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298
DOI: 10.5114/pm.2014.46472
Prz Menopauzalny 2014; 13(5): 298-304
Corresponding author:
Marta Leszko, MSc, Department of Cosmetology, Regional Unit of Physical Education and Sport Department in
Biała Podlaska, Józef Piłsudski Physical Education Academy in Warsaw, 15/30 Sokola St., 20-336 Lublin, Poland,
phone: 501 067 177, e-mail: marta.leszko@gazeta.pl
Review papeR
Submitted: 17.02.2013
Accepted: 01.10.2014
Abstract
Menopause is aphysiological process related to the increasing insufficiency of the hypothalamic-hypophy-
seal-ovarian axis. The pool of ovarian follicles capable of synthesizing female sex hormones becomes gradually
depleted. In response to the sequence of endocrine changes of premenopause, perimenopause, and postmeno-
pause, systemic somatic and emotional disturbances appear. Skin is the target organ for sex hormones. In
women, the trophicity and appearance of the skin are most significantly affected by female sex hormones,
estrogens and progesterone. However, this review also emphasizes the influences of other hormones on the
skin and subcutaneous tissue.
During menopause, alow estrogen concentration is responsible for increased vascular permeability and de-
creased vascular tone, which lead to microcirculation impairment and are important factors predisposing to the
development of cellulite. The effects of estrogen deficiency on the skin connective tissue include adecreased
production and topical content of both type Iand III collagen and elastin fibers, which also contributes to cellulite.
This paper presents diagnostic methods and clinical types of cellulite, as well as principal instrumental and
manual treatments used for the reduction of the condition. Preparations containing ingredients which help to
improve the metabolism of subcutaneous fat and enhance blood and lymphatic circulation, applied in cosmetol-
ogy and esthetic medicine practice, have been reviewed. Furthermore, we provide an array of opinions regarding
the effectiveness of treatment modalities presented here.
Key words: menopause, cellulite, hormones, microcirculation, oestrogen(s).
Introduction
The period of menopause is usually along-standing
running process with stormy hormone changes which
are manifested with somatic systemic disorders and
the lability of the emotional sphere. Apool of Graafian
follicles, responsible for the production of female sex
hormones, yields to the exhaustion. Hormone deficien-
cies can result in many dermatoses and may as well
increase already existing manifestations. Frequently
appearing skin defects are a consequence of these
disorders, so are discolourations, hirsutism or cellulite.
Correctly selected therapy is able to improve the ap-
pearance of the skin, and through that – increase the
quality of life of menopausal women.
Definition of cellulite
The notion of cellulite was first defined by French
doctors in 1922 [1]. From amedical point of view, these
are fibrous and oedematous changes of the subcuta-
neous layer, lipodystrophy or oedemetical, fibrosing
deviation of the connective tissue [2]. In this disease,
because of disorders of the microcirculation, degenera-
tive changes of the connective tissue occur. Cellulite is
more and more often treated as illness, since as the
definition of WHO demonstrates, it more and more of-
ten negatively influences amental state of both women
and men [3].
Cellulite aetiology
Hormonal imbalances are regarded as the crucial
cause of the cellulite, and more precisely – too high
concentration of oestrogens compared to the pro-
gesterone, that is relative hyperestrogenism [4]. Such
ahormone situation can appear physiologically in the
period of pregnancy, maturation, menopause, as well
as while taking the systemic hormone contraceptive or
in the course of the hormone replacement therapy. De-
velopment of cellulite is significantly influenced by two
processes constantly occurring in fat cells – lipogenesis
and lipolysis.
In the fatty tissue built from adipocytes, synthesis
and disintegration occur. Lipogenesis is supporting the
Cellulite in menopause
Marta Leszko
Department of Cosmetology, Regional Unit of Physical Education and Sport Department in Biała Podlaska,
Józef Piłsudski Physical Education Academy in Warsaw, Poland
M R/P M 13(5) 2014
299
accretion of the fatty tissue, however lipolysis is amet-
abolic process which causes the decomposition of the
stored-up fat. Exogenous and endogenic factors affect
both processes. In the prevention of cellulite, it is im-
portant to keep balance between both processes. Local
therapy is aimed at achange of the adipocyte metabo-
lism and should limit lipogenesis and activate lipolysis.
Lipolysis is aprocess of destruction, disintegration
and the reduction of lipids stored up in cells of the fatty
tissue and muscle occurring with the participation of li-
pases. Endogenic factors regulating the lipolysis include
such hormones and neurotransmitters as adrenaline
and noradrenalin (demonstrating poorer action than
adrenaline), estradiol and testosterone, adrenocorti-
cotropic hormone (ACTH), growth hormone (GH), thy-
rotropin (TSH, thyroid stimulating hormone) and lep-
tine, antidiuretic hormone and glucagon. Adrenaline
being connected with receptors on the surface of β3
adipocytes activates G protein which excites adenyl
cyclase and in the end increases cyclical AMP (cAMP).
Protein kinase activated by cAMP stimulates the HSL
(hormone-sensitive lipase) causing the disintegration
of stored up lipids.
Neutral fat lipase (known as desnutrin) hydrolyzes
triglycerides (TG) to diglycerides, and HSL decomposes
diglycerides to monoglycerides [5]. Glycerol and free
fatty acids are final products of the lipolysis (free fatty
acids), being energy sources for cells.
Insulin which is suppressing the initiative of cyklase
is the hormone blocking the process of lipolysis and it
stimulates activity of lipoprotein lipase (LPL), respon-
sible for the synthesis of lipids and the capture of free
fatty acids. The process of lipogenesis is also depend-
ent on SREBP-1 transcripting factor whose expression
is increased by insulin. For this reason, alow concen-
tration of this hormone can support the lipolysis pro-
cess [6].
According to the theory of adipocytary receptors,
a receptors intensify lipogenesis, however β receptors
support lipolysis. Adrenaline, belonging to catecho-
lamines, comes mainly from adrenal medullae and
fibres of the sympathetic nervous system, and the
stimulation of fat cells is one of its roles with a- and
β-adrenergic receptors. An influence on both kinds of
receptors is an effect of its acting. The amount of β adr-
energic receptors is reduced under the influence of such
factors as age – increasing the amount of the fatty tis-
sue which extorts the response of a receptors. It can
be the reason for the accumulation of fatty tissue in
menopausal women. This relation causes the potential
undesirable effect of anti-cellulite therapies [7].
Catechol amines speed up the process of the me-
tabolism via β receptors, affecting carbohydrates and
fats economy [8]. The consequence of hypoestrogenism
is the upset in the balance between noradrenalin, do-
pamine, serotonin or endorphins in the menopause. In-
creased secretion of neuroendocrine can be aresult of
stress, affecting women in their menopause. Increasing
the secretion of the noradrenalin shows the lack of the
stability of the autonomous nervous system. In the pe-
riod, the increased production of cortisol is connected
with the climacteric and at the same time with agreat
concentration of adrenaline and noradrenalin [9].
Mostly oestrogens are the hormones responsible for
the development of cellulite, as they are responsible for
arranging the fatty tissue. In women, the production of
the fatty tissue is independent of the amount of food
eaten. The development of the fatty tissue is subject
to an adjustment of local hormone mechanisms. Aro-
matase, which is elevated in the period of the meno-
pause activity, modifies the deficiency of ovarian oestro-
gens [10], as well as it influences the lipid and glucose
metabolism. This process causes the increase in adi-
pocytes, which under the influence of the pressure on
blood vessels and lymphatic vessels causes the growth
of the local pressure, burdening, and also microcircula-
tion. Shortage of the sex hormone in the menopause
exerts an adverse influence on the vasculature [8]. It
was proved that there is aclose relationship between
disorders of the venous circulation and pathological
changes in the fatty tissue [3].
PPAR nuclear receptor affects the metabolism of the
fatty tissue. Receptors are one of three kinds of PPAR
gamma receptors which influence the maturing and
diversifying of adipocytes. They stimulate the accumu-
lation of lipids and increase the synthesis of adiponec-
tin [6]. PPAR-a receptors are the second kind of units
which influence β-oxidation of free fatty acids and
serve as adjusters in lipogenesis [11]. Activated recep-
tors through peroxisome proliferators of PPAR – retinal
acid and conjugated linoleic acid (CLA) influence the
lipolysis process [2]. Oestrogens activate the action of
adrenergic receptors of the a type, and support the ac-
cumulation of fatty tissue in the region of thighs, hips
and the pelvis, as well as influence the extension and
increase the permeability of blood vessels. This results
in the occurrence of microembolisms and microswell-
ings. Oestrogens hinder the process of lipolysis and el-
evate lipogenesis. They influence the increased amount
of glycosaminoglicans (Gag) which is contributing to
impairment of the microcirculation (accumulating liq-
uid in the intercellular space creates swelling which
causes disorders in the microcirculation).
Progesterone has arelaxing effect on the fibres of
smooth muscles and can cause the venostasis trig-
gering disadvantageous morphological and functional
changes [3]. Disorders in the microcirculation may
cause alocal rise in pressure and support the increased
permeability of veins which is supplying the slow blood
flow and increases the viscosity, creating the leuko-
cytary trap. In individual periods of the menopause, an
impact of subtle interactions on development of the
M R/P M 13(5) 2014
300
cellulite is also being considered, namely the impact of
oestrogens and other hormones, such as progesterone,
growth hormone, melatonin, dehydroepiandrosteron,
androgens or insulin which can additionally entail
changes associated with the wrong transformation of
fats and carbohydrates.
In the premenopause, in spite of lowering concen-
trations of the plasmatic estradiol, escalating luteal de-
ficiency caused by more and more rare ovulations can
translate into the state relative to hyperestrogenism,
and this creates conditions for initiation of growth of
the fatty cellulite along with the tendency of swellings.
Another issue is strongly expressed postmenopau-
sal hypoestrogenism, as the maintained peripheral
production of androgens, can cause relative hyperan-
drogenism in older women [12], which can influence
the change of arranging of the fatty tissue which sur-
renders to reduction among others in places typical of
women, and develops in the belly and torso regions as
well as supports androidal (visceral) type of the build
[13]. With age, reduced stimulation of oestrogens wors-
ens the blood supply to the skin, suppresses the initia-
tive of fibroblasts, disadvantages normal synthesis of
collagen fibres and reduces the number of elastin fibres.
Under the skin there can occur perceptible palpable ir-
regularities – conglomerations of the bruised connec-
tive tissue underlined with the lack of the skin elastic-
ity. Such changes are characteristic of the slender figure
of the cellulite.
Amongst factors predisposing to the development
of cellulite, rather than resulting directly from hormo-
nal disorders, one should mention mostly the genetic
factors. Family tendencies exist to wrong deposition of
the fatty tissue and its characteristic organization at
simultaneously underdeveloped muscle mass. Bad eat-
ing habits are other non-hormone risk factors for the
development of cellulite. The increased supply of car-
bohydrates and fats supports hyperinsulinemia which,
among others, intensifies the process of lipogenesis and
is one of deciding aetiological factors. Badly balanced
diet with alot of preservatives and salt in the food sup-
ports retention of liquids which results in swellings.
Other factors are low physical activity and aseden-
tary lifestyle which disturb correct functioning of the
microcirculation and support the accumulation of fatty
tissue.
Nicotine and many other substances contained in
the cigarette smoke cause constriction of blood vessels
which supports tissue hypoxia. After certain time, loos-
ened vessels and the improvement in oxidation condi-
tions result in allowing reactive oxygen species to act in
the process of hypoxia – the reoxygenation.
Dilators of the peripheral blood vessels applied in
the arterial hypertension can affect the development of
the cellulite: β-blocking agents, antihistamine and ex-
ogenous oestrogens [4].
Improperly selected clothes and footwear, especially
wearing too close-fitting clothes, is definitely disturbing
the venous outflow. Also high-heeled shoes, through the
adverse impact on muscles of calves, disturb the good
posture and weaken the function of the muscle pump
of shins in transferring the venous blood to the heart.
In the prevention of cellulite, it is very important to
pay attention to all factors predisposing to its formation.
Some factors having asignificant influence on cellulite,
as for example genetic factors, are outside the range
of any possible alteration, therefore it is worthwhile to
concentrate on the elimination of factors, which we can
have areal influence, like the change of the inappropri-
ate diet or introducing amore active lifestyle.
Clinical image of cellulite
Clinically, nodular, uneven forming of the surface
of the skin is asign of cellulite. From amedical point
of view, the structure of the tissue with cellulite differs
from the fatty tissue above all with the increased num-
ber and the hypertrophy of adipocytes and with dis-
turbed proportion between saturated and unsaturated
fatty acids included in these cells, unfortunately to the
advantage of saturated fatty acids [7].
Characteristic of both sexes, differences associated
with the structure of the subcutaneous fatty tissue
cause that lipodystrophy appears mainly in women, and
in men exclusively in pathological states and while ap-
plying anti-androgen therapy (e.g. in the prostate can-
cer treatment). The cellulite in men is located within the
neck and belly [7].
In women cellulite most often appears in regions
of thighs, the belly and buttocks, in places, which have
alot of the receptors responsible for the lipogenesis [2].
So far no one has managed to prove the connec-
tion between cellulite and obesity, since cellulite also
appears in slim and active persons.
It is possible to distinguish three main clinical types
of the cellulite:
– fatty – by the overdeveloped fatty tissue;
– lymphatic – transitional, intensified mainly before
the menstruation;
– alleged – appearing because of weakened ten-
sion of the gluteus muscle, visible on the back of
thighs; it is possible to improve this state through
the right exercises [14].
On account of character of skin changes it is pos-
sible to divide cellulite into:
– tough type (in women practising sports where the
great cohesion of the skin and the well-developed
musculature are characteristic);
– slender form (in women of the perimenopausal
age, is also appearing after dieting; pliability of
muscles is characteristic, the skin is poorly tense
and loose);
M R/P M 13(5) 2014
301
Tab. I. Photonumerical scale of cellulite intensification
Clinical morphological features of cellulite advancement Result
1. Number of visible thickenings 0 = absence of thickenings
1 = small number; 1-4 visible thickenings
2 = average number; 5-9 visible thickenings
3 = high number; 10 and more visible thickenings
2. Depth of the thickenings 0 – no changes
1 – superficially deep changes
2 – mild deep changes
3 – deep changes
3. Various morphological models of superficial models of skin changes 0 – no affected areas
1 – ‘orange skin’ look
2 – ‘cottage cheese’ look
3 – ‘mattress’ look
4. Level of loosening and relaxation of the skin 0 – absence of visible changes or skin creasings
1 – light creasings
2 – mild creasings
3 – numerous creasings
5. Nürnberger and Müller’s classification scale – in the standing position
subjected to ‘pinching test’ (at the relaxed buttock muscle there may
not be visible creases; this allows to differentiate 0 from 1)
0 – zero degree
1 – first degree
2 – second degree
3 – third degree
Tab. II. Structure of cellulite intensification scale and its new
typology
Cellulite intensification scale New typology
1-5 Mild form
6-10 Average form
11-15 Advanced form
– hydropic form (the most severe form, appears in
women with serious disorders of the cardiovascu-
lar system) [2].
Cellulite diagnosis
Cellulite is diagnosed by acosmetologist or ader-
matologist. Apalpable medical examination and avis-
ual evaluation are the basis of assessment of cellulite.
There are many scales of the evaluation of cellulite
(Table I). Ascale that is universally used is Nürnberger-
Müller’s scale. The scale of 2009 – Doris Maria Hexsel’s
photonumerical scale of cellulite intensification – is
newer and regarded more exact (Table II). Based on pho-
tographs of 55 patients with cellulite, five key aspects
were distinguished in the assessment of this problem.
Anew classification mentions three stages of cel-
lulite advancement:
Aphotonumeric scale of intensifying changes in cel-
lulite is extremely valuable in monitoring therapeutic
anti-cellulite methods and can be applied for examin-
ing affected patients [15].
It is also possible to assess cellulite basing on spe-
cialist examinations: thermography (it determines the
temperature of the surface of the body, and colours are
indicating the temperature of the tissue), macrography,
TEWL determination (measurement of transcutaneous
dehydration), the apparatus measurement of greasing
or the skin elasticity, videocapillaroscopy (the examina-
tion assesses the state of the filling of capillaries: in the
place of the advanced cellulite the tissue is poorly sup-
plied with blood), electric bioimpedance (determines
content of the fatty tissue and water in the body).
However in the diagnosis of cellulite, computed axial
tomography, magnetic resonance and ultrasonography
turned out to be extremely useful.
But neither the computed axial tomography nor the
magnetic resonance can be universally used on account
of their costs and in the case of the computed axial to-
mography as for the radiation exposure to X-ray. There-
fore, ultrasonography is more and more general and
objective than the palpable scale. The research on the
evaluation of cellulite is performed basing on classical
ultrasound scanners and of high frequencies.
Classical ultrasonography assesses such parameters
as fatness of the corium and, of the subcutaneous layer,
echogenicity of both structures, and the border between
the corium and subcutaneous layer [16]. In the high
frequency ultrasonography it is possible to assess the
M R/P M 13(5) 2014
302
following parameters: the fatness of the cuticle and co-
rium, presence of swellings, echogenicity of corium and
what is most essential, the advanced process of forming
the root of the corium in the subcutaneous layer [17].
Methods of cellulite treatment
Treatments aimed at reduction of cellulite should be
conducted comprehensively and should have amulti-
directional action. One should be aware that they will
not eliminate the problem, and they will only slightly re-
duce its area and therefore will affect the temporary im-
provement in the appearance of the skin. Nevertheless,
this result can be essential for menopausal women.
Methods reducing cellulite are cosmetic procedures,
cosmetic surgery, pharmacology, and surgeon’s pro-
ceedings.
The basis of home therapy is:
1. Application of cosmeceutics, containing active in-
gredients:
• Improving the tightness of blood and lymphatic ves-
sels, e.g. flavonoids, antioxidants, saponins, tannins,
which also help eliminate unnecessary products of
metabolism. The above-mentioned group of sub-
stances appear in extracts from arnica, and seeds and
leaves of the horse chestnut.
• Intake of compounds of plant origin increases the
process of lipolysis, but suppresses lipogenesis such
as caffeine, extracts from guarana, Garcinia gummi-
gutta, theophylline, xanthine (come from coffee, the
green tea and the Paraguayan tea).
• Toning and moistening substances applied in anti-
cellulite cosmetology: hyaluronic acid, vitamin A and
E, urea, plant extracts, amino acids and hydroxyacids.
2. Supplementation – is based above all on products
containing caffeine and vitamin B
1s
, B
5
, B
9
and B
12
.
• Physical activity, sport, appropriate diet. Apreventive
program containing information about factors affect-
ing the development of cellulite and methods of its
elimination. The basis of precaution and also of elimi-
nation of risk factors is:
– preventing the development of the advanced
stage of the cellulite, most resistant to therapy. It
is also important to make women aware of the
need of periodic medical check-ups.
The most popular treatments in the cosmetic and
cosmetic surgery areas applied to reduce the cellulite are:
• Lymphatic drainage – works positively on lymphatic
vessels, eliminates swellings, is also beneficial for
deep layers of the skin.
• Endermology – apparatus massage; increases oxida-
tion of tissues, improves skin elasticity, hastens the
apoptosis of fat cells, however does not strengthen
the corium [18-20].
• Velasmooth™ is at present the most effective appli-
ance in the treatment of cellulite in anon-invasive
method, in which three energy sources are used:
infrared, bipolar electricity of high frequency (RF),
the impulse suction and massage. Their cooperation
considerably increases the effect in comparison to
results obtained when using single energy sources.
All three energies are being administered to the tis-
sue simultaneously, using one therapeutic head. The
treatment comprises 10-12 sessions which are taken
twice aweek for 5-6 weeks [20].
• Triactive™ – three various methods are being used
for the treatment: the diode laser, cryotherapy, deep
massage and lymphatic drainage. The diode laser
stimulates the reconstruction of vessels in the sub-
cutaneous layer, cryotherapy reduces swelling and
lymphatic drainage and massage stimulate blocked
circulation of lymph expelling water and unnecessary
products of metabolism from the organism. Series are
usually applied in about 10-15 treatments 1-2 times
aweek [20].
• SmoothShapes™ – the device is using three techno-
logies – connecting the laser, biostimulating light,
massage with rolls and vacuum [20].
• Alma Accent™ RF system – the device is asource of
high frequency waves for collagen remodelling, im-
proving texture of the skin and cellulite reduction. It
uses two types of radio frequency: unipolar and bipo-
lar. By proper applying different heads for heating (of
heat treatment), appropriate layers of the skin and
the subcutaneous layer are treated.
• IR rays – trigger thermogenesis after which the reduc-
tion in fat cells takes place.
The techniques of the cellulite reduction include
strictly medical aesthetic treatments:
• Liposuction – during the treatment alocal excess of
fat is removed – operation performed by surgeons.
Liposuction can be made with the help of lasers and
apparatuses producing airwaves. In medicine, apply-
ing high frequency waves causes effects of the over-
heating of tissues. Modern apparatuses are equipped
with the cooling system that prevents burns of the
skin (cryogenic liquid) and exchangeable treatment
heads. The treatment consists in the proper dosage
of airwaves, of which the energy is turned into the
central heating, stimulating cells to produce collagen;
waves work on the corium and the subcutaneous
layer. The treatment improves firmness and density
of the skin [20].
• Mesotherapy – method consisting in applying subcu-
taneous injections with nutrients and healing agents
(silica, caffeine, tiratricol). It assists the lipolysis which
reduces cellulite, but it does not directly affect the fat
tissue causing cellulite.
• Injection lipolysis – lipolysis can be applied to sup-
plement liposuction, but cannot replace it; the treat-
ment consists in the reduction in the local fatty tissue
with the injection; phosphatidylcholine has most of-
M R/P M 13(5) 2014
303
ten been applied and sodium deoxycholate, but both
are registered for this purpose. At present for the
injection lipolysis surgery, one uses anew injection
technique – intralipotherapy – which was registered
in 2007 and popularised by Professor Motolese as
Aqualyx preparation. Gel is also applicable in the ‘no-
needle’ mesotherapy against defluvium – Dermaheal
HR. Professor Maurizio Ceccarelli is using vitamin C
and iron for the lipolysis which causes the apoptosis
of fat cells.
• Cryolipolysis consists in exploiting cryotherapy and is
applied for the reduction of the fatty tissue. Under the
influence of the low temperature, cell membranes of
adipocytes are yielding to injury. Next, lipids undergo
crystallization, what in the end leads to their apop-
tosis. Lipids from adipocytes are consumed by mac-
rophages. During one treatment not always we can
destroy all cells – treatment performed by dermatolo-
gists and surgeons [14].
Same as all medical treatments, anti-cellulite treat-
ments should always be preceded by athorough inter-
view and medical consultation. When choosing treat-
ment, especially for menopausal women, one should
take the current medical condition into account, be-
cause diseases coexisting in this period can often make
the treatment impossible. The contraindication for in-
tensive manual and apparatuses treatments is diseases
already frequent in this lifespan, including arterial hy-
pertension, osteoporosis, type 2 diabetes and the ve-
nous failure.
Pharmacological therapy is considerably popular for
improving the appearance of the skin with the cellu-
lite. In women applying hormone replacement therapy
(HRT), by no means, quality and an amount of the ac-
cepted gestagenic component, or the route of admin-
istration, should be considered as marginal. In oral
administration, mineral corticosteroid activity of ge-
stagen can stimulate the system: renin-angiotensin-
aldosterone which stops water and electrolytes in the
system. Activity of glycocorticoid may cause contrac-
tion of blood vessels, dismissal of the blood flow and
venostasis, as well as blood coagulability among others
[17]. Androgenic activity of gestagen entails negative
changes in the profile of lipids of blood, increasing local
atherosclerotic processes [21].
In other words, disorders of the microcirculation
are common characteristics of adverse reactions of
the gestagenic hormone replacement therapy, one of
important factors in the aetiology of cellulite. The per-
cutaneous hormone treatment reduces the above side
effects. In pharmacological therapy of the cellulite,
medicines streamlining and normalizing the metabo-
lism of the fatty tissue are also applicable. Methylox-
antines stimulate lipolysis. Pentoxifylline corrects the
microcirculation and is advantageous for the immuno-
logical system [1].
Good effects are obtained by combined therapy.
These are most often treatments from the cosmetic
area, connected with applying cosmeceutics, with an
increased physical activity and appropriate diet. Even
though they will not get rid of the cellulite permanent-
ly, they will improve the general state of the skin, and
hence improve self-assessment of women in the period
of the menopause.
Conclusions
Cellulite is aclinical state stirring up alot of con-
troversy. There is explicitly no effective method of get-
ting rid of this disease [22]. From the point of view of
physiology, preparations recommended by producers as
those getting rid of cellulite demonstrate limited effica-
cy. By definition, cosmetic substances crossing border
layers of the cuticle do not demonstrate the effective
action towards changed tissues. Cosmetic substances
apriori cannot reach changed tissues.
Only products including in their composition accel-
erators of percutaneous passage, such as ethanol, iso-
propanol, propylene glycol or a-hydroxyacids can facili-
tate transport of active ingredients which can affect the
metabolism of the fatty tissue. Assuming that cellulite is
astate resulting from changes of the structure of the fatty
tissue, it is understandable that the motor activity cannot
be an effective method in itself of getting rid of the cel-
lulite. This problem affects both slim and obese women.
Regularly applied treatments made with the help
of apparatus, provide satisfactory, but short-lived, ef-
fects. Amongst methods listed in the article, abenefi-
cial effect of massage should be mentioned, and more
precisely the fact that exerted pressure on adipocytes
blocks their diversification, which makes the accumu-
lation of fatty tissue impossible [23]. Gentle massage
with elements of aromatherapy is peculiarly recom-
mended for women in the menopausal period, since
added oils not only work favourably on the state of the
skin, but also improve the psychological condition.
One should nurse ahope that research works of the
nearest years will verify the effectiveness of new thera-
pies and will allow us to gain more information about
the cellulite.
Disclosure
Author reports no conflict of interest.
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