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Conti G, Zingaretti N, Busato A, Quintero Sierra L, Amuso D, Scarano A, Iorio EL, Amore R, Ossanna R, Negri A, Conti A, Veronese S, De Francesco F, Riccio M, Parodi PC, Sbarbati A. Gluteal femoral subcutaneous and dermal adipose tissue in female. J Cosmet Dermatol 2024; 23:2726-2735. [PMID: 38638000 DOI: 10.1111/jocd.16314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/05/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND During the sexual maturation, gluteal femoral adipose tissue is subjected to numerous modifications, not observable in other regions, in particular in women and less in men. Other authors described this region, but they used imaging techniques having lower resolution, than MRI proposed in this study. High resolution imaging techniques might provide important and more detailed information about the anatomy of gluteal femoral region. METHODS This study has been performed using 7 T-magnetic resonance imaging and ultrastructural analysis in order to provide accurate description of the subcutaneous adipose tissue and dermis of gluteal femoral region. In this study specimens harvested from cadavers and form living patients have been analyzed. RESULTS The results showed the presence of three layers: superficial, middle, and deep, characterized by different organization of fat lobules. High resolution imaging showed the adipose papilla that originates from dermis and protrude in subcutaneous adipose tissue. Adipose papilla is characterized by a peculiar morphology with a basement, a neck and a head and these elements represent the functional subunits of adipose papilla. Moreover, ultrastructural study evidenced the relationship between adipocytes and sweat glands, regulated by lipid vesicles. CONCLUSIONS This study provides important information about subcutaneous and dermal fat anatomy of gluteal femoral region, improving the past knowledge, and move toward a better understanding of the cellulite physiopathology.
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Affiliation(s)
- Giamaica Conti
- Department of Neurosciences, Biomedicine and Movement Sciences, Anatomy and Histology Section, School of Medicine, University of Verona, Verona, Italy
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
| | - Nicola Zingaretti
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medicine (DMED), University of Udine, Udine, 33100, Italy
| | - Alice Busato
- Department of Neurosciences, Biomedicine and Movement Sciences, Anatomy and Histology Section, School of Medicine, University of Verona, Verona, Italy
| | - Lindsey Quintero Sierra
- Department of Neurosciences, Biomedicine and Movement Sciences, Anatomy and Histology Section, School of Medicine, University of Verona, Verona, Italy
| | - Domenico Amuso
- Neuroscience Biomedicine and Movement Sciences Department, University of Verona, Verona, Italy
| | - Antonio Scarano
- Department of Medical, Dean of Master course in Aesthetic Medicine, Oral and Biotechnological Sciences, University of Chieti-Pescara, Pescara, Italy
| | - Eugenio Luigi Iorio
- Neuroscience Biomedicine and Movement Sciences Department, University of Verona, Verona, Italy
| | - Roberto Amore
- Neuroscience Biomedicine and Movement Sciences Department, University of Verona, Verona, Italy
| | - Riccardo Ossanna
- Neuroscience Biomedicine and Movement Sciences Department, University of Verona, Verona, Italy
| | - Alessandro Negri
- Neuroscience Biomedicine and Movement Sciences Department, University of Verona, Verona, Italy
| | - Anita Conti
- Neuroscience Biomedicine and Movement Sciences Department, University of Verona, Verona, Italy
| | - Sheila Veronese
- Neuroscience Biomedicine and Movement Sciences Department, University of Verona, Verona, Italy
| | - Francesco De Francesco
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
- Department of Reconstructive Surgery and Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
| | - Michele Riccio
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
- Department of Reconstructive Surgery and Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
| | - Pier Camillo Parodi
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medicine (DMED), University of Udine, Udine, 33100, Italy
| | - Andrea Sbarbati
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
- Neuroscience Biomedicine and Movement Sciences Department, University of Verona, Verona, Italy
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Khalil S, Galadari HI. Cellulite: An Update on Pathogenesis and Management. Dermatol Clin 2024; 42:129-137. [PMID: 37977679 DOI: 10.1016/j.det.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Cellulite is a common cosmetic concern among postpubertal women. Despite its high prevalence, there have been only a few high-quality studies assessing its exact prevalence, risk factors, and pathophysiologic mechanisms. It has been difficult to achieve long-lasting results with the available treatments, including topical agents, energy-based devices, subcision, and injectables. In this review, the authors summarize the proposed etiologic factors, grading scales, and treatment options. Further well-designed studies are essential to improve our knowledge of the condition and lead to improved treatment strategies.
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Affiliation(s)
| | - Hassan I Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Dhillon RK, Dayan SH, Hexsel D, Shridharani S, Chilukuri S, LaTowsky B, Fabi SG. Update: Cellulite Therapies and Optimizing Treatment Combinations. Aesthet Surg J 2023; 43:1508-1520. [PMID: 37184131 DOI: 10.1093/asj/sjad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023] Open
Abstract
Cellulite in the proximal lower extremities is a reported concern among many adult females. The unsightly appearance of cellulite leads many affected individuals to seek treatment by trained specialists. The objective of this review is to provide the reader with an update on new and innovative therapies for cellulite including various treatment combinations to maximize therapeutic outcomes, and strategies for minimizing adverse events. The availability of new technologies and the results from recent clinical trials provide additional tools and data to consider when creating treatment plans for cellulite patients. This update to previous treatment recommendations is based on the most recent developments in cellulite management including the personal experiences of the authors with an emphasis on injectable enzymes, acoustic subcision, targeted verifiable subcision, and biostimulators. Formal clinical studies are warranted to compare various treatment modalities and further investigate combination regimens. LEVEL OF EVIDENCE: 5
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Gabriel A, Chan V, Caldarella M, Wayne T, O’Rorke E. Cellulite: Current Understanding and Treatment. Aesthet Surg J Open Forum 2023; 5:ojad050. [PMID: 37424836 PMCID: PMC10324940 DOI: 10.1093/asjof/ojad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Cellulite is an aesthetically distressing skin condition that manifests as dimples and depressions, producing an uneven surface to the skin. Occurring in 80% to 90% of females, mostly on the thighs, buttocks, and hips, it is associated with profound negative psychosocial and quality of life issues. Its ethiopathogenesis and pathophysiology are likely to be multifactorial and complex and not fully understood. There is no effective treatment for cellulite, although a number of different treatment modalities are available, from noninvasive to minimally invasive. The efficacy of most treatments is unpredictable and improvements in cellulite appearance are short lived, although significant progress has been made with newer treatments. This review provides an update on the current state of knowledge about cellulite, with an emphasis on patient assessment and an individualized treatment approach for optimal results. Level of Evidence 5
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Affiliation(s)
- Allen Gabriel
- Corresponding Author: Dr Allen Gabriel, Department of Plastic Surgery, 703 Broadway, Suite 700, Vancouver, WA 98660, USA. E-mail:
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5
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LaTowsky B, Jacob C, Hibler BP, Lorenc PZ, Petraki C, Palm M. Cellulite: Current Treatments, New Technology, and Clinical Management. Dermatol Surg 2023; 49:S8-S14. [PMID: 37000913 DOI: 10.1097/dss.0000000000003747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
BACKGROUND Cellulite is a well-known concern for many women; however, treatment can prove challenging because of the complexities of cellulite etiology, the various factors contributing to its appearance, and the multitude of therapies and procedures available. OBJECTIVE To discuss current cellulite treatment options and effective clinical management. METHODS A roundtable meeting was convened to discuss and share views on current cellulite treatment options, new technologies, and clinical management. The participants' views helped guide a narrative review on this topic. RESULTS Advanced interventions for cellulite treatment-such as physical and acoustic subcision, radiofrequency, and injectable biostimulators-are gradually being established, with accumulating evidence showing efficacy, patient satisfaction, and potentially long-lasting outcomes. Cellulite severity rating scales are necessary for assessing treatment outcomes, but these can be complex to use in clinical practice, and the majority do not include patient or clinician perspectives. CONCLUSION With the advent of new treatments and technologies, cosmetic surgeons and dermatologists will need to tailor their approach to each patient's needs and manage patient expectations because multimodal methods are likely to be required to address the various factors underlying cellulite appearance.
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Atiyeh B, Ghieh F, Oneisi A. Safety and Efficiency of Minimally Invasive Buttock Augmentation: A Review. Aesthetic Plast Surg 2023; 47:245-259. [PMID: 35999464 DOI: 10.1007/s00266-022-03049-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Volume restoration and enhancement of the gluteal region appearance has become nowadays a popular concern in particular for many women. Several options are available, none however are without complications and side effects. Volume enhancement with soft tissue fillers of the gluteal region is emerging as a highly attractive minimally invasive modality. It has led unfortunately to more unlicensed, nonmedical practitioners administering illicitly injections for buttock augmentation at relatively low costs. MATERIALS AND METHODS To determine safety, efficacy, and cost effectiveness of mostly used soft-tissue fillers for buttock augmentation, a systematic literature search of PubMed, Medline, and Embase was conducted to identify the mostly used fillers for gluteal augmentation. It was complemented by searching for each of the identified filler material separately to retrieve any missed reports. References of clinical studies and trials, reviews, and consensus reports were reviewed as well for the same objective. RESULTS In the final analysis 12, mostly strongly biased clinical reports providing a low level of evidence, were identified for inclusion in the review. Two studies involved Polymethylmethacrylate (PMMA), 5 Poly-L-lactic acid, 1 Calcium hydroxyapatite and 4 hyaluronic acid filler injection. No studies were identified involving liquid silicone or Polyacrylamide hydrogel. The little available evidence provided by this review indicates that a specific brand of PMMA in Brazil has a demonstrable relatively good safety, efficiency, and cost-effectiveness record superior to surgical alloplastic gluteal augmentation or to lipofilling only when injected by experts. CONCLUSION Gluteal augmentation with soft tissue fillers is not as simple and innocuous as advertised. Serious complications may occur. Moreover, optimal buttock contouring entails not only volume augmentation but also volume removal; thus, volume augmentation with soft tissue fillers may not be ideal. Popularizing this modality must also be approached with great care. Serious complications do occur; they become inevitable when performed illegally by non-specialized, non-authorized, and unscrupulous practitioners in non-accredited facilities. Patients must be warned that adherence to regulations is critical and that only well-trained certified experts practicing legally in accredited facilities can address safely and efficiently their concerns. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Bishara Atiyeh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Ghieh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Oneisi
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Mazzuco R, Evangelista C, Gobbato DO, de Almeida LM. Clinical and histological comparative outcomes after injections of poly-L-lactic acid and calcium hydroxyapatite in arms: A split side study. J Cosmet Dermatol 2022; 21:6727-6733. [PMID: 36098704 DOI: 10.1111/jocd.15356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although much has been published on the use of poly-L-lactic acid (PLLA) and calcium hydroxyapatite (CaHA) for off-face indications, questions remain regarding their exact mechanisms of action in subcutaneous tissue and their comparative efficacy. OBJECTIVE To present the clinical and histological results of the PLLA and CaHA injections into the opposing arms of the same patients. METHODS Five women received superficial subcutaneous injections of PLLA into the left arm and CaHA into the right arm. After three sessions, the clinical and histological outcomes were analyzed. RESULTS After the first session, three patients showed improvement in the right arm (CaHA), but at the end of study, two patients showed better results in the left arm (PLLA). Histologically, moderate to intense lymphocytic and giant cell infiltrate, as well as collagen and elastic fiber neoformation, were observed equally near the particles of both products. Dermis had no inflammatory or fiber alterations. CONCLUSION In this study, there were no clinical differences between these two fillers. Despite current thinking and previous histological studies, we found both products produced moderate to intense inflammatory reaction, as well as collagenic/elastogenic fiber neoformation, only in the subcutaneous tissue of the immediate vicinity and surrounding the individual filler particles.
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Affiliation(s)
- Rosemarie Mazzuco
- Private Clinic, Carazinho, Rio Grande do Sul and Mato Grosso, Brazil
| | | | | | - Luiz Mauricio de Almeida
- School of Medical Sciences, Santa Casa of Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
- Dermatology Residency Preceptor, Santa Casa of Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
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Christen MO. Collagen Stimulators in Body Applications: A Review Focused on Poly-L-Lactic Acid (PLLA). Clin Cosmet Investig Dermatol 2022; 15:997-1019. [PMID: 35761856 PMCID: PMC9233565 DOI: 10.2147/ccid.s359813] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/18/2022] [Indexed: 11/25/2022]
Abstract
The number of aesthetic procedures performed worldwide continues to grow together with an increase in the population seeking the restoration or preservation of a youthful appearance. Requests for non-surgical body rejuvenation are increasing. Patients are looking for safe and effective minimally invasive aesthetic procedures. Soft-tissue dermal fillers can meet these expectations. Based on the beneficial outcomes of these treatments in many facial areas, a new trend is developing to target body areas. Different dermal fillers are available and include collagen stimulators initially developed to restore facial volume. Furthermore, they are associated with long-lasting efficiency, a high level of patient satisfaction and a good safety profile, with mainly minor adverse events reported. In appropriate conditions of use, they are now used for body rejuvenation in clinical practice. Their use is expanding and allows addressing various issues including volume loss, skin laxity, cellulite, striae distensae and wrinkles. This review focuses on poly-L-lactic acid (PLLA), used in the first collagen stimulator and one of the most investigated in facial and in off-facial body applications. The available published data, although still limited, are presented by body area, neck and chest, buttocks, abdomen, upper arms, thighs, knees, and hands. Key features of the concerned zones and the main clinical signs affecting the body part as well as the injection modalities are provided along with the aesthetic results. This represents the state of the art on which to base further developments necessary for optimal and safe outcomes of treatment with the PLLA-based collagen stimulators and others in this class for body rejuvenation.
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Arora G, Patil A, Hooshanginezhad Z, Fritz K, Salavastru C, Kassir M, Goldman MP, Gold MH, Adatto M, Grabbe S, Goldust M. Cellulite: Presentation and Management. J Cosmet Dermatol 2022; 21:1393-1401. [PMID: 35104044 DOI: 10.1111/jocd.14815] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/02/2022] [Accepted: 01/27/2022] [Indexed: 11/30/2022]
Abstract
Cellulite is a common dermatological condition with a female preponderance, affecting up to 90% post-pubertal females. It is characterized with dimpling and denting of the skin surface, giving it a Peau d'orange appearance. Once considered to be a benign physiological isolated skin condition of only an aesthetic concern, cellulite is now considered a pathological entity with systemic associations and a negative psychological impact on patients. Several treatment options from lifestyle modifications, topical cosmetic therapies to energy-based devices have been studied for its treatment. However, treatment remains a challenge despite many new modalities in the armamentarium. Laser and light therapies along with radiofrequency are useful treatment options with good safety profile. Acoustic wave therapy, subcision, and 1440-nm Nd:YAG minimally invasive laser are beneficial in cellulite reduction. Methodological differences in the trials conducted, makes it difficult to compare different treatment modalities. Overall, treatment needs to be individualized based on the patient characteristics and severity of the condition. Combination of treatments is often required in most patients for reducing cellulite.
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Affiliation(s)
- Gulhima Arora
- Department of Dermatology, Mehektagul Dermaclinic, New Delhi, India
| | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | | | - Klaus Fritz
- Dermatology and Laser Center, Reduitstr. 13 ,D 76829 Landau, Germany; "Carol Davila" University of Medicine and Pharmacy 37 Dionisie Lupu Str, Bucharest, Romania
| | - Carmen Salavastru
- "Colentina" Clinical Hospital, Pediatric Dermatology Discipline, Dermato-oncology Research Facility, 19-21 Stefan cel Mare Str. Bucharest , Romania; "Carol Davila" University of Medicine and Pharmacy 37 Dionisie Lupu Str, Bucharest, 020021, Romania
| | - Martin Kassir
- Founding director, Worldwide laser institute, Dallas, USA
| | - Mitchel P Goldman
- Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA
| | - Michael H Gold
- Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA
| | - Maurice Adatto
- Skinpulse Dermatology and Laser Centre, Geneva, Switzerland
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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