Noninvasive mechanical body contouring: a preliminary clinical outcome study

The Temple Vie weight management and lifestyle programme: initial data and reflections on Covid-19

During the first three months of the Temple Vie programme, average weight loss in 36 subjects exceeded 13 kg. There were associated improvements in Patient Reported Outcome Measures, blood pressure and serum lipids. The Covid-19 pandemic may focus attention on programmes that give rise to rapid weight loss and improvements in cardiovascular health parameters.

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The Temple Vie programme facilitated average weight loss of more than 13kg within the first three months.

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This was accompanied by an improvement in cardiovascular parameters.

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These changes should be protective in any future waves of Covid-19 infection.

Cellulite (Liposclerosis): Etiology and Treatment

This article discusses in detail the pathophysiology of liposclerosis (cellulite). Clinical classifications, phytotherapeutic medications, and treatment methods are tabulated and discussed. Lymphoedema is identified as a major factor in the etiology of cellulite formation. The causes of lymphoedema with fibrosclerosis and dermal retraction as they relate to the formation of cellulite are presented.

The evidence behind noninvasive body contouring devices

The demand for body contouring is rapidly increasing, and interest in noninvasive approaches has also grown. The author reviewed the evidence base behind the currently available devices and methods for nonsurgical body contouring. There is little high-level evidence in the present literature to support the effectiveness of any of these devices.

Benefit of endermology on indurations and panniculitis/lipoatrophy during relapsing-remitting multiple sclerosis long-term treatment with glatiramer acetate

INTRODUCTION

Use of endermology (Endermologie®), which consists of a deep mechanical massage, in patients with multiple sclerosis receiving glatiramer acetate suggested improvements in injection-site indurations and panniculitis/lipoatrophy in our previous pilot experience. We aimed to assess the effect of endermology in a larger population of patients with multiple sclerosis receiving glatiramer acetate in clinical practice.

METHODS

This was the extension phase of our pilot experience, carried out in patients with relapsing-remitting multiple sclerosis (RRMS) and indurations and/or panniculitis/lipoatrophy associated with long-term glatiramer acetate administration. Patients underwent endermology sessions twice per week, for 6 weeks, according to clinical practice.

RESULTS

Seventy evaluable patients were included (mean age, 42.7±9.3 years; female, 95.7%; mean multiple sclerosis duration, 9.2±8.6 years; mean glatiramer acetate duration, 46.7±29.9 months). Fifty (71.4%) patients showed indurations and 58 (82.9%) panniculitis/lipoatrophy. After 12 endermology sessions, the number of patients with indurations significantly decreased (71.4% vs. 28.6%; p<0.001), as did the number of their indurations (4.2±3.6 vs. 3.7±3.4; p<0.001). Although the number of patients with panniculitis/lipoatrophy did not significantly decrease, there was a significant reduction in the number of areas of panniculitis/lipoatrophy (4.3±2.6 vs. 3.9±2.2; p<0.05). Forty-nine (98.0%) patients with indurations and 57 (98.3%) patients with panniculitis/lipoatrophy felt satisfied/very satisfied with treatment and considered endermology useful/very useful. Endermology was well tolerated, as some pain was reported in eight (11.4%) patients, discomfort in three (4.3%) patients, and local blotch/swelling and transient bruise in one (1.4%) patient each. Endermology enabled glatiramer acetate tolerance to be enhanced in 42 (60.0%) patients.

CONCLUSION

This project represents the largest experience available supporting the benefit of endermology in the reduction/disappearance of indurations and improvement in panniculitis/lipoatrophy in patients with RRMS receiving long-term glatiramer acetate treatment. Moreover, these benefits also contributed to enhancing glatiramer acetate tolerance.

Manual lymphatic drainage and therapeutic ultrasound in liposuction and lipoabdominoplasty post-operative period

BACKGROUND

Physiotherapy in the plastic surgery post-operative (PO) is essential to provide means for an adequate and fast recovery as it restores function through the use of physiotherapeutic procedures.

AIM

The aim of the following study is to verify the effects of the association between the manual lymphatic drainage and the therapeutic ultrasound on pain, oedema and the tissue fibrosis in liposuction and lipoabdominoplasty PO.

DESIGN

This is a clinical trial prospective.

MATERIALS AND METHODS

Eighteen women aged between 18 and 60 years participated in this study, in the late PO period following lipoabdominoplasty or liposuction in the abdomen, flanks and lower trunk, which showed tissue fibrosis of the flanks and abdomen regions. They were divided into two groups: Liposuction group and lipoabdominoplasty group. A total of twelve sessions of therapeutic ultrasound followed by the manual lymphatic drainage were performed. The patients were assessed with regard to pain, oedema and tissue fibrosis in different moments: Initial assessment, during assessment and final assessment through the application of the protocol of evaluation of cysts fibrosis levels.

STATISTICAL ANALYSIS

The test of equality for two proportions and the confidence interval test for mean to evaluate the distribution of variables. The significance level adopted for statistical tests was 5% (P < 0.05).

RESULTS

There was a statistically significant reduction of pain, swelling and tissue fibrosis in both groups.

CONCLUSION

the association between manual lymphatic drainage and the therapeutic ultrasound reduced the swelling and the tissue fibrosis and made pain disappear in liposuction and lipoabdominoplasty PO period.

Effects of mechanical massage, manual lymphatic drainage and connective tissue manipulation techniques on fat mass in women with cellulite

OBJECTIVE

To evaluate and compare the effectiveness of three different noninvasive treatment techniques on fat mass and regional fat thickness of the patients with cellulites.

METHODS

Sixty subjects were randomized into three groups. Group 1 (n = 20) treated with mechanical massage (MM), group 2 (n = 20) treated with manual lymphatic drainage (MLD) and group 3 (n = 20) treated with connective tissue manipulation (CTM) techniques. Subjects were evaluated by using standardized photographs, body composition analyzer (TBF 300) (body weight (BW), body mass index (BMI), fat %, fat mass (FM), fat free mass (FFM), total body water (TBW)), circumference measurement from thigh, waist-hip ratio (WHR), fat thickness measurements from abdomen, suprailium and thigh regions with skin fold caliper.

RESULTS

All groups had an improvement in thinning of the subcutaneous fat after the treatment (P < 0.05). Thigh circumference decreased by an average of 0.5 cm in all groups and thigh fat thickness decreased 1.66 mm in Group 1, 2.21 mm in Group 2 and 3.03 mm in Group 3. Abdomen and suprailium fat thicknesses decreased 2.4 and 2.58 mm in Group 1, 1.78 and 2 mm in Group 2 and 1.23 and 0.64 mm in Group 3, respectively. The mean difference in waist-hip ratio was 0.1 cm in all groups.

CONCLUSION

All the treatment techniques are effective in decreasing the regional fat values of the patients with cellulites.

A prospective clinical study to evaluate the efficacy and safety of cellulite treatment using the combination of optical and RF energies for subcutaneous tissue heating

BACKGROUND

There have not been any published studies on the use of radiofrequency (RF)-light-based technologies for the treatment of cellulite. Only preliminary results have recently been reported (ASDS Proceedings, September 2004).

OBJECTIVE

This two-center study investigated the safety and effectiveness of combined energies for cellulite treatment using the VelaSmoothtrade mark system.

METHODS

Thirty-five female subjects with cellulite and/or skin irregularities on the thighs and/or buttocks were treated with the VelaSmooth device. Patients received from eight to 16 treatments twice weekly. All patients maintained their normal lifestyle, and diet and fluid consumption. The circumference of the right and left medial thighs was measured at both baseline and approximately 4 weeks after the last treatment. During the last follow-up visit, the physician graded the level of improvement in skin smoothing and/or cellulite improvement using pre- and post-treatment photographs. Three patients provided biopsy specimens for histological assessment.

RESULTS

All study patients showed some level of reduction in thigh circumference after 8 weeks of treatment; indeed, 70% of all patients showed such a reduction after 4 weeks of treatment. Also, 100% of all patients showed some level of improvement in skin texture and cellulite. The mean decrease in circumference was 0.8 inches. Some patients demonstrated reductions of more than 2 inches. There were minimal complications associated with treatment.

CONCLUSION

This preliminary study demonstrates that the VelaSmooth system can have a beneficial effect on cellulite appearance. Further studies are needed to better define the mechanisms by which RF and light energies affect subdermal tissues and develop a method of quantified cellulite analysis.

Conservative management of local Mycobacterium chelonae infection after combined liposuction and lipofilling

A case of Mycobacterium chelonae infection in the buttock after combined liposuction and lipoinjection is presented. The real possibility of contamination from operating room equipment was the potential etiologic factor of this infection. The clinical presentation of the disease was typical. The difficulty confirming the diagnosis was solved by specific culturing techniques. Successful treatment with limited debridement and irrigation combined with prolonged specific antibiotic therapy effected a long-term cure.

La maladie de Mondor : une complication de la chirurgie mammaire

Mondor's disease is a rare but not uncommon complication of breast surgery. This problem is commonly described as the thrombophlebitis of the superficial thoracoabdominal veins. Symptoms combine painful contracture occurring in the sub-mammary region and/or in the axillary region, rising during arm abduction. The contracture located in the axillary region usually join the epitrochlea. Based on a serie of 8 patients, the fascial hypothesis is developed. All the patients were treated by LPG and myo-fascial techiques with a complete relief of pain in 10 days.

Anti-Aging

The leg is a very important aesthetic unit along with the face, neck, décolleté and hands. In addition to individual and inherited factors, which define the appearance and shape of the legs, multiple changes may occur during life which are cosmetically disturbing and may influence individual attractiveness. These changes offer dermato-phlebologists a wide spectrum of possibilities to intervene. Sclerotherapy, laser procedures, surgical approaches such as liposuction, conventional and endovasal phlebosurgery and physical therapy can all be beneficial.

Dermatological complications of obesity

Obesity is a health problem of considerable magnitude in the Western world. Dermatological changes have been reported in patients with obesity, including: acanthosis nigricans and skin tags (due to insulin resistance); hyperandrogenism; striae due to over extension; stasis pigmentation due to peripheral vascular disease; lymphedema; pathologies associated with augmented folds; morphologic changes in the foot anatomy due to excess load; and complications that may arise from hospitalization. Acanthosis nigricans plaques can be managed by improved control of hyperinsulinemia; the vitamin D3 analog calcipitriol has also been shown to be effective. Skin tags can be removed by snipping with curved scissors, by cryotherapy or by electrodesiccation. Hyperandrogenism, a result of increased production of endogenous androgens due to increased volumes of adipose tissue (which synthesizes testosterone) and hyperinsulinemia (which increases the production of ovarian androgens) needs to be carefully assessed to ensure disorders such as virilizing tumors and congenital adrenal hyperplasia are treated appropriately. Treatment of hyperandrogenism should be centred on controlling insulin levels; weight loss, oral contraceptive and antiandrogenic therapies are also possible treatment options. The etiology of striae distensae, also known as stretch marks, is yet to be defined and treatment options are unsatisfactory at present; striae rubra and alba have been treated with a pulsed dye laser with marginal success. The relationship between obesity and varicose veins is controversial; symptoms are best prevented by the use of elastic stockings. Itching and inflammation associated with stasis pigmentation, the result of red blood cells escaping into the tissues, can be treated with corticosteroids. Lymphedema is associated with dilatation of tissue channels, reduced tissue oxygenation and provides a culture medium for bacterial growth. Lymphedema treatment is directed towards reducing the limb girth and weight, and the prevention of infection. Intertrigo is caused by friction between skin surfaces, combined with moisture and warmth, resulting in infection. This infection, most commonly candidiasis, is best treated with topical antifungal agents; systemic antifungal therapy may be required in some patients. Excess load on the feet can result in morphological changes that require careful diagnosis; insoles may offer some symptom relief while control of obesity is achieved. Obesity-related dermatoses associated with hospitalization, such as pressure ulcers, diminished wound healing, dermatoses secondary to respiratory conditions, and incontinence, must all be carefully managed with an emphasis on prevention where possible. Recognition and control of the dermatological complications of obesity play an important role in diminishing the morbidity of obesity.

Analysis of the effects of deep mechanical massage in the porcine model

Deep mechanical massage has been advocated as an alternative or adjunctive therapy for the contouring of subcutaneous fat and as a treatment for cellulite. We evaluated the effects of deep mechanical massage using two pig models. Yucatan pigs were divided into three groups (n = 4). One side of each body received 4, 10, or 20 treatments and the other side served as a control. Full-thickness tissue sections, including the underlying muscle, were harvested from identical treated and untreated regions. Examination of these regionally matched samples revealed an accumulation of dense, longitudinal collagen bands in the middle dermal and deep subdermal regions, which progressively increased with the number of treatments. Distortion and disruption of adipocytes was noted. In Yorkshire pigs, force-transducing balloon catheters were surgically placed between the deep subcutaneous tissue and muscle fascia. Catheters were inserted into two regions with different skin and subcutaneous tissue characteristics, the midflank and the hip. Standardized maneuvers were performed at suction settings 3, 5, 7, and 9 to record baseline tissue forces. Each maneuver carried a unique force signature. The measurement of tissue forces was repeated on the opposite side after 10 standardized treatment sessions. Analysis showed a significant reduction of measured forces at the midflank after the treatments. The actual force measured with each particular maneuver varied between different operators but not with different suction settings, suggesting that the technique of administering the treatments is the primary factor in creating the force within the tissue. This leads to the conclusion that deep mechanical massage is highly dependent on the individual operator of the device.

Endermologie: humoral repercussions and estrogen interaction

Endermologie is a motorized rhythmic folding-unfolding and suction technique of the panniculus adiposus. Our study shows that one 40-min Endermologie session produces no noticeable changes in biological parameters, except for plasma estradiol levels, which vary significantly, first by decreasing during the session, then by increasing afterward. Such an Endermologie/estrogen interaction can be compared to the clinical effects observed in some patients undergoing regular Endermologie treatment: return of menses in amenorrheal patients and a trophic effect on skin and subcutaneous connective tissue comparable to that observed during postmenopausal hormone replacement therapy. Understanding such an interaction with the estrogen metabolism requires additional studies and opens many paths for research on therapeutic applications before and after menopause beyond refinement of the body contour and improvement of the appearance of the panniculus adiposus.