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PROMOTION alterations of cellulite disease


appear first and the varicose or lymphatic pathology manifests itself only later. Regardless, the characteristic ‘peau d’orange’ appearance of cellulite is either caused by an increase in the fat or interstitial liquid content, or to the alteration and retraction of connective tissue layers occurring at different times and in different manners. Venous-lymphatic stasis is the


outward expression of malfunction- ing in the endocrine-metabolic regulation of the interstitium. However, this definition does not include alI stages of the disease as far as their evolution in time is concerned and furthermore, it does not consider its aetiological and physiopathological variants. There are clearly three stages of


development — oedema, fibrosis, and sclerosis. However, the initial oedema is not always the first pathological manifestation as an alteration to the interstitial matrix, the connective structure, or the adipose tissue often precedes its appearance. In some cases, such as lipoedema and lipo-lymphoedema, the oedema (characterised by the presence of free water rather than lymph) results from an alteration of the interstitial or adipocytic metabolic mechanisms. Based on inspection of the skin, Nürnberger and Müller9,10


formulated a simple


grading-score of cellulite. Up to the 7th or 8th foetal month in both sexes, the upper part of the subcutaneous tissue just below the corium consists of standing fat-cell chambers and septa running radially similar to those of the adult woman. At birth, gender-typical differences are clearly manifest: in male newborns, small, polygonal fat-cell chambers and septa of netted, angled and parallel to the surface, criss-crossing connective tissue are distinctly those of adult males in addition to the corium being thicker and coarser in fibrous structure. These gender-typical structural differences possibly the result of the proliferative effect of androgens on the mesenchyme (fibroblast activity) during the last third of foetal life.


58 ❚


Figure 3 High-frequency high-resolution ultrasound of right thigh before first HERST treatment, corresponding to cellulite degree III


Incipient cellulite, recognised by an orange peel appearance, represents focally enlarged fibro-sclerotic strands partitioning the hypodermis and limiting the out-pouching of fat lobules. In contrast, fully developed cellulite recognised by a dimpled skin surface represents subjugation of the hypertrophic response of the hypodermal connective tissue strands when the resistance is overcome by progressive fat accumulation (in subjects with high body mass indices) forming papillae adiposae that protrude into the lower reticular dermis11


.


Materials and methods A healthy woman, aged 52 years with Fitzpatrick skin type III and cellulite degree III agreed to have the skin at her right thigh treated with HERST over 10 sessions


“Incipient cellulite, recognised by an


orange peel


appearance, represents focally enlarged


fibro-sclerotic strands partitioning the


hypodermis and limiting the


out-pouching of fat lobules.





Figure 4 High-frequency high-resolution ultrasound of right thigh after 10th HERST treatment, corresponding to cellulite degree 0–I.


(Figure 1), and with no treatment at the contra-lateral thigh. The giving of informed consent was required to perform the treatment. The patient was asked to continue with her usual daily routine, without undergoing a specific exercise regimen. Changes in subcutaneous fat where evaluated using diagnostic high-resolution ultrasound (Esaote 25 Gold® device with 15–18 MHz linear probe) and liquid crystal contact thermography


(LCCT)


(Thermo-Cell). Exclusion criteria related to health


status included: ■Disease of the skin


June 2012 | prime-journal.com


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