Cellulite : pathophysiology and treatment

1. Social Impact of Cellulite and Its Impact on Quality of Life . . . . . . . 1 Doris Hexsel and Camile Luisa Hexsel Introduction . . . . 1 Aspects of Cellulite Related to QOL . . . . 2 Conclusions . . . . 4 References . . . . 5 PART I: DIAGNOSIS OF CELLULITE 2. Definition, Clinical Aspects, Associated Conditions, and Differential Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Doris Hexsel, Taciana de Oliveira Dal’Forno, and Stela Cignachi Definition . . . . 7 Nomenclature . . . . 9 Clinical Aspects . . . . 9 Differential Diagnosis . . . . 21 References . . . . 24 Appendix . . . . 27 3. Anatomy of Cellulite and the Interstitial Matrix . . . . . . . . . . . . . . 29 Pier Antonio Bacci Introduction . . . . 29 Cellulite . . . . 29 Interstitial Matrix . . . . 32 References . . . . 38 4. Pathophysiology of Cellulite . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Pier Antonio Bacci and Gustavo Leibaschoff What Is Cellulite? . . . . 41 Definition . . . . 41 xiii Classification . . . . 43 Evolution . . . . 47 Lipedema and Lipolymphedema: Patholophysiologic Hypotheses . . . . 50 Lipodystrophy . . . . 57 The Lymphoadipose System . . . . 58 Venous–Lymphatic Stasis . . . . 61 How Cellulite Develops . . . . 62 Manifestations of Cellulite . . . . 62 Clinical Classification . . . . 63 Why Cellulite Is a Concern . . . . 63 Liposclerosis and Localized Adiposity . . . . 63 Etiopathogenic Factors . . . . 68 The Term ‘‘Cellulite’’ . . . . 70 References . . . . 72 5. Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Gustavo Leibaschoff Patient History . . . . 75 Clinical Examination . . . . 75 Laboratory Investigations . . . . 80 ROM Test . . . . 81 Primary Instrument Examinations . . . . 82 Secondary Instrument Examinations . . . . 86 Photography . . . . 88 Diagnosis . . . . 88 Therapeutic Strategy . . . . 95 Medical History . . . . 95 References . . . . 97 Appendix A . . . . 98 Appendix B . . . . 101 6. Cellulite Characterization by High-Frequency Ultrasound and High-Resolution Magnetic Resonance Imaging . . . . . . . . . . . . . . 105 Bernard Querleux Introduction . . . . 105 Materials and Methods . . . . 105 Results . . . . 108 Discussion . . . . 112 References . . . . 114 7. Clinical–Therapeutic Classification: BIMED–TCD . . . . . . . . . . . 115 Pier Antonio Bacci and Gustavo Leibaschoff Introduction . . . . 115 Binazzi’s Classification . . . . 115 Curri’s Classification . . . . 116 xiv & CONTENTS Bartoletti’s Classification . . . . 116 BIMED Classification . . . . 117 BIMED–TCD Classification . . . . 127 Pathophysiological Classification and Protocols of BIMED–TCD . . . . 130 Edematous Cellulite . . . . 131 Adipose Cellulite . . . . 134 Interstitial Cellulite (Lipedema) . . . . 135 Fibrous Cellulite . . . . 137 Summary . . . . 139 References . . . . 140 8. Medical Treatment of Cellulite . . . . . . . . . . . . . . . . . . . . . . . . . 143 Gustavo Leibaschoff Introduction . . . . 143 Abstracts of Studies in Cellasene1 . . . . 146 New Research About the Use of Cellasene1 or Cellulase Gold1 . . . . 147 References . . . . 153 9. Theory and Working Principles of Beautytek
in Cosmetic Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Valerio Genitoni 10. Topical Management of Cellulite . . . . . . . . . . . . . . . . . . . . . . . . 159 Doris Hexsel, Debora Zechmeister do Prado, Jaggi Rao, and Mitchel P. Goldman Introduction . . . . 159 Definition and Nature of Cellulite . . . . 160 Pathophysiologic Mechanisms of Cellulite Formation . . . . 160 Topical Management . . . . 161 Conclusion . . . . 168 References . . . . 169 11. The Role of Endermologie
in Treatment of Cellulite . . . . . . . . . 171 Pier Antonio Bacci Introduction . . . . 171 Anatomy and Physiology . . . . 173 Adipose Tissue and Lipoderma . . . . 176 The Superficial Fascia . . . . 177 Massage . . . . 178 Manual Lymphatic Drainage . . . . 178 The Technique ‘‘Endermologie1’’ . . . . 178 Indications . . . . 181 Method . . . . 182 Conclusions . . . . 185 References . . . . 186 CONTENTS & xv 12. The Use of TriActiveTM in the Treatment of Cellulite . . . . . . . . . 189 Anju Pabby and Mitchel P. Goldman Mechanism . . . . 189 Review of Cellulite . . . . 189 Parameters . . . . 189 Initial Studies . . . . 190 Other Uses . . . . 191 Contraindications . . . . 191 Protocol . . . . 191 13. Carboxytherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Gustavo Leibaschoff Introduction . . . . 197 Indications . . . . 198 Treatment Method . . . . 201 Conclusions . . . . 207 References . . . . 209 14. Surgical Treatment A: Lipoplasty, Vibro-Assisted Liposuction, Lipofilling, and Ultrasonic Hydroliposuction . . . . . . . . . . . . . . . . . . . . . . . . 211 Gustavo Leibaschoff Lipoplasty . . . . 211 Historical Background . . . . 212 B: VASER
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 Alberto Di Giuseppe Definition . . . . 222 Fat Tissue Vascularization . . . . 223 Patient Selection . . . . 223 Prescriptions . . . . 228 Postoperative Scheme . . . . 229 Conclusion . . . . 230 C: Vibro-Assisted Liposuction . . . . . . . . . . . . . . . . . . . . . . . . . . 231 Pier Antonio Bacci, M. Scatolini, P. Belardi, S. Leonardi, and S. Mancini Introduction . . . . 231 Lipoplasty . . . . 232 Lipolymphosuction . . . . 232 The Vibro-Assisted Method . . . . 232 D: Lipofilling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234 S. V. Savchenko, Marlen A. Sulamanidze, and George M. Sulamanidze Lifting . . . . 236 Liposhifting . . . . 237 xvi & CONTENTS E: Ultrasonic Hydrolipoclasis (External Ultrasound) . . . . . . . . . . 239 Maurizio Ceccarelli Cavitation . . . . 242 Biological Effects . . . . 242 Technique . . . . 244 References . . . . 248 15. Subcision
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 Doris Hexsel and Rosemari Mazzuco Introduction . . . . 251 Indications and Mechanisms of Action . . . . 251 Contraindications for Subcision1 . . . . 254 Preoperative Consultation . . . . 254 Surgical Technique . . . . 254 The Postoperative Period . . . . 257 Complications . . . . 257 Conclusions . . . . 260 References . . . . 262 16. Mesotherapy in the Treatment of Cellulite . . . . . . . . . . . . . . . . . 263 Gustavo Leibaschoff and Denise Steiner A Brief History . . . . 263 The Concept . . . . 263 Action Mechanism of Mesotherapy . . . . 264 Benefits and Advantages of the Method . . . . 265 Materials and Techniques . . . . 266 General Indications for Mesotherapy . . . . 267 Mesotherapy in Cellulite . . . . 267 Uses for Mesotherapy . . . . 270 What Is Mesotherapy? . . . . 271 Why Are Drugs Injected into the Skin? . . . . 271 What Drugs Are Used? . . . . 271 Which Drugs Should Be Used and How Should They Be Administered? . . . . 272 Drugs and Products Used in Mesotherapy . . . . 277 No-Needle MesotherapyTM . . . . 282 Conclusion . . . . 283 References . . . . 284 17. Manual Lymphatic Drainage . . . . . . . . . . . . . . . . . . . . . . . . . . 287 Gustavo Leibaschoff References . . . . 290 CONTENTS & xvii 18. The Role of Dermoelectroporation . . . . . . . . . . . . . . . . . . . . . . . 291 Pier Antonio Bacci Introduction . . . . 291 Transderm1 Method . . . . 292 Characteristic Features . . . . 292 Possible Uses . . . . 293 Dermoelectroporation Treatment . . . . 293 Clinical Study . . . . 294 Conclusions . . . . 297 References . . . . 298 19. Lipodissolve for Body Sculpting . . . . . . . . . . . . . . . . . . . . . . . . 301 Martin Braun Introduction . . . . 301 Phosphatidylcholine (PC) . . . . 302 Deoxycholate (Deoxycholic Acid) . . . . 305 Availability of Lipostabil1 in the United States and Canada . . . . 306 Contraindications for Lipodissolve Injections . . . . 307 Side Effects of Lipodissolve Injections . . . . 307 Dosages and Techniques for Lipodissolve Injections . . . . 309 General Considerations for Lipodissolve Injections . . . . 309 Lipodissolve Formulae for Fat Pad Dissolution . . . . 310 Procedure for Injecting Lipodissolve into Fatty Pads . . . . 312 Clinical Examples of Lipodissolve Therapy . . . . 313 Lipodissolve Summary: Simple Injections for Fat Reduction . . . . 313 References . . . . 322 Index . . . . 323