Cellulite : pathophysiology and treatment

220 Pages·2010·14.327 MB·English

by  Goldman, Mitchel P., Hexsel, Doris

Cellulite
PATHOPHYSIOLOGY AND TREATMENT
Second edition
Basic and Clinical Dermatology
Series Editor
Alan R. Shalita, M.D.
Distinguished Teaching Professor and Chairman
Department of Dermatology
SUNY Downstate Medical Center
Brooklyn, New York
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Cellulite
PATHOPHYSIOLOGY AND TREATMENT
Second edition
edited by
Mitchel P Goldman, MD
Volunteer Clinical Professor of Medicine/Dermatology
University of California
San Diego, California
USA
Doris Hexsel, MD
Preceptor and Coordinator, Cosmetic Dermatology
Department of Dermatology
Pontifi cia Universidade Católica do Rio Grande do Sul
Porto Alegre, Rio Grande do Sul
Brazil
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Table of contents
Series introduction vi 13. Endermologie–LPG Systems“ aft er 15 Years 91
Preface vii Pier Antonio Bacci
List of contributors viii
14. Th e Use of the Tri-ActiveTM in the Treatment
1. Social Impact of Cellulite and Its Impact on of Cellulite 99
Quality of Life 1 Mitchel P Goldman
Doris Hexsel, Camile Luisa Hexsel, and
15. VelaSmooth and VelaShape 108
Magda B Weber
Neil S Sadick
2. Psychological Impact of Cellulite on the Aff ected
16. Accent“ Unipolar Radiofrequency 115
Patients 5
Jane Unaeze and David J Goldberg
Cristiano Brum
17. Scientifi c Bases for the Use of Low-Level Light
3. Anatomy of Cellulite and the Interstitial Matrix 8
Energy on the Treatment of Cellulite 120
Pier Antonio Bacci
Gordon H Sasaki
4. Defi nition, Clinical Aspects, Classifi cations, and 18. SmoothShapes“ Treatment of Cellulite and Th igh
Diagnostic Techniques 13 Circumference Reduction: When Less Is More 126
Doris Hexsel, Taciana de Oliveira Dal’Forno, and Michail M Pankratov and Serge Mordon
Rosemarie Mazzuco
19. High Frequency Ultrasound Evaluation of
5. Cellulite Pathophysiology 24 Cellulite Treated with the 1064 nm Nd:YAG Laser 136
Zoe Diana Draelos Régine Bousquet-Rouaud, Marie Bazan, Jean
Chaintreuil, and Agustina Vila Echague
6. Diagnostic Techniques 27
Molly Wanner and Mathew Avram 20. Dermoelectroporation and Biodermogenesi“ 145
Pier Antonio Bacci
7. Cellulite-Associated Clinical Conditions of
21. Carboxitherapy 151
Aesthetic Interest 33
Gustavo Leibaschoff
Rosemarie Mazzuco and Taciana de Oliveira
Dal’Forno
22. TriPollarTM Radiofrequency 158
Woraphong Manuskiatti
8. Medical Th erapy 43
Fabrizio Angelini, Carmine Orlandi,
23. CryolipolysisTM for Subcutaneous Fat Layer
Pietro Di Fiore, Luca Gatteschi, Mirko Guerra,
Reduction 168
Fulvio Marzatico, Massimo Rapetti, and
Mathew Avram
Attilio Speciani
24. Subcision“ 174
9. Topical Management of Cellulite 62
Doris Hexsel, Rosemarie Mazzuco, and
Doris Hexsel, Débora Zechmeister do Prado, and
Mariana Soirefmann
Mitchel P Goldman
25. Surgical Treatment: Liposuction, Liposculpture, and
10. Golden Lift “ in the Management of Cellulite:
Lipoplasty 180
A New Member from the Golden Peel“ Family 69
Gustavo Leibaschoff
José Enrique Hernández-Pérez, Mauricio
Hernández-Pérez, and Enrique 26. Study Protocols in Cellulite 191
Hernández-Pérez Débora Zechmeister do Prado, Amanda
Stapenhorst, and Marie-Laurence Abella
11. Injection Lipolysis for Body Sculpting and Cellulite
Reduction 74 27. Digital Photography and Other Imaging
Martin Braun Techniques in Cellulite 195
Ana Beatris Rossi, Alex Nkengne, and Christiane
12. No-Needle Mesotherapy 86 Bertin
Gustavo Leibaschoff Index 203
v
Series introduction
Over the past twenty-one years we have edited a series of forty-fi ve d emonstrates that the need for new information is compelling.
volumes relating to the art and science of dermatology. Th e series Th e authors, Drs Mitchel Goldman and Doris Hexsel, not only
has been purposefully broad in content to attract the interest of a are distinguished authorities in the fi eld in their own right, but
large variety of readers, from clinicians to basic scientists, affi liated also have assembled a coterie of other distinguished contribu-
with universities, industry, and in private practice. tors. We trust that this volume will again be of broad interest to
Th e past decade has seen an explosion in interest in aesthetic scientists and clinicians alike.
dermatology. Signifi cant advances have been made in cos-
metic science and in new instrumentation for the treatment
of aesthetic problems. Th us, a new focus has developed on the ALAN R. SHALITA, M.D., Sc.D(hon)
science of skin care both from the point of view of the practitioner Distinguished Teaching Professor and Chairman
as well as industry. Department of Dermatology
Th e latest addition to this series, Cellulite: Pathophysiology SUNY Downstate Medical Center
and Treatment, is the second edition of this popular work and Brooklyn, NY, U.S.A.
vi
Preface
Artists in painting and sculpture over the last two millennia business; it is estimated that the sales of cellulite equipment is over
have perceived beauty in a woman’s fi gure as consisting in few 30 million dollars each year.
muscles and a thick layer of subcutaneous fat. However, within It is therefore time for a comprehensive textbook on the
the last four decades, there has been a radical change in per- pathophysiology and treatment of cellulite. Th is subject is not
ception, with today’s society defi ning the ideal female body as taught in medical schools nor in residency training programs
youthful and almost pre-pubertal; well-defi ned musculature and there are few medical publications in the English language on
with very little body fat is now the ideal. Th is recent defi nition this subject. As patients go to their physicians (mostly cosmetic
of beauty has led to the development of a new medical “disease,” and plastic surgeons and dermatologists) to seek advice on the
cellulite. pathophysiology and treatment of cellulite, physicians will need
Cellulite can best be described as a normal physiologic state in to educate themselves on this subject.
post-adolescent women whose purpose is to maximize adipose To this end, we have enlisted the enthusiastic support of some
retention to ensure adequate caloric availability for pregnancy and of the world's leaders in cellulite research. Th ese respected profes-
lactation. Almost all women who are not cachectic have cellulite. sors and clinicians from the USA, Brazil, France, Italy, Argentina,
Th e topic of cellulite appears every month on multiple televi- Canada, Th ailand and El Salvador are recognized as leaders on
sion medical and talk shows, as well as in the lay public women’s this subject. Th ey have published numerous scientifi c papers on
health magazines (which oft en show the cellulite in various female this subject in both their native languages and English. Our role as
celebrities caught wearing a bathing suit, without the benefi t of the editors of this work, in addition to contributing separate chapters
air brushing that their publicity photographs undergo). Demand on our own unique research, is to ensure that this second edi-
for the treatment of cellulite has become extremely popular: tion of Cellulite is complete and up to date. We look forward to
“90% of women have cellulite and the other 10% think they do.” this textbook stimulating further research eventuating improved
Sales of various topical therapies constitute a multimillion-dollar treatment of this cosmetically important condition.
Mitchel P Goldman
Doris Hexsel
vii
List of contributors
Marie-Laurence Abella L’Oréal Recherche, Chevilly-Larue, Mitchel P Goldman Department of Dermatology, University of
France California, San Diego, California, USA
Fabrizio Angelini Department of Endocrinology, University of Mirko Guerra La Cittadella Socio Sanitaria di Cavarzere,
Parma, Parma, Italy Cavarzere, Italy
Mathew Avram Department of Dermatology, Massachusetts Enrique Hernández-Pérez Center for Dermatology and
General Hospital, Harvard Medical School, Boston, Massachu- Cosmetic Surgery, San Salvador, El Salvador
setts, USA
José Enrique Hernández-Pérez Center for Dermatology and
Pier Antonio Bacci University of Siena, and Cosmetic Patholo-
Cosmetic Surgery, San Salvador, El Salvador
gies Center, Arezzo, Italy
Mauricio Hernández-Pérez Center for Dermatology and
Marie Bazan Candela Corporation, Wayland, Massachusetts,
Cosmetic Surgery, San Salvador, El Salvador
USA
Camile Luisa Hexsel Department of Dermatology, Henry Ford
Christiane Bertin Johnson & Johnson Group of Consumer
Hospital, Detroit, Michigan, USA
Companies, Paris, France
Doris Hexsel Department of Dermatology, Pontifi cia Universi-
Régine Bousquet-Rouaud Dermatological Laser Unit, Millen-
dade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do
nium Clinic, Montpellier, France
Sul, Brazil
Martin Braun Vancouver Laser and Skin Care Centre, Van-
Gustavo Leibaschoff University of Buenos Aires School of
couver, British Columbia, Canada
Medicine, and International Union of Lipolasty, Buenos Aires,
Argentina
Cristiano Brum Brazilian Center for Studies in Dermatology
and Santa Casa Hospital Complex, Porto Alegre, Rio Grande do
Woraphong Manuskiatti Department of Dermatology, Siriraj
Sul, Brazil
Hospital, Mahidol University, Bangkok, Th ailand
Jean Chaintreuil Candela Corporation, Wayland, Massachu-
Fulvio Marzatico Laboratory of Pharmacobiochemistry, Health
setts, USA
Nutriceutical and Nutrition Research, University of Pavia, Pavia,
Italy
Taciana de Oliveira Dal’Forno Brazilian Center for Studies in
Dermatology, Porto Alegre, Rio Grande do Sul, Brazil
Rosemarie Mazzuco Brazilian Center for Studies in Dermato-
logy, Porto Alegre, Rio Grande do Sul, Brazil
Zoe Diana Draelos Department of Dermatology, Wake Forest
University School of Medicine, Winston-Salem, North Caro-
Serge Mordon INSERM, Lille University Hospital, Lille,
lina and Dermatology Consulting Services, High Point, North
France
Carolina, USA
Alex Nkengne Johnson & Johnson Group of Consumer Com-
Agustina Vila Echague Candela Corporation, Wayland,
panies, Paris, France
Massachusetts, USA
Carmine Orlandi Istituto di Ricerche Cliniche Ecomedica,
Pietro Di Fiore Sports Medicine and Nutrition, Center for Pre- Empoli, Italy
vention and Cure of Obesity, Palermo, Italy
Michail M Pankratov Eleme Medical, Inc., Merrimack, New
Luca Gatteschi Sports Medicine Clinic, Florence, Italy Hampshire, USA
David J Goldberg Skin Laser Specialists of NY/NJ, and Mount Débora Zechmeister do Prado Brazilian Center for Studies in
Sinai School of Medicine, New York, New York, USA Dermatology, Porto Alegre, Rio Grande do Sul, Brazil
viii
Massimo Rapetti Istituto di Ricerche Cliniche Ecomedica, Attilio Speciani Eurosalus, Milan, Italy
Empoli, Italy
Amanda Stapenhorst Brazilian Center for Studies in Derma-
Ana Beatris Rossi Research and Development, Johnson & tology, Porto Alegre, Rio Grande do Sul, Brazil
Johnson Group of Consumer Companies, Paris, France
Jane Unaeze Albert Einstein College of Medicine, New York,
Neil S Sadick Department of Dermatology, Weill Medical
New York, USA
College of Cornell University and Sadick Dermatology, New York,
New York, USA
Molly Wanner Department of Dermatology, Massachusetts
Gordon H Sasaki Sasaki Advanced Aesthetic Medical Center, General Hospital, Harvard Medical School, Boston, Massachu-
Pasadena, California and Linda Loma University Medical Center, setts, USA
Linda Loma, California, USA
Magda B Weber Department of Dermatology, Federal
Mariana Soirefmann Brazilian Center for Studies in Derma- University of Health Science, Porto Alegre, Rio Grande do Sul,
tology, Porto Alegre, Rio Grande do Sul, Brazil Brazil
ix
1
Social Impact of Cellulite and Its Impact on Quality of Life
Doris Hexsel, Camile Luisa Hexsel, and Magda B Weber
Introduction social, aff ective, and sexual relations as well as the avoidance of
Almost all women have or believe they have cellulite. As it is more normal everyday activities such as visiting a swimming pool or
common to expose the body in certain cultures and in sunny coun- beach, practicing sports or exposing the body during intimacy.
tries such as Brazil, cellulite is of great concern to many women A number of studies have been published that deal with QoL
and also represents a problem of great social impact. and recognize the value of specifi c questionnaires for dermatolog-
In today’s globalized culture, physical well-being, including ical diseases such as psoriasis, acne, melasma, atopic dermatitis,
care taken with appearance, is highly valued. From this perspec- hyperhidrosis, and alopecia among others [2–9]. Th ese studies
tive, it is very important to evaluate the impact on quality of life have revealed the existence of similar facets related to QoL in
(QoL) of such cosmetic problems as cellulite, wrinkles and aging. patients from various countries [10] and point to the discomfort
Th e fact that these have an impact on the QoL is indirectly shown and the psycho-emotional eff ect on the patients. However, in gen-
by the growing interest in the investigation and treatment of these eral, little research has been done on the psychological, environ-
problems, which until recently were considered to be of minor mental, and social aspects of dermatological diseases. Moreover,
signifi cance. New studies involving QoL will benefi t all those who to date, no study on the QoL of those affl icted by cellulite has been
suff er to a greater or lesser degree from these problems, and will published.
be of great value in assessing the need for new scientifi c research Patients suff ering from skin diseases should not be treated
into the treatment of these problems. merely for the physical harm caused by the disease [10]. Th e skin
Medical treatments traditionally focused on quantitative fac- is the most external and apparent organ, and skin contact contrib-
tors, such as the reduction of morbidity and mortality and the utes to the formation and structure of the personality.
assessment of treatment safety and social markers of health.
Qualitative factors, such as patients’ perceptions of well-being and Aspects of Cellulite Related to Qol
capacity to perform activities of daily life were not a primary aim. Cellulite is a clinical and aesthetic condition aff ecting most
In recent decades, however, the measurement of patient’s quality women. It may appear in preadolescence, adolescence, or adult-
of life and the evaluation of diff erent treatments have been the hood. With cellulite, the connective tissue and adipose tissue
focus of growing attention. undergo alterations, resulting in blood and lymphatic altera-
Sarwer et al. published a review of the literature that focused on tions [11]. Clinically, cellulite is characterized by alterations to the
psychological and social-cultural aspects, their relation to phys- cutaneous surface, especially on the buttocks and thighs, giving
ical appearance, and their infl uence on the decision to undergo the skin an orange peel or mattress appearance [12,13]. Clini-
cosmetic treatments [1]. Th eir study revealed that in the 37 dif- cally, cellulite is classifi ed into degrees that range from 0 to III
ferent cultures studied, men and women gave greater priority according to the clinical characteristics [14]. As well as classifying
to sexual attraction in the choice of partners than to aspects the cellulite, it is suggested that associated factors such as obesity
of personality such as independence, emotional stability and [measured by the body mass index (BMI)] and degree of fl accidity
maturity [1]. Dermatological diseases and cosmetic problems (classifi ed as light, moderate, or severe) be characterized.
signifi cantly aff ect self-esteem. As the symptoms are visible, the Our clinical experience has shown that cellulite is a problem
discomfort and psycho-emotional eff ects are frequently more that has an impact on the QoL of both younger and more mature
serious than the physical alterations caused by the disease. Th us, women, though the impact is greater in younger women. It
it becomes very important to assess and quantify the emotional also seems that cellulite is more frequent nowadays than many
and social parameters in these patients, in order to understand years ago.
the disruption that the problem causes in various daily activities. We report here on a clinical study carried out in 62 female
Th is will facilitate the follow-up and treatment evaluation, and patients, aged between 18 and 45 years (average age 32) with
consequently allow for improvements in the QoL of the patients. BMIs between 18 and 25 (average 21.8), having various degrees
Th e great importance given to QoL evaluation in clinical inves- of cellulite on the buttocks and thighs. Over a period of two
tigation and patient care has led to the development of ques- months, these patients received mechanical treatment in both
tionnaires designed for the collection of information from the legs and topical treatment in only one randomly chosen leg.
patients on the impact of the disease on their everyday lives. Th is Th e degree of cellulite in each patient was evaluated before
knowledge allows the medical professional to better observe how and at the end of the treatment and attributed a classifi ca-
the disease aff ects the patients physically, psychologically, and tion between 0 and III, according to the clinical appearance of
socially, and facilitates the evaluation of the eff ects on the lives of the cellulite. No patients included in this study had a cellulite
the patients. classifi cation of 0.
In the case of cellulite, the reasons that lead the patient to seek Th ese patients also answered a non-validated questionnaire
treatment are generally social and, sometimes, also emotional. created by the authors at the beginning and end of the treatment.
Th ese may include the embarrassment caused by cellulite in Th is questionnaire evaluated patients’ self-esteem and highlighted