Cellulite: nature and aetiopathogenesis

The safety and effectiveness of low-level light therapy (LLLT) with light-emitting diode (LED) bed system and a novel topical anti-cellulite gel on grades 1-2 thigh/buttock cellulite: a randomized, comparative-controlled split-thigh/buttock IRB study

BACKGROUND

Cellulite of the upper lateral and posterior thighs and lower buttocks represents a common unwanted condition.

OBJECTIVES

The author sought to comparea LLLT-LED bed therapy and a novel topical anti-cellulite gel on one thigh/buttock cellulite vs light therapy for cellulite to the opposite side.

METHODS

Eight healthy female subjects were randomly treated with a LLLT-LED bed twice weekly for 20 minutes in prone/supine positions with twice daily application of a novel anti-cellulite gel to one randomized thigh/buttock.

RESULTS

At the end of the 3-month trial, skin elasticity increased after combined therapy on one thigh but decreased with only LLLT-LED bed treatments on the opposite thigh. Thighs treated with active gel and LLLT-LED bed, were downgraded to a lower cellulite grade, while monotherapy did not demonstrate any change from their baseline cellulite grading. Changes in thigh circumference did not correlate with either treatments regimens.Subject and investigator questionnaire evaluations at month-3 were assessed as "satisfactory" results. There were no adverse reactions to treatments.

CONCLUSIONS

The use of LLLT-LED bed therapy and an anti-cellulite gel demonstrated an efficient alternative in the treatment of cellulite-involved thighs/buttocks over similarly affected thighs/buttocks that were treated only with LLLT-LED bed therapy.

The correlation between the severity of symptoms and the thickness of the fat fold in cellulite-affected areas-A pilot study

OBJECTIVE

The aim of the study was to assess the correlation between the cellulite severity and the thickness of the fat fold.

MATERIAL AND METHODS

The study comprised 62 women aged 22 to 26 years. A palpation and visual evaluation of cellulite severity was performed on the basis of the Nurnberger and Muller classification, and the thickness of adipose tissue (fatty tissue) was measured with the use of a skinfold caliper.

RESULTS

The H0 hypothesis was rejected in favor of the H1 hypothesis (p < 0.001) in the chi-square independence test; therefore, a relationship between the thickness of the adipose tissue fold and the severity of cellulite was confirmed. Moreover, on the basis of obtained results, the hypothesis of the independence of the studied variables (p < 0.0000001) was also rejected. It can be concluded that there is an association between the thickness of adipose tissue and the degree of cellulite. Moreover, the values of the obtained coefficients are greater than zero (the correlation is positive), and the obtained Spearman's R (0.89) and Kendall's tau (0.79) values indicate a very strong correlation between the studied variables.

CONCLUSIONS

On the basis of obtained results and their statistical analysis, we can state that there is a relationship between the degree of cellulite and the thickness of the fat fold-the degree of cellulite increases with the increase in the thickness of the measured fat fold.

Effects of Essential Oils and Some Constituents from Ingredients of Anti-Cellulite Herbal Compress on 3T3-L1 Adipocytes and Rat Aortae

Cellulite is associated with a complex array of adipocytes under the skin and vascular system. A herbal compress that was previously developed was proven to have an anti-cellulite effect in healthy volunteers within 2 weeks of treatment. However, its mechanism and ingredients responsible for reducing cellulite were not known. The purpose of this study was to investigate the activity of eight essential oils in, and two water extracts from, the ingredients of the herbal compress together with nine monoterpenoid constituents on the 3T3-L1 adipocytes. The vasodilatory effect on rat aortae was also studied. The adipocytes were induced by dexamethasone, 3-isobutyl-1-methylxanthine and insulin. At all concentrations tested, all essential oils, water extracts and their monoterpenoid constituents significantly inhibited lipid accumulation activity (p < 0.05) and decreased the amount of triglycerides when compared to untreated cells (p < 0.01). In addition, our results showed that the mixed oil distilled from the herbal compress mixed ingredients could relax the isolated rat aorta (EC₅₀ = 14.74 ± 2.65 µg/mL). In conclusion, all essential oils, extracts and chemical constituents tested showed effects on adipogenesis inhibition and lipolysis induction on the cultured adipocytes with the mixed oil demonstrating vasorelaxation activity, all of which might be the mechanisms of the anti-cellulite effects of the herbal compress.

The BODY-Q Cellulite Scale: A Development and Validation Study

BACKGROUND

Cellulite is a localized metabolic disorder of the subcutaneous tissue. To measure the impact of cellulite and its treatment(s) on patients' health-related quality of life, a psychometrically sound patient-reported outcome measure is needed.

OBJECTIVES

The authors sought to develop and field test a new BODY-Q cellulite scale to measure the appearance of cellulite.

METHODS

Appearance-related codes from the original BODY-Q qualitative interviews were reexamined, and a set of cellulite-specific items was developed and refined through cognitive patient interviews (n = 10) and expert input (n = 17). This scale was field-tested in adults with cellulite through 2 crowdworking platforms. Rasch Measurement Theory analysis was employed to refine the scale and examine its psychometric properties.

RESULTS

The field-test sample included 2129 participants. The 15-item scale was reduced in length to 11 items. Data from the sample fit the Rasch model (X2 [99] = 21.32, P = 0.06). All items had ordered thresholds and mapped out a targeted clinical hierarchy. The reliability statistics for the person separation index was 0.94 and for Cronbach's alpha was 0.97. In terms of validity, worse scores on the cellulite scale were associated with being more bothered by how the cellulite looked overall, having more severe cellulite on the Patient-Reported Photo-numeric Cellulite Severity Scale, and having more self-reported cellulite and more areas of the body with cellulite.

CONCLUSIONS

The BODY-Q cellulite scale can be utilized to measure appearance of cellulite and provides a solid basis for future studies evaluating the impact of cellulite and its treatment.

Examination of age-related changes of viscoelasticity in the dermis and subcutaneous fat layer using ultrasound elastography

BACKGROUND

Using ultrasound elastography, the present study aimed to measure the viscoelasticity in each skin layer and to determine the relationship between the measured value, age, and body mass index (BMI).

MATERIALS AND METHODS

The present study included 77 Japanese women. We calculated the BMI and measured the facial cheek via elastography. With the use of the elastographic image, the dermis was divided into two layers, and the subcutaneous fat layer was divided into five equal sections according to the depth, ultimately obtaining seven layers. Furthermore, the thickness and viscoelasticity of each divided layer were measured.

RESULTS

The analysis of echo images revealed that the thickness of the upper dermis layer decreased with age, whereas that of the subcutaneous fat layer tended to increase with age and BMI. As measured by elastography, the viscoelasticity of both the lower dermis and the upper subcutaneous fat layer decreased with age. As the BMI increased, the viscoelasticity of the lower subcutaneous layer also increased, but that of the upper subcutaneous layer decreased.

CONCLUSIONS

The present study revealed the relationship between aging and viscoelasticity in the lower dermis and the relationship between aging, BMI, and viscoelasticity in the upper subcutaneous fat layer.

A validated photonumeric cellulite severity scale for the area above the knees: the knee cellulite severity score

BACKGROUND

Treatment for cellulite above the knees is increasingly requested. However, a classification of cellulite of this area has not yet been developed.

OBJECTIVE

To validate the proposed knee cellulite severity score (KCSS) for the assessment of cellulite and skin laxity above the knee.

MATERIALS AND METHODS

Based on standardized photographs of cellulite and skin laxity above the knees of 57 females (114 knees), three key morphological aspects of cellulite were identified. A photonumeric KCSS was developed and validated by three independent assessors.

RESULTS

The three key cellulite morphological features (number of depressions, depth of depressions and presence of laxity) are each graded from 0 to 3, producing a classification of no lesions (0), mild (1-3), moderate (4-6) and severe (7-9). Evaluators at different time points repeated similar classifications (intraclass correlation coefficient >0.9), which were also similar among the assessors (inter-observer reliability >0.9). All three key morphological aspects were deemed necessary, and positively contributed, to the overall scale (item-total correlation analysis values >0.89, P < 0.05).

CONCLUSIONS

The KCSS is a consistent, comprehensive, reliable, and reproducible tool for standardized and objective assessment of the severity of cellulite and skin laxity above the knees.

Mesotherapy: From Historical Notes to Scientific Evidence and Future Prospects

Intradermal therapy, known as mesotherapy, is a technique used to inject a drug into the surface layer of the skin. In particular, it involves the use of a short needle to deposit the drug in the dermis. The intradermal microdeposit modulates the drug's kinetics, slowing absorption and prolonging the local mechanism of action. It is successfully applied in the treatment of some forms of localized pain syndromes and other local clinical conditions. It could be suggested when a systemic drug-sparing effect is useful, when other therapies have failed (or cannot be used), and when it can synergize with other pharmacological or nonpharmacological therapies. Despite the lack of randomized clinical trials in some fields of application, a general consensus is also reached in nonpharmacological mechanism of action, the technique execution modalities, the scientific rationale to apply it in some indications, and the usefulness of the informed consent. The Italian Mesotherapy Society proposes this position paper to apply intradermal therapy based on scientific evidence and no longer on personal bias.

Proteomic and Ultrastructural Analysis of Cellulite-New Findings on an Old Topic

Background: Cellulite is a condition in which the skin has a dimpled lumpy appearance. The main causes of cellulite development, studied until now, comprehends modified sensitivity to estrogens, the damage of microvasculature present among dermis and hypodermis. The differences of adipose tissue architecture between male and female might make female more susceptible to cellulite. Adipose tissue is seen to be deeply modified during cellulite development. Our study tried to understand the overall features within and surrounding cellulite to apply the best therapeutic approach. Methods: Samples of gluteal femoral area were collected from cadavers and women who had undergone surgical treatment to remove orange peel characteristics on the skin. Samples from cadavers were employed for an accurate study of cellulite using magnetic resonance imaging at 7 Tesla and for light microscopy. Specimens from patients were employed for the proteomic analysis, which was performed using high resolution mass spectroscopy (MS). Stromal vascular fraction (SVF) was obtained from the samples, which was studied using MS and flow cytometry. Results: light and electron microscopy of the cellulite affected area showed a morphology completely different from the other usual adipose depots. In cellulite affected tissues, sweat glands associated with adipocytes were found. In particular, there were vesicles in the extracellular matrix, indicating a crosstalk between the two different components. Proteomic analysis showed that adipose tissue affected by cellulite is characterized by high degree of oxidative stress and by remodeling phenomena. Conclusions: The novel aspects of this study are the peculiar morphology of adipose tissue affected by cellulite, which could influence the surgical procedures finalized to the reduction of dimpling, based on the collagen fibers cutting. The second novel aspect is the role played by the mesenchymal stem cells isolated from stromal vascular fraction of adipose tissue affected by cellulite.

A Multicenter, Retrospective Evaluation of Tissue Stabilized-Guided Subcision in the Management of Cellulite

BACKGROUND

The first FDA-cleared, long-lasting, minimally invasive device for improving the appearance of cellulite was recently launched in Canada as a novel, tissue stabilized-guided subcision (TS-GS) system (Cellfina, Merz North America, Inc., Raleigh, NC). Clinicians from 2 of the first Canadian sites offering this procedure were interested in evaluating treatment efficacy and patient satisfaction after its first year on the market.

OBJECTIVES

The authors sought to evaluate the efficacy of TS-GS and the level of patient satisfaction associated with the procedure.

METHODS

Medical charts of female patients treated with the TS-GS system in 2017 were retrospectively analyzed at 2 Canadian centers. Measurements at baseline and 3 months posttreatment were assessed for patient satisfaction and physician-rated efficacy. Patient satisfaction was assessed using a 5-point Likert-type scale, and efficacy was evaluated through physician review of 2-deminsional and 3-dimensional photography, the Nürnberger-Müller Scale for cellulite, and the Global Assessment of Improvement Scale.

RESULTS

We reviewed 25 patient charts. At month 3, 95.6% of patients were satisfied with treatment results and physician evaluations revealed that on average, patients displayed a 1-point improvement in their cellulite grades. Moreover, Global Assessment of Improvement Scale scores indicated that all patients had visible improvement in the global appearance of cellulite. No serious adverse events were observed within 3 months postprocedure.

CONCLUSIONS

The physician ratings, patient satisfaction, and photographic evidence support the efficacy of the TS-GS system to manage grades 1 to 3 cellulite in women's thighs and buttocks. These findings indicate the safety of the TS-GS system.

Level of Evidence: 4.

Cellulite: a cosmetic or systemic issue? Contemporary views on the etiopathogenesis of cellulite

Cellulite (also known as gynoid lipodystrophy or orange peel syndrome) is one of the most common lipodystrophy syndromes, which affects millions of post-adolescent women. Cellulite is manifested by topographic disorders of subcutaneous tissue such as nodules, edema, and abnormal fibrosis. It is located mainly on the pelvic area, especially on the buttocks. Its pathogenesis is complexed and unclear. There are several theories about its pathophysiology. Hormonal disorders, endothelial dysfunction and genetic predispositions are taken under consideration.

The Effect of Combination of Red, Infrared and Blue Wavelengths of Low-Level Laser on Reduction of Abdominal Girth: A Before-After Case Series

Introduction: The objective of this study was to assess the efficacy of a combination of 3 wavelengths (including red, infra-red, and blue) of low-level laser (LLL) as a non-invasive therapeutic method to reduce abdominal girth. To achieve biochemical activity on adipocytes, a red laser was used in our selective laser combination. Near-infrared laser was used to increase depth of penetration. Nitrosyl complexes of hemoglobin (NO-Hb) are sensitive to blue light, thereby leading to increase in release of biologically active nitric oxide (NO), which can affect tissue perfusion. Thus, a blue LED was added to the laser combination. Methods: Eighteen females participated in the study. Twelve sessions of laser therapy were performed, 2 sessions per week for each subject. Continuous wave diode lasers, including red (630 nm), infra-red (808 nm), and a blue LED (450 nm) were applied and were all designed by the Canadian Optic and Laser Center. Results: Statistical analyses revealed that upper abdomen size significantly decreased from pre- (91.86 ± 11.16) to post- (87.41 ± 10.52) low-level laser therapy (LLLT) (P<0.001). Middle abdomen size showed significant reduction from pre- (97.02 ± 8.82) to post- (91.97 ± 8.49) LLLT (P<0.001). Lower abdomen size significantly decreased from pre- (100.36 ± 9.45) to post- (95.80 ± 8.52) LLLT (P<0.001). Conclusion: Based on this case series pilot investigation, the combination of 3 different wavelengths of LLL was effective for abdominal girth reduction in 100% of our subjects (P<0.001), without any side effects. Future studies will assess the long-term benefits of this laser combination for reduction of subcutaneous fat deposits.

A Standardized Composition Comprised of Extracts from Rosmarinus officinalis, Annona squamosa and Zanthoxylum clava-herculis for Cellulite

Background

Cellulite, characterized by changes in the skin morphology presented as dimpled or puckered skin appearance, is highly prevalent among postadolescent women. Cellulite management ranges from topical cream applications to invasive procedures. While some interventions showed improvements in physical appearances of affected areas, so far, none have reversed the condition to a full recovery. These unsuccessful measures signify the intricate nature of cellulite etiology highlighting its complexity leading to the possibility for a combination treatment approach to target multiple mechanisms.

Materials and Methods

We screened our plant library for extracts that reduce cellular lipid accumulation, improve microcirculation, possess high total antioxidant capacity, significant anti-platelet aggregation, and anti-inflammatory activities using lipid accumulation assay in 3T3-L1 cells, Croton oil-induced hemorrhoid test in rats as a model for microcirculation, anti-platelet aggregation assay, nitric oxide (NO) inhibition assay, and 1,1-diphenyl-2-picrylhydrazyl assay.

Results

Three known botanicals such as Rosemary officinalis, Annona squamosa and Zanthoxylum clava-herculis were identified as lead extracts in these tests. Treatment of 3T3 cell with A. squamosa at 1 μg/ml resulted in 68.8% reduction in lipid accumulation. In croton oil-induced hemorrhoid study, Z. clava-herculis reduced the recto-anus coefficient by 79.6% at 6 mg/kg indicating improvement in microcirculations. Similarly, R. officinalis caused inhibition of 82%, 71.8%, and 91.8% in platelet aggregation, NO production and free radical generation at 31.25 μg/ml, 6.2 μg/ml, and 40 μg/ml concentrations suggesting its anti-oxidant, and anti-inflammatory activities.

Conclusions

Data depicted here suggest that formulation of these well-known botanicals at a specific ratio perhaps may yield a composition with a much wider spectrum of mechanisms of actions to impact the multiple pathways involved in cellulite onset, continuation, or exacerbations.

SUMMARY

Cellulite represents one of the main esthetic concerns of women with a likely cause of psychological insecurities. Its pathophysiology involves multiple pathways that include vascular, adipose tissues, inflammation, structural and physiological.Treatment strategies for cellulite comprises increasing microcirculation flow, reducing lipogenesis, promoting lipolysis, free radicals scavenging or formation reduction, anti-inflammation and other invasive procedures.We screened our plant library for extracts that reduces cellular lipid accumulation, improves microcirculation, possesses high total antioxidant capacity, inhibits platelet aggregation, and moderates inflammation.Botanical extracts from Rosmarinus officinalis, Annona squamosa and Zanthoxylum clava-herculis were identified as leads and formulated to yield a standardized composition designated as UP1307 and suggested its usage for cellulite. Abbreviations Used: GMP: Good Manufacturing Practice; CA: Carnosic acid; NF-kB: nuclear factor-kB; HPLC: high-performance liquid chromatography; EtOH: Ethanol; DMEM: Dulbecco's modified Eagle's medium; FBS: fetal bovine serum; SD: Sprague Dawley; RAC: recto-anus coefficient; LPS: Lipopolysaccharide; DPPH: 1,1-diphenyl-2-picryl-hydrazyl; TNF-α: tumor necrosis factor; NO: Nitric oxide.

Effectiveness of carboxytherapy in the treatment of cellulite in healthy women: a pilot study

Background

Carbon dioxide therapy, better known as carboxytherapy, relates to percutaneous infusion of medical carbon dioxide with therapeutic approaches, and its use in the treatment of localized fat has demonstrated good results. Gynoid lipodystrophy, also known as cellulite, affects 80%–90% of women after puberty, especially in the buttocks and thighs. Its etiology is complex and involves multifactorial aspects. Its treatment and evaluation require the use of new technologies (more effective and low-cost approaches). The objective was to investigate the effectiveness of carboxytherapy in the treatment of cellulite in the areas of buttocks and posterior thigh.

Patients and methods

Ten women, 29±6.1 years, were selected and all of them received eight treatment sessions, with an interval of 7 days between sessions. Standardized digital photographs were used to assess the severity of cellulite, and panoramic images were collected by ultrasound diagnosis. The evaluations were performed before the first treatment (baseline) and 7 days after the last treatment session of carboxytherapy.

Results

After the treatment, there was a significant reduction (P=0.0025) of the cellulite from degree III to degree II, and this improvement had correlation with the improvement in the organization of the fibrous lines and the disposal of adipose tissue lines of the treated regions observed through the panoramic ultrasound images diagnosis.

Conclusion

Carboxytherapy is an effective technique of treatment of cellulite in the buttocks region and posterior thighs of healthy women.

Application of an aqueous two-phase micellar system to extract bromelain from pineapple (Ananas comosus) peel waste and analysis of bromelain stability in cosmetic formulations

Bromelain is a set of proteolytic enzymes found in pineapple (Ananas comosus) tissues such as stem, fruit and leaves. Because of its proteolytic activity, bromelain has potential applications in the cosmetic, pharmaceutical, and food industries. The present study focused on the recovery of bromelain from pineapple peel by liquid-liquid extraction in aqueous two-phase micellar systems (ATPMS), using Triton X-114 (TX-114) and McIlvaine buffer, in the absence and presence of electrolytes CaCl2 and KI; the cloud points of the generated extraction systems were studied by plotting binodal curves. Based on the cloud points, three temperatures were selected for extraction: 30, 33, and 36°C for systems in the absence of salts; 40, 43, and 46°C in the presence of KI; 24, 27, and 30°C in the presence of CaCl2 . Total protein and enzymatic activities were analyzed to monitor bromelain. Employing the ATPMS chosen for extraction (0.5 M KI with 3% TX-114, at pH 6.0, at 40°C), the bromelain extract stability was assessed after incorporation into three cosmetic bases: an anhydrous gel, a cream, and a cream-gel formulation. The cream-gel formulation presented as the most appropriate base to convey bromelain, and its optimal storage conditions were found to be 4.0 ± 0.5°C. The selected ATPMS enabled the extraction of a biomolecule with high added value from waste lined-up in a cosmetic formulation, allowing for exploration of further cosmetic potential.

Characterization of symptoms and edema distribution in premenstrual syndrome

Background

Premenstrual syndrome is a group of symptoms linked to the menstrual cycle, and edema is among these symptoms. Physiotherapy is often sought by many patients for the treatment of edema; however, for an adequate prescription of physiotherapeutic procedures, the distribution of edema throughout the body has yet to be characterized.

Objective

To determine the most frequent symptoms and body regions that present with edema in women during the premenstrual period.

Subjects and methods

Sixty women with a mean age of 24.6±4.7 years were evaluated during their premenstrual (between days 21 and 28) and menstrual period (between days 1 and 3), and the collected data included body mass, height, biotype (body-fat distribution), face, breast, limb-circumference measurements, and limb-volume estimate, and an adapted version of the Premenstrual Symptoms Screening Tool was used. Statistical analysis was performed using Student’s t-test and the test for equality of two proportions (P≤0.05).

Results

Premenstrual syndrome was identified in 91.7% of the women, and the most frequent symptoms were irritability (73.33%) and physical symptoms, including swelling (65%), and anxiety (58.3%). Edema was detected in the following areas: facial, epigastric, mammary, umbilical, and pubic, the mid-third of the arms, distal forearm, in both thighs and in the mid-third of the legs determined by circumference measurements, and in both upper and lower limbs, according to the estimated volume.

Conclusion

In this study population, the most frequent symptoms were irritability, physical symptoms, and anxiety, with distribution of edema in the face, breast, abdomen, pubic area, distal upper limb, and proximal lower limb.

Skin manifestations in CDG

The group of congenital disorders of glycosylation (CDG) has expanded tremendously since its first description in 1980, with around 70 distinct disorders described to date. A great phenotypic variability exists, ranging from multisystem disease to single organ involvement. Skin manifestations, although inconsistently present, are part of this broad clinical spectrum. Indeed, the presence of inverted nipples, fat pads and orange peel skin in a patient with developmental delay are considered as a hallmark of CDG, particularly seen in PMM2 deficiency. However, over the years many more dermatological findings have been observed (e.g., ichthyosis, cutis laxa, tumoral calcinosis…). In this review we will discuss the variety of skin manifestations reported in CDG. Moreover, we will explore the possible mechanisms that link a certain glycosylation deficiency to its skin phenotype.

Cellulite: advances in treatment: facts and controversies

Cellulite is traditionally considered a highly prevalent aesthetic condition in women. From a clinical standpoint, it is characterized by a cottage-cheese-like appearance of the skin, which can be most commonly found in certain areas of the body (eg, thighs, buttocks, and legs). Although cellulite is generally asymptomatic, the more severe stages can be accompanied by the appearance of painful nodules and increased local temperature, which are suggestive of an inflammatory reaction occurring in the dermis and in the underlying subcutaneous adipose tissue. Whether cellulite is a real disease or only a disturbing aesthetic issue is still a matter of controversy. This debate notwithstanding, it seems clear from market trends that there is considerable commercial interest in developing effective strategies aimed at reducing the cottage-cheese-like appearance of cellulite areas. Quite disturbingly, the majority of treatment attempts to date have been conducted in an empirical manner and without the application of rigorous scientific methodology. This is likely due--at least in part--to the lack of major, evidence-based pathophysiological insights into the nature of this condition. More stringent regulatory control is needed over commercial products aiming at improving the appearance of cellulite.

Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite

BACKGROUND

Extracorporeal shock wave therapy has been successfully introduced for the treatment of cellulite in recent years. However, it is still unknown whether the individual clinical outcome of cellulite treatment with extracorporeal shock wave therapy can be predicted by the patient's individual cellulite grade at baseline, individual patient age, body mass index (BMI), weight, and/or height.

METHODS

Fourteen Caucasian females with cellulite were enrolled in a prospective, single-center, randomized, open-label Phase II study. The mean (± standard error of the mean) cellulite grade at baseline was 2.5±0.09 and mean BMI was 22.8±1.17. All patients were treated with radial extracorporeal shock waves using the Swiss DolorClast(®) device (Electro Medical Systems, S.A., Nyon, Switzerland). Patients were treated unilaterally with 2 weekly treatments for 4 weeks on a randomly selected side (left or right), totaling eight treatments on the selected side. Treatment was performed at 3.5-4.0 bar, with 15,000 impulses per session applied at 15 Hz. Impulses were homogeneously distributed over the posterior thigh and buttock area (resulting in 7,500 impulses per area). Treatment success was evaluated after the last treatment and 4 weeks later by clinical examination, photographic documentation, contact thermography, and patient satisfaction questionnaires.

RESULTS

The mean cellulite grade improved from 2.5±0.09 at baseline to 1.57±0.18 after the last treatment (ie, mean δ-1 was 0.93 cellulite grades) and 1.68±0.16 at follow-up (ie, mean δ-2 was 0.82 cellulite grades). Compared with baseline, no patient's condition worsened, the treatment was well tolerated, and no unwanted side effects were observed. No statistically significant (ie, P<0.05) correlation was found between individual values for δ-1 and δ-2 and cellulite grade at baseline, BMI, weight, height, or age.

CONCLUSION

Radial shock wave therapy is a safe and effective treatment option for cellulite. The individual clinical outcome cannot be predicted by the patient's individual cellulite grade at baseline, BMI, weight, height, or age.

An integral topical gel for cellulite reduction: results from a double-blind, randomized, placebo-controlled evaluation of efficacy

BACKGROUND

Cellulite is a serious cosmetic concern for most of the 90% of women affected by it.

OBJECTIVE

To assess the clinical efficacy of a complex integral anti-cellulite gel.

METHODS

This double-blind, randomized, placebo-controlled study involved 44 healthy women, aged 25-55 years. Subjects had a normal to slightly overweight body mass index and presented slight to moderate cellulite on their thighs, buttocks, and/or hips at baseline. Subjects were randomly assigned to either the treated or placebo group and accordingly applied the active product or placebo on their hips, stomach, buttocks, and thighs, twice daily for 3 months. Skin tonicity, orange-peel aspect, and stubborn cellulite were assessed at day 0, 28, 56, and 84. A self-evaluation questionnaire was completed by all volunteers.

RESULTS

At the end of the study, an average of 81% of the subjects applying the active product presented improvement in their cellulite condition versus 32% for the placebo group (all descriptors and sites combined). At day 84, skin tonicity, orange-peel appearance, and stubborn cellulite were improved in a significant manner (P<0.05) over placebo, on all studied areas. Skin tonicity improved on average by +41% for buttocks, +35% for hips, and +31% for thighs. Orange peel appearance was reduced on average by -25% for buttocks, -22% for hips, and -22% for thighs. Stubborn cellulite was reduced on average by -19% for buttocks, -24% for hips, and -22% for thighs. Circumference measurements decreased in a significant manner (P<0.05) over placebo, for the abdomen (average value of -1.1 cm) and thighs (average value of -0.8 cm). The product was well tolerated and perceived by the volunteers themselves as better performing than placebo on all criteria.

CONCLUSION

All results validate the efficacy of the present integral formulation to significantly reduce signs of cellulite and reshape the silhouette.

Cellulite's aetiology: a review

Cellulite, highly prevalent among women, represents a serious problem for many of them, and one of their main aesthetic concerns. It is difficult to pinpoint its aetiology and physiology/pathophysiology, as there are many factors that are involved in it, affect it, and many processes that are taking place simultaneously and sequentially. Our objective is therefore, to review the scientific scholarship on cellulite to explore the causes of its origin. We carried out a preliminary search of the Medline, Cochrane, and Web of Knowledge databases covering the period from 1978 to April 2011. As there is no specific key word for the phenomenon at hand, we used the following descriptors: adipose tissue, subcutaneous fat, subcutaneous tissue, connective tissue, skin, skin disease and dermis. This resulted in a retrieval of 26 articles contributing to relevant information on the aetiology of cellulite. As a result of our first research, we concluded that cellulite is a physiological phenomenon or at least, that it has a physiological origin, which is characteristic of women, and multi-causal, with the coexistence of a number of factors that trigger, perpetuate, or exacerbate it. The outstanding factors include, among others, connective tissue architecture, oestrogen action, microvascular alterations and certain genetic and hormonal characteristics. All of them provide us with future and novel clues to cellulite treatment, and is necessary to take some or all of these factors into account in developing an effective therapy. However, we are aware of the necessity of further investigation in this field.

Intensive treatment of cellulite based on physiopathological principles

Aim. The aim of this paper is to report a novel intensive therapy of gynoid lipodystrophy (cellulite) based on a new hypothesis. Methods. Were evaluated in 10 patients with ages ranging between 25 and 59 years (mean 35.6 years) grade IV cellulite identified by clinical evaluation. Before initiating treatment, perimetry was performed at 5 cm intervals along both thighs, at the gluteal fold, 5, 10, and 15 cm above the gluteal fold, at the navel, and 5 cm above the navel. The patients were submitted to a 4-hour daily treatment session that consisted of manual and mechanical lymph drainage and cervical stimulation by the Godoy & Godoy technique adapted for the treatment of cellulite. After 10 sessions over two weeks, the patients were again evaluated. The paired t-test was utilized for statistical analysis with an alpha error of 5% (P value < 0.05). A reduction was identified at all of the measurement points (paired t-test; P value < 0.0001). Results. The mean reductions varied between 4.0 and 5.7 cm at the measurement points but reductions of more than 10 cm in perimeter were achieved in some patients. Conclusion. This technique involving lymphatic system stimulation is efficacious in the treatment of cellulite.

Análise dos efeitos do ultrassom terapêutico e da eletrolipoforese nas alterações decorrentes do fibroedema geloide

INTRODUÇÃO: A síndrome da desarmonia corporal (SDC) inclui a presença de fibroedema geloide (FEG), adiposidade localizada, aumento de gordura corporal total e flacidez muscular - frequentemente associados - e esses distúrbios estéticos representam uma ameaça à integridade emocional do indivíduo, sendo uma variedade de terapias propostas para o seu tratamento. OBJETIVOS: Avaliar os efeitos do ultrassom terapêutico (UST) e da eletrolipoforese no tratamento das alterações decorrentes do fibroedema geloide. MATERIAIS E MÉTODOS: Foram estudadas 22 voluntárias, com idade entre 17-35 anos, presença de FEG graus 1 e/ou 2 em glúteos, sedentárias e usando anticoncepcional. Previamente foram avaliadas as variáveis de perimetria, sensibilidade, dor, satisfação pessoal, adipometria, avaliação fotográfica e bioimpedância elétrica bipolar. Foram realizadas 10 sessões com UST em 11 das voluntárias e as demais 11 voluntarias receberam tratamento por eletrolipoforese. Todas as técnicas foram aplicadas na região glútea bilateralmente, três vezes por semana, e ao término do tratamento as variáveis foram reavaliadas. Na análise estatística foi aplicado o teste t de Student para verificar a significância entre os resultados obtidos em cada tratamento e entre os tratamentos. O nível de significância estabelecido foi de p < 0,05. RESULTADOS: Não houve diferença estatisticamente significante na perimetria, adipometria e bioimpedância após os tratamentos instituídos. Na avaliação fotográfica houve melhora no aspecto visual do FEG em 68,18% das participantes. A satisfação pessoal aumentou em ambos os grupos (UST p = 0,03* e eletrolipólise p = 0,04*). CONCLUSÃO: Os tratamentos apresentaram melhora no aspecto visual do FEG e na satisfação pessoal, porém não alteraram medidas perimétricas, de adipometria e da bioimpedância.

Adiponectin expression in subcutaneous adipose tissue is reduced in women with cellulite

BACKGROUND

Cellulite, which appears as orange peel-type or cottage cheese-like dimpling of the skin on the thighs and buttocks, is a complex, multifactorial, cosmetic disorder of the subcutaneous fat layer and the overlying superficial skin. Adiponectin is an adipocyte-derived hormone mainly produced by subcutaneous fat that shows important protective anti-inflammatory and vasodilatory effects. We hypothesized that adiponectin expressed in the subcutaneous adipose tissue (SAT) might play a role in the pathogenesis of cellulite. We reasoned that a reduction in the expression of adiponectin - a humoral vasodilator - in the SAT of cellulite areas might contribute to the altered microcirculation frequently found in these regions.

METHODS

A total of 15 lean (body mass index [BMI] < 25 kg/m(2) ) women with cellulite and 15 age- and BMI-matched women without cellulite participated in this study. Real-time reverse transcription polymerase chain reaction (RT-PCR) was used to assess adiponectin gene expression. Plasma adiponectin levels were measured using a commercial enzyme immunoassay kit.

RESULTS

Adiponectin mRNA expression in the SAT of the gluteal region was significantly lower in areas with cellulite compared with those without (12.6 ± 3.1 AU versus 16.6 ± 4.1 AU; P=0.006). However, plasma adiponectin levels did not differ between women with (20.3 ± 7.3 μg/ml) and without (19.3 ± 6.1 μg/ml) cellulite (P=0.69).

CONCLUSIONS

Adiponectin expression is significantly reduced in the SAT in areas affected by cellulite. Our findings provide novel insights into the nature of cellulite and may give clues to the treatment of this cosmetic issue.

Treatment of cellulite based on the hypothesis of a novel physiopathology

Background:

The aim of the current study is to report on a new form of treatment for cellulite based on a novel physiological hypothesis.

Methods:

A novel treatment for cellulite was evaluated in 14 patients aged 19–36 (mean 27.5) years. The only inclusion criterion was clinically diagnosed cellulite, and the exclusion criteria were history of edema, obesity, or any other disease diagnosed during the physical examination. Perimetry was performed at the gluteal fold, at 5 cm and 10 cm below the gluteal fold for both legs, and 5 cm and 10 cm below the navel. Additionally, standard photographs were taken and a questionnaire of satisfaction was applied. The patients were submitted to a treatment regimen of 1.5 hours per day adapted for the treatment of cellulite, consisting of manual and mechanical lymph drainage and cervical stimulation using the Godoy and Godoy technique. After 10 sessions over two weeks, the patients were evaluated again.

Results:

Reductions were identified at both points below the navel, the points on the thighs, and at the gluteal fold (P < 0.0001).

Conclusion:

This technique of lymphatic system stimulation is efficacious in the treatment of cellulite.

Evaluation of the prevalence of concomitant idiopathic cyclic edema and cellulite

The aim of this study was to evaluate the prevalence of concomitant idiopathic cyclic edema with Grade II and III cellulite. All patients treated for Grade II and III cellulite were evaluated for idiopathic cyclic edema in a retrospective, quantitative and cross-sectional study. The study was carried out at the Godoy Clinic in the period from 2006 to 2010. All patients with body mass indexes > 25, Grade I cellulite and other causes of edema were excluded. The diagnosis of idiopathic cyclic edema was based on a clinical history and fluid retention throughout the day, in particular difficulty in removing rings on waking in the morning which improves later in the day. All patients with cyclic edema were treated with 75 mg aminaphtone three times daily. Statistical analysis considered the frequency of edema. Of the 82 women evaluated with ages between 18 and 58 years old (mean of 34.9 years) 41 (50.0%) were diagnosed with idiopathic cyclic edema. Idiopathic cyclic edema is an aggravating factor for cellulite and is frequently associated with the more advanced stages of the disease. Its control is essential in the treatment of cellulite.

Lipoedema: presentation and management

Lipoedema is a distinct clinical condition characterized by bilateral, symmetrical enlargement of the buttocks and lower limbs owing to excess deposition of subcutaneous fat. It is found almost exclusively in women. The common features associated with this condition are 'column- shaped' legs with sparing of the feet, bruising, sensitivity to pressure, and orthostatic oedema. The progression to lipo-lymphoedema or morbid obesity is possible. Conservative measures used in the management of lymphoedema can prevent progression/limit the orthostatic oedema. Surgical procedures may also play a part in the management of lipoedema.

Post-pregnancy body contouring using a combined radiofrequency, infrared light and tissue manipulation device

BACKGROUND

Non-invasive body contouring is an increasingly popular aesthetic application. Previous data support the efficacy of combined radiofrequency, infrared and skin manipulation for cellulite treatment.

OBJECTIVE

To evaluate the performance of a high-power device (50 W as opposed to 25 W) combining these energies for reshaping and improvement of skin texture/laxity in postpartum women.

METHODS

Twenty women received five weekly treatments to the abdomen, buttocks and thighs with the VelaShape system. We followed up each patient's weight and nutritional habits. Outcome was assessed using reproducible circumference measurements, digital photography, the physician's scores of cellulite and improvement as well as patient satisfaction. Safety was evaluated by recording subjects' comfort and tolerance.

RESULTS

The overall mean circumferences reduction was 5.4 +/- 0.7 cm (p < 0.001). Significant (p < 0.02) improvement in skin laxity and tightening was noted by both the physician and patients. Treatments were well tolerated with no major safety concerns (one purpura, one mild burn).

CONCLUSIONS

The enhanced capabilities of the evaluated system enabled significant results in fewer and shorter sessions without compromising patients' safety or comfort. These data suggest that postpartum reshaping via circumferential reduction and skin laxity improvement can be effectively and safely achieved using a high-energy combination of radiofrequency, infrared and mechanical manipulation.

A multilocus candidate approach identifies ACE and HIF1A as susceptibility genes for cellulite

BACKGROUND

Cellulite is a common complex cosmetic problem for many post-adolescent women characterised by relief alterations of the skin surface, which give the skin an orange-peel appearance. Although genetic factors have been suggested to play a role in the development of cellulite, the genetic background of this condition remains unclear. We therefore conducted a multi-locus genetic study examining the potential associations of candidate gene variants in oestrogen receptors, endothelial function/adipose tissue hypoxia, lipid metabolism, extracellular matrix homeostasis, inflammation and adipose tissue biology, with the risk of cellulite.

METHODS

Using a case-control study of 200 lean women with cellulite and 200 age- and BMI-matched controls (grade 0 according to Nurnberger-Muller scale), we examined the association of cellulite with 25 polymorphisms in 15 candidate genes.

RESULTS

Two of the 25 polymorphisms were significantly associated with cellulite at the P < 0.01 level. After allowance for age, body mass index, the prevalence of contraceptive use and smoking in logistic regression analysis, the multivariable-adjusted odds ratios for cellulite were 1.19 (95% CI: 1.10-1.51; P < 0.01) for ACE rs1799752 and 0.61 (95% CI: 0.45-0.88, P < 0.01) for HIF1A rs11549465.

CONCLUSIONS

This study, which demonstrates an independent role of ACE and HIF1A in predisposing to cellulite, may provide novel information on the pathophysiology of this common cosmetic problem, and offer a topic for research for novel beautification interventions.

Confiabilidade intra e interexaminadores da fotogrametria na classificação do grau de lipodistrofia ginóide em mulheres assintomáticas

A lipodistrofia ginóide (celulite) é uma afecção dermatológica comum entre as mulheres. Uma de suas formas de avaliação é a inspeção visual por meio da fotogrametria. Entretanto, não foram encontrados estudos que verifiquem a repetibilidade e reprodutibilidade dessa avaliação. O objetivo deste estudo foi verificar a confiabilidade intra e interexaminadores da avaliação da celulite por meio da fotogrametria. Foram fotografadas e avaliadas as regiões glúteas de 50 mulheres (26,14±4,45 anos). A reprodutibilidade foi testada pela avaliação da mesma fotografia por dois examinadores em duas ocasiões diferentes, com intervalo de um ano; a repetibilidade por um mesmo examinador, com intervalo de uma semana. Os dados foram analisados estatisticamente e utilizado o índice Kappa ponderado. Os resultados indicaram substancial correlação (κ=0,70) entre os avaliadores para o grau de celulite no glúteo superior e moderada correlação (κ=0,50) para o grau de celulite no glúteo inferior. Nas análises de repetibilidade, os dados demonstraram excelente correlação (κ=0,81) para o grau de celulite no glúteo superior e substancial correlação (κ=0,75) para os graus no glúteo inferior. O método proposto para qualificação dos diferentes graus de celulite pela fotogrametria apresentou confiabilidade aceitável intra e interexaminadores para a maioria das regiões avaliadas, com exceção da região do glúteo inferior.

The effect of topical caffeine on the morphology of swine hypodermis as measured by ultrasound

BACKGROUND

Cellulite or lipodystrophy involves the modification of the subcutaneous adipose tissue. A wide variety of topical products is available to combat cellulite, but these have difficulties in being absorbed through the skin. One option is the therapeutic use of the ultrasound to enhance the trans-dermic transport of these drugs.

AIM

The objective of this study was the analysis of the effect of caffeine on the morphology of the swine hypodermis, both when applied topically and in combination with ultrasound treatment.

METHODS

The following treatments were applied to the dorsal areas of five pigs (Landrace x Large White, 35 days old, weighing 15 kg each): gel, gel + ultrasound, gel + caffeine (5%, w/w), and gel + caffeine + ultrasound, daily for 15 days. A fifth area received no topical application and was used as a control. Continuous ultrasound of 3 MHz with an intensity of 0.2 W/cm(2) was applied at a rate of 1 min/cm(2). After histological processing (hematoxylin and eosin), morphometric analyses were conducted to determine the thickness and numerical profile of the hypodermis. A one-way analysis variance using a Kolmogorov-Smirnov test was conducted, with a Tukey test used to identify significant differences. A confidence level of P < or = 0.05 was adopted.

RESULTS

Caffeine treatment was effective only when associated with ultrasound therapy; the combination resulted in a significant reduction in the thickness of the subcutaneous adipose tissue, as well as damage to the adipocytes, consequently decreasing the number of cells.

CONCLUSION

Ultrasound treatment was effective in increasing the cutaneous permeation of caffeine, as evidenced by the reduction in thickness of the hypodermis and number of adipocytes.

Correlation between lumbar lordosis angle and degree of gynoid lipodystrophy (cellulite) in asymptomatic women

INTRODUCTION

Gynoid lipodystrophy (cellulite) has been cited as a common dermatological alteration. It occurs mainly in adult women and tends to gather around the thighs and buttocks. Its presence and severity have been related to many factors, including biotype, age, sex, circulatory changes, and, as some authors have suggested, mechanical alterations such as lumbar hyperlordosis.

OBJECTIVE

To correlate the degree of cellulite with the angle of lumbar lordosis in asymptomatic women.

METHODS

Fifty volunteers were evaluated by digital photos, palpation, and thermograph. The degree of cellulite was classified on a scale of 1-4. Analyses were performed on the superior, inferior, right and left buttocks (SRB, IRB, SLB, ILB), and the superior right and left thighs (SRT, SLT). The volunteers underwent a lateral-view X-ray, and the angle of lumbar lordosis was measured using Cobb's method (inferior endplate of T12 and the superior endplate of S). The data were statistically analyzed using ANOVA and Spearman's correlation. A significance level of 5% was adopted.

RESULTS

Volunteers had a mean age of 26.1+/-4.4 years and a mean body mass index of 20.7+/-1.9 kg/m(2). There was no significant difference in lumbar lordosis angle between those with cellulite classes 2 and 3 (p>or=0.297). There was also no correlation between lumbar lordosis angle and the degree of cellulite (p>or=0.085 and r>or=0.246).

CONCLUSIONS

The analysis suggests that there is no correlation between the degree of cellulite and the angle of lumbar lordosis as measured using Cobb's method.

Effects of caffeine and siloxanetriol alginate caffeine, as anticellulite agents, on fatty tissue: histological evaluation

BACKGROUND

Cellulite is a physiological condition that presents etiologic plurality. Caffeine and its derivatives are used in anticellulite cosmetics due to their lipolytic activity on fatty cells. Siloxanetriol alginate caffeine (SAC) is a silanol derived from organic silicon. Radicals primarily from SAC are caffeine and the mannuronic acid.

AIMS

This study aims to analyze the effects of caffeine and siloxanetriol alginate caffeine on fatty tissue by histological evaluation.

METHODS

Formulations were developed with caffeine, caffeine + sodium benzoate or SAC and were applied topically for 21 days on Wistar female mice. The study regarded the histological aspects by determination of diameter and number of fatty cells with a light microscope.

RESULTS

Emulsion with caffeine caused a reduction of 17% on the diameter of the fatty cells compared with the control. The emulsion with caffeine + sodium benzoate did not cause alterations on cell diameter. Emulsion with SAC provoked reduction on fatty cell diameters of 16%. No significant alterations were observed on the diameter of the fatty cells treated with gels, although it was noticed that gel with SAC promoted a reduction of 26% on the number of fatty cells.

CONCLUSIONS

Emulsion with SAC was considered more indicated to promote the lipolytic action on fatty tissue, acting as a complement to treat cellulite. When sodium benzoate was added to the preparations, it inhibited the caffeine efficiency. Gel was not an adequate vehicle to be incorporated with caffeine and SAC.