechanism retracts or protrudes and methods for using the percutaneous cellulite removal needle.  
      Cellulite is a popular term used to describe the dimpled or “lumpy skin” appearance of the skin that some people have on their hips, thighs, and buttocks. Cellulite often occurs in women who are not particularly overweight or a good candidate for liposuction. It is caused by a “buttoning” or “mattress effect” of the skin  24  with tethering of the dermis  22  to the underlying muscle or fascial layers  26  by fibrous bands  28  or by fibrous septae in the subcutaneous fat.  
      Dietary supplements, topical creams, massage treatments, and other methods have been suggested for treatment of cellulite. There are few scientific studies, however, that demonstrate the efficacy of any of these methods. Nor is liposuction—a surgical technique for extracting fat by vacuuming it from under the skin—always an effective treatment for cellulite. This is because the dimpled appearance is the result of deposits of subcutaneous fat in combination with the fibrous bridges that attach the skin to underlying muscle. When the fibrous bridges tighten, the skin is pulled tight over the deposits of subcutaneous fat creating a dimpled appearance. Removal of the subcutaneous fat by liposuction does not alter the dimpled appearance of the skin and, in fact, may worsen the appearance of the skin. In order to smooth the skin, it is necessary to break the fibrous bridges.  
      A method for the treatment of cellulite by breaking fibrous bridges is disclosed in  Surgical Treatment of Cellulite and its Results,  by Clara Lieberman, M.D. and Joseph Cohen, M.D., American Journal of Cosmetic Surgery, Vol. 16, No. 4, 1999, 299-303. The Lieberman-Cohen method is a surgical treatment using liposuction and release of the fibrous tissue bridges with blunt thin cannulas. Specifically, the cannulas break the fibrous bridges that originate from the herniation of subcutaneous fat. While this method represents a significant advance in the treatment of cellulite, a disadvantage of this method is that it uses an instrument that was not designed for the purpose of cutting fibrous bridges or septae. The use of a liposuction cannula is invasive, awkward, imprecise, and physically difficult.  
      Because treatment of cellulite by breaking fibrous bridges or septae is a recent development, prior art surgical devices were not developed with this purpose in mind. Prior art cutting devices generally contemplate cutting tissue other than fibrous bridges using a cutting mechanism located at the distal tip of the device. Several representative prior art devices are described below. Each of the devices described would need to be used in the same manner that the liposuction cannula is employed in the Lieberman-Cohen method and suffers from the same and additional disadvantages.  
      U.S. Pat. No. 3,526,219 to Balamuth (the “Balamuth reference”) is directed to a method and apparatus for ultrasonically microchopping tissue and removing the tissue fragments from a body. The Balamuth device has a fine edge that is vibrated in the ultrasonic frequency range and accelerated above 50,000 g to produce a tissue breakdown fundamentally different from tissue slicing. A fluid stream controls temperature while a built-in suction machine removes tissue and fluid. Because the Balamuth fine edge is located at the distal tip, the device is adapted only for removal of tissue directly ahead of the distal tip.  
      U.S. Pat. No. 5,690,664 to Sauer et al. is directed to a laparoscopic trocar that has a cutting blade positioned inside the distal tip of the trocar for penetrating the peritoneum. The Sauer trocar is pistol-shaped and an operator deploys the distally located cutting blade by pulling a trigger. Movement of the cutting blade between the non-deployed and deployed positions facilitates tissue penetration by cutting the tissue directly ahead of the distal tip of the trocar.  
      An example of a surgical cutting instrument for removing sections of bodily tissue taking a slightly different approach from the devices discussed above is U.S. Pat. No. 6,152,894 to Kubler (the “Kubler reference”). The Kubler instrument is a pointed linear shank percutaneously insertable through a trocar. Once inserted, an external actuator pulls a cord inside the device that deforms the distal end of the shank into a curved sickle shape. Cutting blades are arranged along the inside curve of the curved sickle and a spherical piece of tissue located at the end of the shank may be excised by rotating the shaft of the Kubler device. Although the Kubler approach is somewhat different, the tissue cut is still directly ahead of the distal tip of the device.  
      U.S. Pat. No. 5,419,761 to Narayanan et al. (the “Narayanan reference”) is directed to a cannula for an ultrasonic liposuction method. The Narayanan cannula transmits an ultrasonic wave through the cannula producing cavitation at the distal tip. Adipose tissue is liquefied in front of the distal tip and aspirated through a bore in the cannula. A disadvantage of the Narayanan cannula is that the intensity of the ultrasonic wave would likely need to be increased substantially to sever fibrous tissue and this increase would likely result in unwanted ancillary damage to nearby tissue. In addition, the tissue acted upon is still directly ahead of the distal tip of the device.  
      U.S. Pat. No. 5,569,291 to Privitera et al. (the “Privitera reference”) is directed to a surgical penetration instrument for dissection having a tube through which an endoscope can be inserted. The endoscope locks into place so that movement relative to the tube is prevented. A conical transparent tip on the tube allows the endoscope to visualize the insertion path and treatment site. The conical tip has two blades positioned 180 degrees apart that extend longitudinally from the tip to the base of the conical tip. The blades are for facilitating insertion and cutting target tissues. The Privitera device views and cuts tissue only directly ahead of the distal tip.  
      U.S. Pat. No. 5,797,944 to Nobles et al. (the “Nobles reference”) is directed to a laparoscopic trocar allowing a view. The Nobles trocar has blades positioned on a pointed head for percutaneous insertion. A slanted window on the pointed head and a hollow shaft allow visualization by an optional endoscope. The Nobles reference provides a view only directly ahead of the distal tip of the device.  
     BRIEF SUMMARY OF THE INVENTION  
      The present invention relates to an apparatus and method for making the appearance of cellulite less obvious by cutting the fibrous bridges that connect the skin to muscle or the fibrous septae in subcutaneous fat in a minimally invasive manner, and specifically to a percutaneous cellulite removal needle with at least one lateral opening in its peripheral surface through which a surgical instrument and/or a cutting mechanism retracts or protrudes and methods for using the percutaneous cellulite removal needle.  
      A percutaneous cellulite removal needle of the present invention includes a body having an internal chamber that ends at a laterally disposed aperture defined in the outer peripheral surface of the body. A cutting mechanism is substantially positioned within the internal chamber in a retracted position and at least partially protrudes through the laterally disposed aperture in a cutting position. A situating mechanism transitions the cutting mechanism between the retracted position and the cutting position. Additional chambers for additional surgical instruments may be incorporated in the invention.  
      The present invention also includes a method for cutting fibrous bridges that connect skin to muscle or the fibrous septae in subcutaneous fat in a minimally invasive manner. In this method the percutaneous cellulite removal needle is inserted through the skin with the cutting mechanism in the retracted position. The cutting mechanism is then extruded so that the cutting mechanism is in the cutting position. Next the cutting mechanism is actuated, for example by rotating, to cut at least one the fibrous bridge. These steps may be repeated to cut other fibrous bridges reachable by the cutting mechanism. The cutting mechanism is then retracted and the percutaneous cellulite removal needle is removed.  
      The foregoing and other objectives, features, and advantages of the invention will be more readily understood upon consideration of the following detailed description of the invention, taken in conjunction with the accompanying drawings.  
    
    
     BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS  
       FIG. 1  is a side cross-sectional view of a generic preferred embodiment of the percutaneous cellulite removal needle of the present invention showing a flexible, retractable cutting mechanism in an extended, cutting position.  
       FIG. 2  is a perspective view of a first exemplary embodiment of the percutaneous cellulite removal needle of the present invention.  
       FIG. 3  is a side cross-sectional view of a second exemplary embodiment of the percutaneous cellulite removal needle of the present invention.  
       FIG. 4  is a side cross-sectional view of a third exemplary embodiment of the percutaneous cellulite removal needle of the present invention.  
       FIG. 5  is a side cross-sectional view of an exemplary embodiment of the percutaneous cellulite removal needle of the present invention showing, a substantially solid body embodiment, the internal chamber formed as a guide shaft, and the lateral aperture having a cover.  
       FIG. 6  is a side view of an exemplary embodiment of the percutaneous cellulite removal needle of the present invention showing a cutting mechanism in a cutting position, an endoscope in an operative position, and an aspiration in an operative position.  
       FIG. 7  is a side view of an exemplary embodiment of the percutaneous cellulite removal needle of the present invention showing two lateral apertures formed in the outer peripheral surface on opposite sides of the percutaneous cellulite removal needle.  
       FIG. 8  is a top view of an exemplary embodiment of the percutaneous cellulite removal needle of the present invention showing directions of movement to sever fibrous bridges.  
       FIG. 9  is a flow chart showing an exemplary method of the present invention.  
       FIGS. 10-12  illustrate exemplary steps of the method of  FIG. 9 .  
       FIG. 13  is a cross sectional side view of an exemplary embodiment of the present invention where the situating mechanism is a lever.  
       FIG. 14  is a cross sectional side view of an exemplary embodiment of the present invention where the situating mechanism is a dial.  
       FIG. 15  is an enlarged partial cross sectional side view of an exemplary embodiment of the present invention where the situating mechanism is a ratchet.  
       FIG. 16  is a cross sectional side view of an exemplary embodiment of the present invention where the situating mechanism is a button.  
    
    
     DETAILED DESCRIPTION OF THE INVENTION  
      As shown in  FIGS. 1-4 , the present invention is directed to a percutaneous cellulite removal needle  30  (exemplary preferred embodiments are labeled as  30   a  ( FIG. 2 ),  30   b  ( FIG. 3 ), and  30   c  ( FIG. 4 )) that includes a surgical instrument (shown individually as  29   a - 29   k,  but discussed as a group as  29 ) such as a flexible blade or other cutting mechanism  31  for cutting the fibrous bridges  28  or the fibrous septae in subcutaneous fat that connect the dermis  22  to muscle/fascia  26  in a minimally invasive manner. Throughout the remainder of this disclosure, the fibrous bridges  28  will be discussed, but the same principles can be applied to fibrous septae in subcutaneous fat.  FIG. 1  shows a generic or basic percutaneous cellulite removal needle  30  of the present invention that will be used to discuss some of the features of the various embodiments.  
      The Body: The main housing or body  32  of the percutaneous cellulite removal needle  30  consists of a slender, elongated, hollow tube with an internal chamber  33  that houses the cutting mechanism  31 . The body  32  may be rigid or flexible. In shown preferred embodiments, the body  32  has a proximal end  34   a  which remains outside the human body and a closed distal end  34   b  suitable for penetrating tissue and insertion within the human body. The internal chamber  33  preferably ends in a lateral aperture  35  formed in the outer peripheral surface  36  of the body  32  near the distal end  34   b.  The body  32  may have a cross section of any shape and, for exemplary purposes only, is being shown as a circular cross section. Similarly, the internal chamber  33  may have a cross section of any shape and, for exemplary purposes only, is being shown as circular. The outer peripheral surface  36  is preferably smooth to aid in insertion.  
      For purposes of describing the present invention, the term “needle” means a slender, elongated, hollow instrument with a lateral opening in its peripheral surface. It should be understood that the term needle, as used herein, includes a needle, a trocar, a trocar obturator, a trocar cannula, a tube, a cylinder or any other slender, elongated, hollow instrument or device suitable for use in the surgical procedure of the present invention. The term “needle” further refers to any slender, hollow, sharp-pointed instrument for puncturing tissue and introducing material into a human body. A trocar (or trocar obturator or obturator) commonly refers to an elongated, cylindrical shaft or rod with a sharp tip capable of penetrating tissue and is ordinarily used with a cannula (or trocar cannula). A trocar cannula is an elongated hollow tube that functions as a sleeve for the trocar obturator. In use, the trocar obturator is slid into the trocar cannula and the assembly is advanced into tissue. After the assembly has penetrated the human body wall, the trocar obturator is withdrawn leaving the trocar cannula. The trocar cannula may be used to withdraw fluids from various body cavities, or used as a passage way for the insertion and withdrawal of surgical instruments in procedures such as endoscopic surgery. The term trocar also refers to the assembly of the trocar obturator and trocar cannula. In addition, the terms trocar or cannula may also refer to specialized surgical instruments adapted from the traditional trocar obturator/cannula assembly, such as a cannula that serves as a passageway for an aspirator in liposuction procedures. The percutaneous cellulite removal needle  30  may be any of these needles.  
      In one preferred embodiment, a sharp blade-like edge distal end  34   b  facilitates penetration of tissue. The blade-like edge distal end  34   b  may be an integral or separate component removably attached to percutaneous cellulite removal needle  30 . In addition, the blade-like edge distal end  34   b  may consist of two or more blades. In an alternative preferred embodiment, the distal end  34   b  is rounded and blunt, as shown in  FIG. 5 . This blunt embodiment is advantageous when percutaneous cellulite removal needle  30  is inserted into an incision made by another instrument and/or protection of tissue directly ahead of the percutaneous cellulite removal needle  30  is desired. Other shapes for distal end  34   b  are contemplated, such as conical. The choice of shape for distal end  34   b  depends on the surgical site where the method of the present invention will be performed and the preferences of the surgeon.  
      The Lateral Aperture. The lateral aperture  35  is preferably formed in the outer peripheral surface  36  near the distal end  34   b  of the percutaneous cellulite removal needle  30 . This location provides the advantage of minimizing the depth that the percutaneous cellulite removal needle  30  should be inserted. But the lateral aperture  35  need not be formed near the distal end  34   b.  In alternative exemplary embodiments, the lateral aperture  35  may be formed at any point between the proximal and distal ends  34   a,    34   b.    
      In addition, in alternative preferred embodiments the percutaneous cellulite removal needle  30  may include two or more lateral apertures  35  (e.g. two lateral apertures  35  formed on the same side of the percutaneous cellulite removal needle  30  ( FIG. 6 ) or lateral apertures  35  formed on the opposite sides of the percutaneous cellulite removal needle  30  ( FIG. 7 )).  
      The lateral aperture  35  may be round, oval, rectangular, or any other suitable shape.  
      To prevent tissue and fluids from entering the internal chamber  33 , the lateral aperture  35  may have a cover  52  ( FIGS. 4 and 5 ) associated with it that may be closed ( FIG. 5 ) to facilitate insertion and removal of the surgical percutaneous cellulite removal needle  30 , and opened ( FIG. 4 ) when the surgical percutaneous cellulite removal needle  20  is in its cutting position. The cover  52  may hold and/or support the cutting mechanism  31  at a desired angle (shown as a right angle, but any angle could be accomplished). The cover  52  may be self-sealing. For example, in one alternative embodiment (not shown) it could be a self-sealing membrane. It should be noted that the cover  52  is an optional feature of the present invention.  
      The Cutting Means. The cutting mechanism  31  of the present invention is shown as a thin flexible blade for cutting fibrous bridges  28 . The shown flexible blade  31  may extend through the lateral aperture  35  approximately 0.5 to 3 cm. The width of flexible blade  31  may be 1 to 5 mm. These dimensions, however, are exemplary and other dimensions are contemplated. In addition, it is contemplated that the cutting mechanism  31  may be any of a variety of apparatus known in the art for cutting tissue, such as a cautery (shown as  29   b  in  FIG. 6 ), a harmonic scalpel (shown as  29   c  in  FIG. 6 ), an ultrasonic cutting instrument (shown as  29 d in  FIG. 6 ), a rotary cutter (shown as  29   e  in  FIG. 6 ), a laser cutter (shown as  29   f  in  FIG. 6 ), an oscillating saw (shown as  29   g  in  FIG. 6 ), or any other suitable cutting apparatus. Devices known in the art for cutting tissue are collectively referred to herein as cutting mechanisms  31 .  
      The cutting mechanism  31  preferably moves between two positions: a retracted position in which the cutting mechanism  31  is within the internal chamber  33  and a cutting position (in phantom) in which the cutting mechanism  31  extends through the lateral aperture  35  to the side of the percutaneous cellulite removal needle  30 . In the retracted position, the cutting mechanism  31  is substantially contained within the internal chamber  33  and may rest on or near a guide surface  46  formed by the closed distal end  34   b.  In the cutting position, the cutting mechanism  31  may be substantially perpendicular to the longitudinal axis of the percutaneous cellulite removal needle  30 . (The longitudinal axis is an imaginary line running through the center of percutaneous cellulite removal needle  30  from the proximal end  34   a  to the distal end  34   b. ) The guide surface  46  serves to guide the cutting mechanism  31  from its retracted position to its cutting position, and may be, for example, sloped, curved, or flat.  
       FIG. 8  shows a top view of an exemplary percutaneous cellulite removal needle  30  in the cutting position with the cutting mechanism  31  extending out of the internal chamber  33 . In the shown embodiment, the cutting mechanism severs fibrous bridges  28  as it is moved in the direction of action arrow R. Alternatively, or in combination, the cutting mechanism  31  may have a sharp tip for cutting. In this embodiment, the cutting mechanism  31  severs fibrous bridges  28  as it is moved in the direction of action arrow D.  
      The Situating Means. A situating mechanism  44  (the reference numeral  44  (as shown in  FIGS. 4 and 8 ) is a general reference to any type of situating mechanism including, but not limited to exemplary situating mechanisms  44   a - 44   f  ( FIG. 1 )) controls the transition of the cutting mechanism  31  between the retracted position in which the cutting mechanism  31  is within the internal chamber  33  and the cutting position in which the cutting mechanism  31  extends through the lateral aperture  35  to the side of the percutaneous cellulite removal needle  30 . Exemplary situating mechanisms  44  may include an extrusion mechanism  44   a  ( FIG. 2 ) such as a button or lever that maybe slid between two positions, a handle  44   b  ( FIG. 3 ) that may be pulled up or pushed down, a dial  44   c  ( FIG. 14 ) that may be rotated between two positions, a ratchet  44   e  ( FIG. 15 ), or any device capable of having two positions. Details of exemplary situating mechanisms are shown in  FIGS. 13-16  (e.g. a lever  44   d  ( FIG. 13 ), a dial  44   c  ( FIG. 14 ), a ratchet  44   e  ( FIG. 15 ), and a button  44   f  ( FIG. 16 )). These situating mechanisms are meant to be exemplary and are not meant to limit the scope of the invention.  
      The Connecting Means. In a preferred embodiment, a connecting member  42  is contained within internal chamber  33 . One end of the connecting member  42  is functionally connected to the cutting mechanism  31 . The other end of the connecting member  42  is functionally connected to the situating mechanism  44 . The present invention, however, contemplates alternatives to connecting member  42 . In one preferred embodiment, the cutting mechanism  31  extends the length of internal chamber  33  and attaches directly to situating mechanism  44 , eliminating the need for connecting member  42 . In another preferred embodiment the connecting member  42  extends perpendicular to the cutting mechanism and through the body  32  to the situating mechanism  44  ( FIG. 2 ).  
      If the cutting mechanism is not the flexible blade  31  or if alternative surgical instruments other than cutting mechanisms  31  are received within internal chamber  33 , a connecting member  42  may be used, an alternative connecting member may be used, or no connecting mechanism may be used. For example, a laser cutter may use an optical fiber enclosed in a rigid tubular housing as a connecting member  42 . As another example, a cautery may use an insulated shaft covering electrically conductive wires as a connecting member  42 . In yet another example, a rotary cutter may require a connecting mechanism capable of transferring rotational mechanical energy, such as driveshaft enclosed in a housing.  
      The Actuating Means. The term “actuating mechanism 54” refers to any device that may be used to cause an instrument to perform its designated function. In one preferred embodiment, an actuating mechanism  54  may be used to rotate the percutaneous cellulite removal needle  30  to cut fibrous bridges  28 . In alternative embodiments, actuating mechanisms might include mechanisms for starting and/or controlling surgical instruments such as endoscopes or aspirators.  
      Exemplary actuating mechanisms  54  (the reference numeral  5  (as shown in  FIG. 8 ) is a general reference to any type of actuating mechanism including, but not limited to exemplary situating mechanisms  54   a - 54   h  (shown in phantom in  FIG. 1 )) may include the housing  54   a  ( FIG. 2 ) that can be rotated between a user&#39;s fingers, a movable handle  54   b  ( FIG. 3 ), or a fixed handle  54   c  ( FIG. 4 ). Alternative actuating mechanisms  54  may include levers  54   d,  dials  54   e,  ratchets  54   f,  buttons  54   g,  or any other similar device or apparatus  54   h  that causes the cutting mechanism  31  to sever fibrous bridges  28 . These actuating mechanisms  54  are meant to be exemplary and are not meant to limit the scope of the invention.  
      In the embodiment of  FIG. 2 , the actuating mechanism  54   a  is the exterior housing  54   a  that may be rotated by a user so that the cutting mechanism is rotated about the longitudinal axis. In this embodiment the percutaneous cellulite removal needle  30  can also be actuated using the housing  54   a  by pushing in and pulling out the entire needle, moving the needle back and forth, or making saw-like motions.  
       FIGS. 3, 4 , and  8  show another preferred embodiment where the T-handle actuating mechanism  54   b,    54   c  rotates the percutaneous cellulite removal needle  30  and/or cutting mechanism  31  about the longitudinal axis. In this embodiment, the rotating motion is indicated by the directional action arrows “R.” In the shown embodiment, as the percutaneous cellulite removal needle  30  is rotated, the sharp side-edge (shown as  31   a  in  FIG. 8 ) of flexible blade  31  severs fibrous bridges  28 .  
      In another preferred embodiment the percutaneous cellulite removal needle  30  is actuated when a blade  31  with a sharp tip moves forward (e.g. protruding out of the needle  30 ) and backward to cut fibrous bridges  28 . This actuating movement is shown in the figures as motion D. For example, when an actuating mechanism  54  is pushed down, the sharp tip moves forward to cut fibrous bridges  28  in front of it and, when the actuating mechanism  54  is pulled up, sharp tip is pulled in and reset for future cutting. In yet another preferred embodiment a serrated blade may be used that may also cut on backward movement.  
      Additional or Optional Features.  FIG. 5  shows several exemplary additional or optional features that may be incorporated into any of the embodiments of the present invention. For example,  FIG. 5  shows exemplary additional or optional substantially solid needle body  32 ′. Another exemplary additional or optional feature is a blunt distal end  34   b ′. Yet another exemplary additional or optional feature is a cover  52  that covers the lateral aperture  35 . This cover could be the cover of  FIG. 4  in the closed position. The cover shown  52  is self-sealing.  
       FIGS. 6 and 7  show exemplary or optional additional lateral apertures (which may be sealed with optional covers (not shown)) through which other surgical instruments  29  may be used alone or in combination with the cutting mechanism  31 . In addition to surgical instruments  29  such as cutting mechanisms  31 , (e.g. a flexible blade (shown as  29   a  in  FIG. 6 ), cautery (shown as  29   b  in  FIG. 6 ), a harmonic scalpel (shown as  29   c  in  FIG. 6 ), an ultrasonic cutting instrument (shown as  29   d  in  FIG. 6 ), a rotary cutter (shown as  29   e  in  FIG. 6 ), a laser cutter (shown as  29   f  in  FIG. 6 ), an oscillating saw (shown as  29   g  in  FIG. 6 ), and/or a saw blade (shown as  29   h  in  FIG. 6 ) other surgical instruments  29  may include, for example, an endoscope (shown as  29   i  in  FIG. 6 ), an aspirator (shown as  29   j  in  FIG. 6 ), and/or an irrigation mechanism (shown as  29   k  in  FIG. 6 ). An embodiment including multiple apertures may be used to view a surgical site and to simultaneously perform both liposuction and sever fibrous bridges  28  or septae. In one preferred embodiment, a mechanism for visualizing a surgical site, such as an endoscope or other visualizing instrument, is used with the percutaneous cellulite removal needle  30 . In another preferred embodiment, a mechanism for aspirating a surgical site is used with percutaneous cellulite removal needle  30 . The mechanism for aspirating may be any surgical aspirator. In still another preferred embodiment, an irrigation mechanism is used with percutaneous cellulite removal needle  30 . The irrigation mechanism would be used for introducing irrigation or fluid to increase tissue tumescense and accentuate the appearance of cellulite by tightening fibrous bridges or septae. In these multiple lateral aperture embodiments, it is contemplated that the other surgical instruments  29  may be used alone or in combination with the cutting mechanism  31 . For example, using the embodiment of  FIG. 6  an endoscope, an aspirator, and a cutting mechanism  31  may be used simultaneously.  
      It should be noted that alternative surgical instruments  29  (e.g. endoscopes (shown as  29   i  in  FIG. 6 ), aspirators (shown as  29   j  in  FIG. 6 ), and/or irrigation mechanisms (shown as  29   k  in  FIG. 6 )) can be used alone in place of the cutting mechanism  31  in a single lateral aperture embodiment. Further, the alternative surgical instruments  29  may be used in various combinations in a multiple lateral aperture embodiment.  
      Another additional or optional feature, as shown in  FIG. 2 , is a depth indicator  60 . As shown, the depth indicator  60  may be markings near the distal end  35   b  that clearly set forth measurements. The depth indicator  60  may be, for example, a numerical or a color coded indicator.  
      Yet another additional or optional feature (not shown) is a needle sheath that serves to protect tissue from the cutting mechanism  31  until the cutting mechanism  31  is completely extended and in the correct position for cutting.  
      It should be noted that the present invention may be used for the exemplary stated purposes. Further, the present invention may be used for adhesions. Still further, the present invention may be used as an endoscopic or arthroscopic cutting device. Although the present invention may be used manually, in alternative preferred embodiments it may be manipulated by machines.  
      It should be noted that other embodiments not shown or discussed could be used to implement the present invention. For example, a “ball-point pen” embodiment could be developed where pushing a button causes the blade to retract or protrude and it is held in position by a spring and notch mechanism. Other embodiments could use blades that telescope or unwind.  
      First Embodiment Example. Referring to in  FIG. 2 , a first exemplary preferred embodiment of the present invention of the percutaneous cellulite removal needle  30   a  includes a thick flexible and retractable blade  31 . An extrusion mechanism is the situating mechanism  44   a  that controls the transition of the flexible blade  31  between a retracted position in which the flexible blade  31  is within the internal chamber  33  and a cutting position (in phantom) in which the flexible blade  31  extends through the lateral aperture  35  to the side of the percutaneous cellulite removal needle  30   a.  The plastic housing  32  serves as the actuating mechanism  54   a  as the surgeon rotates the housing  32  between his fingers so that the flexible blade  31  rotates to cut fibrous bridges  28 .  
      Second Embodiment Example. Referring to  FIG. 3 , a second exemplary preferred embodiment of the present invention of the percutaneous cellulite removal needle  30   b  includes a flexible and retractable blade  31  that is connected directly or indirectly to a handle  44   b,    54   b  that serves both as the situating mechanism  44   b  and the actuating mechanism  54   b.  In this embodiment the lateral aperture  35  is an elongated slot perpendicular to the longitudinal axis of the needle  30 . By pushing the handle up and down it acts as the situating mechanism  44   b  that controls the transition of the flexible blade  31  between a retracted position and the cutting position (in phantom). In this embodiment the body  32  is held in place and, by rotating the handle  54   b  it acts as the actuating mechanism  54   b  and moves the blade  31  within the elongated slot lateral aperture  35 . Alternatively, the body  32  may be rotated to act as the actuating mechanism  54   b.    
      Third Embodiment Example. Referring to  FIG. 4 , a third exemplary preferred embodiment of the present invention of the percutaneous cellulite removal needle  30   c  includes a flexible and retractable blade  31  within a chamber. At the closed proximal end  34   a  of this embodiment is a T-handle  54   c  that serves as the actuating mechanism. A separate situating mechanism such as a dial  44   c  is preferably connected directly or indirectly to the flexible blade  31  and may be moved (perhaps by rotating) between two positions to control the transition of the flexible blade  31  between a retracted position and the cutting position. Rotating the T-handle  54   c  while the flexible blade  31  is in the cutting position causes the blade  31  to rotate and sever fibrous bridges  28 . The embodiment shown in this figure also includes an optional cover  52  that covers the lateral aperture  35 . In one preferred embodiment, cover  52  helps hold flexible blade  31  in a substantially perpendicular cutting position by providing a perpendicular support surface.  
      Dimensions. In one preferred embodiment, the percutaneous cellulite removal needle  30  is a large bore (1.5-2.0 mm) percutaneous cellulite removal needle, such as a 12 or 14 gauge needle. In an alternative preferred embodiment, the percutaneous cellulite removal needle  30  would have a length of 15 cm and an outer diameter of 6 mm. The internal chamber  33  of the percutaneous cellulite removal needle  30  is preferably of sufficient size (diameter up to 4 mm) to accommodate one or more instruments. Similarly, the lateral opening in the peripheral surface of the percutaneous cellulite removal needle  30  is preferably of sufficient size (diameter up to 2 mm) to form a passageway for at least one of the instruments. These dimensions are exemplary and other dimensions are contemplated depending on the surgical site, the dimensions of the cutting mechanism  31  and/or other instrument(s), the size of the patient (for example, there may be small, medium, and large embodiments), and other size related factors.  
     Methods  
      The present invention is also directed to methods for cutting the fibrous bridges  28  that connect the dermis  22  to muscle/fascia  26  in a minimally invasive manner. For purposes of illustrating one preferred method of the present invention, reference is made to the preferred embodiment of the percutaneous cellulite removal needle  30  shown in  FIG. 2 . It will be assumed that standard medical practices (e.g. sterilization and anesthesia) will be observed and, therefore, are not discussed as part of this exemplary method.  FIG. 9  shows the basic steps of the exemplary method and  FIGS. 10-12  show graphical representations of some of the steps.  
      The first step is preferably to locate at least one dimple on the skin  100 . This step could be avoided if, for example, the remaining steps are practiced in a systematic manner (e.g. by insertion of the percutaneous cellulite removal needle  30  at regular intervals). Alternatively, this step could be avoided or reduced by a series of random insertions where to provide a quick start to the procedure and, after a majority of fibrous bridges  28  have been cut, the step of locating the dimples could be practiced.  
      Next, the fibrous bridge  28  may be tightened  102 .  FIG. 10  illustrates a method for performing this step using a suction device to gently lift the skin around the fibrous bridge  28 . Using suction the user can lift the area of treatment, accentuating tension on the fibrous band  28 . Alternative methods could be using adhesive in place of the suction or simply pinching the skin around the fibrous bridge  28 . It should be noted that this step is optional, can be performed before or after insertion, and can be accomplished using alternative methods. Another example of an alternative method to ease visualization could be to inject fluid (either using the percutaneous cellulite removal needle  30  or via a separate injection needle) to cause tension on the fibrous band. A small wheal of local anesthetic can optionally be administered.  
      The percutaneous cellulite removal needle  30  is then inserted through the skin  104 . Specifically, the distal end  34   b  of the percutaneous cellulite removal needle  30  is inserted through the skin with the cutting mechanism  31  in a retracted position. For example, with the cutting mechanism  31  in its retracted position, the handle  54  may be used to push the percutaneous cellulite removal needle  30  through the skin  24  until the lateral aperture  35  reaches the desired depth. It should be noted that the depth indicator  60  could be used to verify the depth of the lateral aperture  35 . The percutaneous cellulite removal needle  30  may then be used to probe for one or more fibrous bridge  28  to be cut  106 .  
      In one alternative embodiment, the percutaneous cellulite removal needle  30  has a blunt distal end  34   b  and, therefore, a separate instrument may be used to make an insertion in the skin  24 . The percutaneous cellulite removal needle  30  is then inserted into the insertion to probe for and/or cut the fibrous bridge  28 . In another alternative embodiment, a separate instrument may be used to probe for fibrous bridges  28  to be cut.  
      Once a fibrous bridge  28  is found, the cutting mechanism  31  is extruded  108  using the situating mechanism  44 . As shown in  FIG. 11 , in one preferred embodiment of the method, the extruding may be through the side of the percutaneous cellulite removal needle  30 . In one preferred embodiment, by activating the situating mechanism  44 , the connecting member  42  forces the cutting mechanism  31  from its retracted position within the internal chamber  33 , through lateral aperture  35 , and into its cutting position.  
      Then, using the actuating mechanism  54 , the cutting mechanism  31  is actuated so as to cut the fibrous bridge  110 . In one preferred embodiment the cutting is accomplished by rotating the percutaneous cellulite removal needle  30 . Using the percutaneous cellulite removal needle  30  of  FIG. 2 , the activating mechanism  54   a  may be used to turn the percutaneous cellulite removal needle  30  about its longitudinal axis. As the percutaneous cellulite removal needle  30  is turned, the cutting mechanism  31  severs one or more fibrous bridge  28  located within a radius of percutaneous cellulite removal needle  30  defined by the length of the cutting mechanism  31 .  
      As shown in  FIG. 12 , the cutting mechanism  31  may then be retracted  112  and the percutaneous cellulite removal needle  30  may either be used to further probe for more fibrous bridges  28  or removed  114 .  
      The steps set forth above are preferably repeated. The procedure may be done in a staged fashion. For example, after the percutaneous cellulite removal needle  30  has been rotated 360°, the procedure may be repeated at another location at the surgical site until all fibrous bands at the surgical site have been severed.  
      While a preferred method of the present invention has been described with reference to one preferred embodiment, it will be appreciated that this method may be appropriately modified to accommodate other embodiments of the present invention. For example, the step of turning or rotating the percutaneous cellulite removal needle  30  to sever fibrous bridges  28  may be modified so that the cutting mechanism  31  is moved in the direction of action arrow D to sever fibrous bridges  28  or as the cutting mechanism may require. Further, although the disclosure focused on fibrous bridges  28 , the same principles can be applied to fibrous septae in subcutaneous fat.  
      The terms and expressions that have been employed in the foregoing specification are used as terms of description and not of limitation, and are not intended to exclude equivalents of the features shown and described or portions of them. The scope of the invention is defined and limited only by the claims that follow.