Chapter 3 Pathophysiology of Cellulite
What is cellulite? Certainly this clinical cutaneous phenotype is nothing, if not one of the
most vexing aesthetic medical pathologies in all of cosmetic medicine. There have been
many different modalities that have been employed to treat this disease, from injectable
chemical therapy (mesotherapy), injectable gases (carboxytherapy), topical therapies,
mobilization procedures (endermology, lympathic massage, Lymphapress and sequential
compression garments), oral medications (cellanase), ultrasound and laser (LED’s), all of
which held much promise when they launched, but ultimately proved to be inconsistent
and insubstantial.
Cellulite Definition:
Cellulite is a clinical pathology characterized best by its phenotypical
appearance of “lumpy-bumpy” cottage cheese, peu d’orange skin.
There are areas of raised skin and subcutaneous fat, admixed with areas of
retraction.
Cellulite Pathophysiology
There is a progression of pathophysiologic changes that leads the clinical
end-point of “peau d’orange”. The pathophysiologic alterations occur in the
interstitial matrix of the dermis and soft-tissue. There is a complex array of
pathophysiologic changes that occur. They are outlined as follows:
(i)
Metabolic alterations in the interstitial matrix including: increase
tissue acidity, deteriorating redox potential, diminished arteriole
flow, diminished permeability and oxygen tissue tension
(ii)
Free water increase and reduced hyaluronic acid, proteoglycan, and
Glycosaminoglycan functionality
(iii)
(iv)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)
altered connective structures and dermal collagen
development of pathological lipedema
development of lipolymphedema
alterations in lipogenesis-lypolysis
venous-lymphatic microcirculation
surface hypoxia
lipodystrophy
tissular fibrosis
sclerotic connective
microaneurysms
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(xiii)
(xiv)
(xv)
(xvi)
(xvii)
(xviii)
lipedema
changes in venous capillary permeability
decrease in the amount of GAG in vascular sleeves
chronic tissue hypoxia
adipose lobular edema
fibrinoid and fibrous retratctions
Clinical Presentation
Cellulite most commonly affects the back, side and/or front of the thighs,
and buttocks.
The following alterations may be found:
Diminished sensitivity
Pain, cramps
Heaviness
Nocturnal restlessness
Cold Feet
Changes in skin coloration
Livedo reticularis
Dry Skin
Ecchymosis
Edema
Clinical Classification
1.
2.
3.
4.
5.
6.
7.
Adipose cellulite
Edematous cellulite
Adipoedematous cellulite
Edematoadipose cellulite
Fibrous cellulite
Sclerotic cellulite
Mixed cellulite
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Investigations
Most treatments are instituted based on clinical diagnosis alone, but others
advocate:
Doppler Laser
Doppler
Echo Doppler
Thermography
Vega STT Test
Videocapilloscopy
Treatment
Diet
Molecular therapy
Colonotherapy
Subdermal therapy
VelaSmooth™
Mesotherapy
Caroboxytherapy
Pathophysiology of LipoLite™ Cellulite treatments:
VelaSmooth™ delivers radiofrequency (RF) heat 2.5 cm into the fat and 0.5cm of
Infrared (IR) heat into the dermis and fat. Through the thermogenic influences of the RF
and IR there is a vasodilation, increased blood flow and increased tissue oxygenation.
This leads to decongestion, improved venous and capillary blood flow and decreased
lobular fat congestion.
The mesotherapy, depending upon the “cocktail” leads to vasodilation, lipolysis, lobular
decongestion and clinical smoothening. Carboxytherapy, again leads to vasodilation,
increased blood flow, oxygenation and improvement in the clinical appearance of
cellulite.
.
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