PEER-REVIEW | BODY CONTOURING |


Figure 1 Representation of the elements included in the ECM


STRUCTURAL FIBROUS PROTEINS Fibroblasts


LYMPHATIC SYSTEM


ADHESIVE PROTEINS


Fibronectin Laminin Integrins


CIRCULATORY UNIT


MICRO-


Capillary Venous


Arterial


MIGRATING CELLS


Macrophages Lymphocytes Dendritic cells Mast cells Neutrophil


Monocytes Granulocytes


Aesthetic pathology Cellulite is an aesthetic pathological condition and treatments. should range from a review of lifestyle habits and behaviours to shaping surgery. This article will give an overview of the following: Nutritional endocrinology Skin care Body building-aerobic exercise Hormonal rebalancing Manual lymphatic drainage Platelet-rich plasma (PRP) Mesotherapy


■ Carboxytherapy ■ Endermologie ■ Radiofrequency ■ Liposculpture.


First steps The objectives of cellulite treatment should be to: ■ Restore local microcirculation ■ Favour local metabolic exchanges ■ Increase local proteoglycan-levels ■ Increase veno-lymphatic drainage ■ Increase lipolytic action (physiology lipolysis) ■ Diminish fibrous trapping of adipocytes. The first step in the treatment should be the stimulation


of microcirculation and the removal of accumulated fluids and toxic elements. This can: ■ Improve the interstitial matrix basal regulation, (ECM regulation)


■ Improve fibroblast activity ■ Decrease interstitial oedema ■ Increase lipolysis (physiology lipolysis — the reduction


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


FIXED CELLS


Mesenchymal cells


Fibroblasts Adypocytes


CELLULAR MATRIX)


ECM(EXTRA GAGs


Chondroitin sulfate Hyaluronic acid


of the size of the fat cells with the release of glycerol and NEFA. The number of fat cells remain the same)


■ Improve better oxygen and nutrition of the adipose tissue.


Treatment


Nutritional Endocrinology Food as a medicine has been referred to as pharmacy- nutrition or nutritional endocrinology15


nutritional therapy of cellulite, it has three targets15


. In the efficacious :


■ Correcting overweight and obesity if present ■ Increasing the blood flow ■ Reducing inflammation. Nutritional treatment of cellulite is not just a


hypocaloric approach but is aimed at improving the state of tissue trophism and, in particular, at preventing and in some cases reducing the tissue phlogosis characteristic of the disease. With nutritional endocrinology, it relates to the stimulation using macro nutrients (carbohydrates, fats, and proteins) of specific hormonal systems (insulin- glycogen-eicosanoids), which may favour or damage the state of health in general and, in the case of cellulite, the worsening of the state of the tissues involved (adipose, connective, interstitial) in the glutei-femoral areas or on the inside of the knee. The correction of overweight and/or obesity, may be


reached by means of a reduction of the calorie intake, especially if derived from carbohydrates with a high glycemic index, which raise blood sugar levels with a consequent increase in levels of insulin. Increasing the blood flow and reducing


Nutritional


treatment of cellulite is not just a hypocaloric


approach but is aimed at improving the state


of tissue trophism and, in particular, at


preventing and in some cases reducing the tissue phlogosis


characteristic of the disease.


inflammation may be reached by means of a balanced diet of carbohydrates, proteins, and fats and is rich in fruit and vegetables, lean meat, fish, and mono-unsaturated fat such as olive oil. It is not only important to choose healthy foods but also to avoid substances contained in foods such as hydrogenated fats, interesterified oils, monosodium glutamate, and aspartame. It is also fundamental to propose nutritional models that are valid for a lifetime and not just for brief periods, so that the yo-yo effect is avoided, which would cause a worsening of the initial state of the cellulite. The use of integrators, such as omega-3, vitamins, and minerals, must be evaluated to reduce the inflammation further15


.


Food intolerance Patients often have complex manifestations that involve all body systems. It is not unusual for a patient to present unique symptoms as articular pain, abdominal pain, reflux disease (GERD), colitis, cough, asthma, and skin allergies appearing after eating a particular food15


. Most


doctors are often unprepared to handle these type of phenomenon. Overweight, obesity, and cellulite (even in underweight


patients or those with alimentary behaviour disorders) can often be a side-effect of inflammation determined


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