Cellulite Treatments

CHAPTER 61 Cellulite Treatments



Yves Hébert


Cellulite is a condition that occurs mostly in postpubescent women in which the skin of the lower limbs, abdomen, and pelvic region becomes dimpled. The term was first used in the 1920s in France and began appearing in English-language publications in the late 1960s.


Descriptive names for cellulite include orange-peel syndrome and cottage cheese skin. Synonyms include adiposis edematosa, dermopanniculosis deformans, sclerotic-fibrous-edematous panniculopathy, and gynoid lipodystrophy.



Anatomy of Cellulite


Fat is stored in fat cells that lie between the skin and the muscle underneath.


The fat cells are grouped together into large collections that are separated by fibrous strands, or septa (Fig. 61-1). These septa run between the muscle and the skin. As the fat cells expand with weight gain, the gap between muscle and skin expands, but unfortunately the septa cannot stretch. This results in the dimpling characteristic of cellulite.


image

Figure 61-1 Skin and subcutaneous tissue with fat lobules and septa.


The layers of fat are separated into three zones by two planes of connective tissue (Fig. 61-2):


• The upper zone, where the fat cell chambers stand vertically separated by radially running septa of connective tissue

• The middle and lower zones, where the squat fat chambers and the septa of connective tissue run tangentially to the fascia

image

Figure 61-2 Zones of connective tissue in the hypodermis.



Classification


Cellulite is classified using the Nurnberger-Muller scale:


• Stage 0: Skin surface is smooth while standing or lying, but folds or furrows appear when the skin is pinched.

• Stage 1: Skin surface is smooth while standing or lying, but dimples appear when the skin is pinched.

• Stage 2: Cellulite is present when standing, but disappears when lying.

• Stage 3: Cellulite is present regardless of position.


Pathophysiology


The overlying skin begins to bulge as excess fat is stored in the subcutaneous fat cells. With time, the accumulating fatty deposits compress the circulation and create congestion. As congestion increases, fluid and sugars leak out of the vessels to form complex sugar chains that draw even more fluid out of the vasculature through osmolarity. Fat cells begin to organize within fibrous nets to become fatty lobules. Gradually, these fatty lobules invade the skin’s dermis and the fibrous nets become more rigid, finally creating skin dimpling (“peau d’orange”).



Causes of Cellulite


Currently, the causes of cellulite are poorly understood. It is widely accepted that hormonal factors play a dominant role:


• Estrogens seem to initiate and aggravate cellulite

• Insulin, catecholamines, epinephrine and norepinephrine, thyroid hormones, and prolactin participate in the development of cellulite

Disorders of water metabolism, abnormal hyperpolymerization of the connective tissue, and chronic venous insufficiency are also involved in the pathogenesis of cellulite.


Many predisposing factors are identifiable:


• Sex

• Race

• Phenotype

• Lifestyle

• Smoking status

• Predisposition to circulatory insufficiency

• Abnormal distribution of subcutaneous fat (apple or pear shape)

• Obesity


Treatment of Cellulite



Detoxification Diet


The detoxification diet has been shown to affect the development and amount of cellulite, but it is not a definite cure for cellulite. This diet recommends less alcohol, caffeine, refined food (salt), saturated fat, refined carbohydrates, smoking, diet pills, sleeping pills, laxatives, and diuretics, and more fresh vegetables and fruits, water, fibers and whole-grain foods, essential nutrients (calcium, potassium, vitamins B and C, glucosamine), and essential fatty acids. All patients wishing to improve the appearance of cellulite should adopt most of the recommendations of this diet but must understand that diet by itself is not a cure for cellulite.



Exercise


Exercise plays an important role in cellulite reduction and is one of the most effective and inexpensive measures for cellulite reduction. Exercise improves the following:


• Muscle tone

• Circulation

• Lymphatic drainage

Aerobic activity, yoga, Pilates, swimming, walking, biking, and stair climbing are excellent forms of exercise for patients with cellulite. Exercise is a fundamental part of the treatment of cellulite and should be strongly encouraged in all patients.



Physical and Mechanical Methods


Numerous therapies have been attempted:


• Iontophoresis (transdermal transmission of medication using small electrical charges)

• Ultrasound (high-frequency sound waves)

• Thermotherapy (induced localized hyperthermia)

• Pressotherapy (pneumatic massaging in the direction of the circulation)

• Lymphatic drainage (massage technique to stimulate lymphatic flow)

• Electrolipophoresis (application of a low-frequency electric current)

However, no reports in the scientific literature have shown consistent results. They are possibly helpful in selected patients with lymphatic drainage deficiency.



Pharmacologic Agents


Several drugs that act on fatty tissue have been tried as therapeutic agents. Certain drugs act on the fatty tissue, connective tissue, and the microcirculation. They can be used topically, systemically, or transdermally:


• Methylxanthines (theobromine, theophylline, aminophylline, caffeine), which act through phosphodiesterase inhibition

• Pentoxyphilline, which improves the microcirculation

• β-Adrenergic agonists (isoproterenol and epinephrine)

• α-Adrenergic agonists (yohimbine, piperoxan, phentolamine, dihydroergotamine)

• Methylxanthine enhancers (coenzyme A and the amino acid L-carnitine)

• Drugs with connective tissue activity (silicium and Centella asiatica)

• Microcirculation-active drugs (Indian chestnut, gingko biloba, and rutin)

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May 14, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Cellulite Treatments

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