Table of Contents Title Page Copyright List of contributors Abbreviations Chapter 1: Introduction Anatomy and physiology of adipose tissue Adipogenesis: from stem cell to fat cell Summary References Chapter 2: Facial fat: anatomy and implications for rejuvenation Introduction Aging changes in multiple structural tissues Summary Conclusions/future directions References Chapter 3: Histology and pathology of subcutaneous tissue White adipose tissue Brown adipose tissue Tumors of fat Panniculitis References Chapter 4: Injectable treatments for fat and cellulite Introduction Clarification of terms and history Clarifying the roles of deoxycholate and phosphatidylcholine Detergents and tissue interactions The fate of adipolytic therapy Injectables for cellulite Conclusions References Chapter 5: The architecture of cellulite Introduction What defines cellulite? Gender differences in lipid metabolism What type of fat is cellulite made of? Other factors Conclusion References Chapter 6: Cellulite treatment Brief overview of cellulite Cellulite anatomy Cellulite grading Approach to a patient with cellulite Recent advances and controversies in cellulite treatment TriActive in the treatment of cellulite Treatment protocol VelaSmooth and VelaShape Mechanism of action Treatment protocol SmoothShapes Mechanism of action Treatment protocol Mechanism of action Accent Treatment protocol Thermage Treatment protocol Other laser devices for the treatment of cellulite Conclusion References Chapter 7: Cooling for fat Introduction Cryolipolysis Clinical effects of cryolipolysis Patient selection Consultation Preoperative procedures/considerations Pearls Complications: how to avoid them and how to treat them Postoperative care/considerations Summary References Chapter 8: Laser lipolysis and laser-assisted liposuction Introduction History of laser lipolysis Wavelength and pulse duration Indications and patient selection Laser lipolysis procedure Complications Skin effects Summary References Chapter 9: Soft tissue augmentation for facial lipoatrophy and volumization Introduction Hyaluronic acid derivatives Calcium hydroxylapatite Poly-L-lactic acid Permanent filler – silicone for HIV lipoatrophy Conclusion References Index End User License Agreement List of Illustrations Figure 1.1 Figure 1.2 Figure 2.1 Figure 2.2 Figure 2.3 Figure 2.4 Figure 2.5 Figure 2.6 Figure 2.7 Figure 3.1 Figure 3.2 Figure 3.3 Figure 3.4 Figure 3.5 Figure 3.6 Figure 3.7 Figure 4.1 Figure 4.2 Figure 4.3 Figure 4.4 Figure 4.5 Figure 4.6 Figure 4.7 Figure 4.8 Figure 4.9 Figure 4.10 Figure 4.11 Figure 4.12 Figure 6.1 Figure 6.2 Figure 6.3 Figure 6.4 Figure 6.5 Figure 6.6 Figure 6.7 Figure 6.8 Figure 6.9 Figure 6.10 Figure 6.11 Figure 6.12 Figure 6.13 Figure 6.14 Figure 6.15 Figure 6.16 Figure 6.17 Figure 6.18 Figure 6.19 Figure 6.20 Figure 6.21 Figure 6.22 Figure 6.23 Figure 6.24 Figure 6.25 Figure 7.1 Figure 7.2 Figure 7.3 Figure 7.4 Figure 7.5 Figure 7.6 Figure 7.7 Figure 7.8 Figure 7.9 Figure 7.11 Figure 7.12 Figure 7.13 Figure 8.1 Figure 8.2 Figure 8.3 Figure 8.4 Figure 8.5 Figure 8.6 Figure 8.7 Figure 8.8 List of Tables Table 4.1 Table 6.1 Table 6.2 Table 6.3 Table 8.1 Table 8.2 Table 8.3 Fat removal Invasive and non-invasive body contouring Mathew M. Avram MD, JD Dermatology Laser & Cosmetic Center Massachusetts General Hospital Boston, MA, USA This edition first published 2015; © 2015 by John Wiley & Sons Ltd Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. All rights reserved. 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List of contributors Kenneth Arndt MD President, SkinCare Physicians, Chestnut Hill, MA, USA Clinical Professor of Dermatology Emeritus, Harvard Medical School, Boston, MA, USA Adjunct Professor of Dermatology, Brown University, Providence, RI, USA Adjunct Professor, Department of Surgery, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA Alison Avram MD Dermatology Laser & Cosmetic Center, Massachusetts General Hospital, Boston, MA, USA Mathew M. Avram, MD Dermatology Laser & Cosmetic Center, Massachusetts General Hospital, MA, USA Suveena Bhutani MD Sadick Dermatology and Research, NY, USA Rebecca Fitzgerald MD Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA Private Practice, Los Angeles, CA, USA Selim M. Nasser MD Department of Pathology, Clemenceau Medical Center, Beirut, Lebanon Andrew A. Nelson MD Nelson Dermatology, Saint Petersburg, FL, USA Assistant Clinical Professor, Department of Dermatology, Tufts University School of