| BODY CONTOURING | PEER-REVIEW


hormone functional alterations and patients consuming oestrogen or hormone-supplemented food


■ Dietary disorders, particularly an excess of sugar, fat, and hormones


■ Digestive disorders, especially those associated with intestinal flora alterations


■ Disorders of the intestinal flora, which is the initial pathology in all degenerative tissue alterations such as arthrosis, myalgia, angiopathies, and cellulite pathologies


■ Postural problems associated with foot orthopedic pathologies, such as inadequate footwear


■ Psychosomatic disorders, especially depressive anxiety or languid, apathetic, and body dysmorphic disorder9


■ Sexuality, a healthy balance between physiological and emotional needs ensures the chemical catalyst of many other metabolic functions. Lifestyle, poor diet, being obese or overweight, or having constipation are contributory factors


the use of any medicine that may contribute to increase the deposit of fat in the affected areas


■ Other aspects that should be researched with patients include if they are sedentary, diet programmes, psychosomatic factors, smoking habits, prior pregnancies, and the behavior of cellulite during pregnancy or other conditions.


Instrumental test Patients should take an instrumental test, ultrasound 7.5– 10 Mhz, which distinguishes the different components in the skin and the adipose tissue, such as water, fibrosis, and micro and macro nodules1


. Observing the


physiopathology of cellulite, it is understandable why treatments should be integrated and not limited to just adipose tissue treatments.


■ External compression, tight clothing does not help the intestine lymph adipose system in its functions or the cutaneous microcirculatory system, thus favouring cellulite pathologies of the metabolic hypoxic type


■ Infections may cause tissue damage, which, in turn, results in alterations and fibrosclerosis


■ Smoking slows down microcirculation in the cutaneous arterioles and is thus lipogenetic, generating the cutaneous hypoxia traditionally known as orange peel skin. However, permanent and deceitful damages in the interstitium due to an excess of free radicals when defence mechanisms, such as superoxide dismutase (SOD), fail should also be assessed


■ The intake of estro-progestagens, such as those included in birth-control pills and food preservatives. These favour interstitial liquid retention generating endothelial oedema and activating Fenton reactions. The process inevitably generates some form of lipoedema and lipolymphoedema, which in their turn result in lipodystrophy. Women who are administered hormones show a high level of free radicals as may be easily seen in Reactive Oxygen Metabolites (ROM) tests10,11


.


Clinical evaluation of cellulite patients As with other pathologies, the medical history should be detailed in the evaluation of cellulite. The patient should also be questioned regarding: ■ The age of onset of cellulite ■ Prior occurrence of trauma ■ Liposuction or injections in the affected area ■ The history of prior disease or surgery ■ Family history ■ The presence of chronic vascular or associated hormonal diseases


■ The occasional or regular use of medications and previous or current history of hormonal treatment or


Measurements should include dermal thickness between the epidermal hyperechogenic line and the deep dermal line, and adipose tissue thickness between the dermal hyperechogenic line and the hyperechogenic muscular fascia. Studies have proven that this examination not


control12,13


only shows the differences between localised adiposity and lipodystrophic panniculopathy, but also identifies the disease stage and provides . Therefore, it is an apt procedure to select the best


therapeutic strategy and, above all, it helps the physician make a prognosis. It is performed with a 7.5 or 8 MHz transducer. A 20 MHz Scan C may be used for a more detailed study of the skin surface.


Videocapillaroscopy The optical probe videocapillaroscope magnifies samples 10 to 1000 times, but a 200 magnification is normally used14


. The videocapillaroscope works with an optical


probe with epiluminescence and polarised light relayed to an image digitalisation system. It is a scientific research method used for angio-tectonic mapping, for studying microvessel responses to physical-mechanical and haemodynamic stimuli, as well as endocrine responses, and for monitoring drug therapies. For aesthetic pathologies, it represents the basic examination tool for skin, for the diagnosis of localised adiposities and lipodystrophy, and also for monitoring therapeutic responses. The patient should remain in position in a neutral


thermal environment and should not have smoked for the past 2 hours. Once the optical fibre or scope is in contact with the skin, different morphological aspects of regional microcirculation may be studied, in particular the regional angio-tectonic structure. Thus, blood microflow and aggregation or capillary alteration phenomena may be efficiently examined1


. The instrumental help of the videocapillaroscopy


optical probe (VCOP), permits a clinical diagnostic classification that corresponds to histomorphological alterations and anatomotopography of the adipose tissue. The VCOP is a noninvasive method that analyses


capillaries in a static and dynamic form and when integrated with the digital images, transforms the qualitative to quantitative characteristics allowing comparative images taken at different times as well as comparisons of sequential images over time1


. prime-journal.com | January/February 2015 ❚ 41


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