ArticlePDF AvailableLiterature Review

Cellulite in menopause

Authors:

Abstract

Menopause is a physiological process related to the increasing insufficiency of the hypothalamic-hypophyseal-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 postmenopause, 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, a low estrogen concentration is responsible for increased vascular permeability and decreased 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 a decreased production and topical content of both type I and 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 cosmetology and esthetic medicine practice, have been reviewed. Furthermore, we provide an array of opinions regarding the effectiveness of treatment modalities presented here.
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 aphysiological 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, alow 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 adecreased
production and topical content of both type Iand 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 along-standing
running process with stormy hormone changes which
are manifested with somatic systemic disorders and
the lability of the emotional sphere. Apool 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 amedical 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 amental 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
ahormone 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
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299
accretion of the fatty tissue, however lipolysis is amet-
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 achange of the adipocyte metabo-
lism and should limit lipogenesis and activate lipolysis.
Lipolysis is aprocess 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, alow 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 aresult 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 agreat
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 aclose 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 arelaxing 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 alocal 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
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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 alot of preservatives and salt in the food sup-
ports retention of liquids which results in swellings.
Other factors are low physical activity and aseden-
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 asignificant 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 areal influence, like the change of the inappropri-
ate diet or introducing amore active lifestyle.
Clinical image of cellulite
Clinically, nodular, uneven forming of the surface
of the skin is asign of cellulite. From amedical 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
alot 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);
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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 acosmetologist or ader-
matologist. Apalpable medical examination and avis-
ual evaluation are the basis of assessment of cellulite.
There are many scales of the evaluation of cellulite
(Table I). Ascale 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.
Anew classification mentions three stages of cel-
lulite advancement:
Aphotonumeric 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
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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 amulti-
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. Apreventive
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 anon-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 aweek 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
aweek [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 asource 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 alocal 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-
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ten been applied and sodium deoxycholate, but both
are registered for this purpose. At present for the
injection lipolysis surgery, one uses anew 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 athorough 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 aclinical state stirring up alot 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
apriori 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
astate 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, abenefi-
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 ahope 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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... The diminished type I and III collagen and elastin fiber content also contributes to cellulite formation. 12 A new innovation for treating cellulite is a controlled mechanical method of focal fibrous septa release designed for in-office use. The locations of cellulite depressions are marked while the patient is in a relaxed, standing position. ...
Article
Full-text available
Cellulite is a common and often emotionally distressing condition among affected individuals. The dimpled appearance is caused by fibrous connective tissue, or septa, which tether the dermis to underlying fascia. A novel, minimally invasive, controlled focal septa release method was developed to selectively identify, target and manually release the tethers in a precise manner from a single insertion point (Revelle Aesthetics). The following pilot study evaluated the safety and feasibility of this method for treating subjects with moderate-to-severe cellulite. Methods: Female subjects (N = 10), 21-55 years old underwent unilateral controlled, focal fibrous septa release on the buttocks and thighs. Local anesthesia was administered using standard techniques. Cellulite depressions were marked with the subject standing at rest. Target septa were identified in the marked areas by applying tension with the device to reproduce the dimple appearance on the skin. Once identified, the contributing septa were severed with the device. For eight subjects, access was achieved with one small incision in the gluteal crease. Study assessments occurred on posttreatment days 1, 3, 14, 30, and 90. Results: All procedures were successfully completed with no serious or unexpected adverse events and the procedure was well tolerated. Mild adverse events were transient bruising and soreness. Target septa can be visualized on the skin by applying tension with the device. Multiple depressions can be treated from a single entry point. Conclusion: These results confirm the safety and feasibility of the controlled focal fibrous septa release method to treat moderate and severe cellulite. Additional trials are ongoing.
... Since the classic study by Nürnberger and Muller [2], cellulite has been a controversial issue in the health sciences. It is certainly known that important changes in the subcutaneous layer occur, such as edema, lipodystrophy, and fibrous deviation of connective tissue, involving hormonal changes and inflammatory mediators [3]. ...
Article
Full-text available
Cellulite is a morphological alteration of the tegument tissue, directly interfering in self-esteem with etiology and pathophysiology far from being a consensus. Although the visual diagnosis of cellulitis is well known, it does not represent the real pathological condition of the subcutaneous tissue. The aim of the study was to investigate the hypothesis that the more heterogeneous tissue pattern analyzed by infrared thermography, the more severe is the cellulite grade. Forty female participants were selected and 60 thighs were analyzed by clinical anamnesis and infrared thermography. Classical visual analysis was correlated to the tissue heterogeneity measured by thermography. R Spearman’s correlation between visual evaluation and thermography was 0.92. Phototype presented a negative significant correlation of 0.67 with classical visual analysis. In the present study, we presented a simple method based on infrared thermography that can be adopted in any esthetics office with a correlation of 0.92 with the visual classic evaluation, but, besides, may be very helpful to the clinician to decide which treatment will be adopted, i.e., an aggressive and inflammatory approach such as the radiofrequency of shockwave therapy or an anti-inflammatory approach such as photobiomodulation, depending on the inflammatory status of cellulite.
... Anti-androgen therapy for prostate cancer may also lead to cellulite. 6 Genetic, environmental, and hormonal factors have been implicated in the development of cellulite. Caucasian race is more prone to develop it. ...
Article
Background: Cellulite is a common dermatological condition with a female preponderance, affecting up to 90% post-pubertal females. It is characterized with dimpling and denting of the skin surface, giving it a Peau d'orange appearance. Once considered to be a benign physiological isolated skin condition of only an esthetic concern, cellulite is now considered a pathological entity with systemic associations and a negative psychological impact on patients. Aims: The objective of this article was to discuss etiology, pathophysiology, and treatment of cellulite. Materials and methods: Literature was screened to retrieve articles from PubMed/Medline and Google Scholar and related websites. Cross-references from the relevant articles were also considered for review. Review articles, clinical studies, systematic reviews, meta-analysis, and relevant information from selected websites were included. Results: Several treatment options from lifestyle modifications and topical cosmetic therapies to energy-based devices have been studied for its treatment. However, treatment remains a challenge despite many new modalities in the armamentarium. Laser and light therapies along with radiofrequency are useful treatment options with good safety profile. Acoustic wave therapy, subcision, and 1440-nm Nd:YAG minimally invasive laser are beneficial in cellulite reduction. Discussion: Methodological differences in the trials conducted make it difficult to compare different treatment modalities. Conclusion: Overall, treatment needs to be individualized based on the patient characteristics and severity of the condition. A combination of treatments is often required in most patients for reducing cellulite.
... 1. Genetic predisposition: Genetic factors affecting subcutaneous tissue response to hypoxia play an important role in the pathogenesis of cellulite [15]; 2. Gender differences: Females are exclusively affected by cellulite in its classic [2]; 3. Ethnicity: White women are affected more than Asian women [2]; 4. Eating habits: Non-balanced diet with excessive carbohydrate intake trigger hyperinsulinemia and stimulate lipogenesis, which subsequently increase total percent of body fat. Excessive salt intake increase fluid retention thereby augment cellulite [16]; 5. Sedentary lifestyle: Lack of muscle movement or prolonged sitting and standing periods will induce tendon and muscle flaccidity, resulting in stasis in venous return and alter blood circulation in cellulite prone areas by decreasing microcirculation [16]; 6. Smoking: It alters microcirculation inducing tissue hypoxia; moreover, promote production of free radicals, while alcohol stimulates lipogenesis [17]; 7. Pregnancy: Prolactin and insulin hormones escalate promptly during pregnancy, which induces lipogenesis and fluid retention. Alongside, the increase in overall body fluid volume aid in developing cellulite [18]. ...
Article
Cellulite is a multifactorial condition induced by topographic alteration of skin giving rise to ‘orange peel’ appearance. It is a universal aesthetic problem affecting 85% of post pubertal females. The present article provides an exclusive overview of all aspects related to cellulite, including its clinical manifestation, etiology, pathophysiology, evaluation and classification. Approaches for reducing cellulite appearance are innumerable. Conventional therapeutic strategies and modern practices such as physical, mechanical methods - including subcision and mesotherapy- and pharmacological agents, oral and topical routes, are reviewed. Novel delivery systems based on nanocarriers incorporating anti-cellulite agents developed in the past decade have been enumerated and analyzed for their efficacy in delivering drugs to target sites. Two main carrier based systems have been reviewed; lipid and polymer based carriers. Methylxanthines, specifically caffeine, has been critically evaluated due to its lipolytic effect of fat cells through inhibition of phosphodiesterase enzymes. The main challenge of this active moiety is its inability to penetrate the closely packed lipophilic stratum corneum. Its incorporation in such delivery systems have shown promising results in its bioavailability and efficacy. However, despite the utilization of nanocarriers in achieving targeted drug delivery has been demonstrated, yet its application in this indication has emerged recently and is limited. It is anticipated that this is a golden opportunistic research area to be exploited and developed.
... 1. Genetic predisposition: Genetic factors affecting subcutaneous tissue response to hypoxia play an important role in the pathogenesis of cellulite [15]; 2. Gender differences: Females are exclusively affected by cellulite in its classic [2]; 3. Ethnicity: White women are affected more than Asian women [2]; 4. Eating habits: Non-balanced diet with excessive carbohydrate intake trigger hyperinsulinemia and stimulate lipogenesis, which subsequently increase total percent of body fat. Excessive salt intake increase fluid retention thereby augment cellulite [16]; 5. Sedentary lifestyle: Lack of muscle movement or prolonged sitting and standing periods will induce tendon and muscle flaccidity, resulting in stasis in venous return and alter blood circulation in cellulite prone areas by decreasing microcirculation [16]; 6. Smoking: It alters microcirculation inducing tissue hypoxia; moreover, promote production of free radicals, while alcohol stimulates lipogenesis [17]; 7. Pregnancy: Prolactin and insulin hormones escalate promptly during pregnancy, which induces lipogenesis and fluid retention. Alongside, the increase in overall body fluid volume aid in developing cellulite [18]. ...
Article
Full-text available
Cellulite is a multifactorial condition induced by topographic alteration of skin giving rise to ‘orange peel’ appearance. It is a universal aesthetic problem affecting 85% of post pubertal females. The present article provides an exclusive overview of all aspects related to cellulite,including its clinical manifestation, etiology, pathophysiology, evaluation and classification. Approaches for reducing cellulite appearance are innumerable. Conventional therapeutic strategies and modern practices such as physical, mechanical methods - including subcision and mesotherapy- and pharmacological agents, oral and topical routes, are reviewed. Novel delivery systems based on nanocarriers incorporating anti-cellulite agents developed in the past decade have been enumerated and analyzed for their efficacy in delivering drugs to target sites. Two main carrier based systems have been reviewed; lipid and polymer based carriers. Methylxanthines, specifically caffeine, has been critically evaluated due to its lipolytic effect of fat cells through inhibition of phosphodiesterase enzymes. The main challenge of this active moiety is its inability to penetrate the closely packed lipophilic stratum corneum. Its incorporation in such delivery systems have shown promising results in its bioavailability and efficacy. However, despite the utilization of nanocarriers in achieving targeted drug delivery has been demonstrated, yet its application in this indication has emerged recently and is limited. It is anticipated that this is a golden opportunistic research area to be exploited and developed.
... Previous research has shown that the hormonal imbalances of menopause (ie, low concentration of estrogen) can predispose women to several dermatoses, including cellulite. 2,4,41 Other predisposing factors include genetic tendencies to deposition of fatty tissue and its organization, eating habits, diet rich in preservatives and salt, sedentary lifestyle, smoking, alcohol, and emotional distress. Although the etiopathogenic explanation of cellulite remains unknown, the inclusion of these factors may increase the confidence in the study findings. ...
Article
Full-text available
Background Cellulite is a localized metabolic disorder of the subcutaneous tissue. To measure the impact of cellulite and its treatment(s) on patients’ health-related quality of life a psychometrically sound patient-reported outcome measure (PROM) is needed. Objective To develop and field-test a new BODY-Q Cellulite scale to measure the appearance of cellulite. Methods Appearance-related codes from the original BODY-Q qualitative interviews were reexamined, and a set of cellulite-specific items was developed and refined through cognitive patient interviews (n=10) and expert input (n=17). This scale was field-tested in adults with cellulite through 2 crowdworking platforms. Rasch Measurement Theory (RMT) analysis was used to refine the scale and examine its psychometric properties. Results The field-test sample included 2129 participants. The 15-item scale was reduced in length to 11 items. Data from the sample fit the Rasch model (X2 (99) = 21.32, p=0.06). All items had ordered thresholds and mapped out a targeted clinical hierarchy. The reliability statistics for the person separation index was 0.94, and for Cronbach’s alpha was 0.97. In terms of validity, worse scores on the Cellulite scale were associated with being more bothered by how the cellulite looked overall, having more severe cellulite on the Patient-Reported Photo-numeric Cellulite Severity Scale, and having more self-reported cellulite and more areas of the body with cellulite. Conclusion The BODY-Q Cellulite scale can be used to measure appearance of cellulite and provides a solid basis for future studies evaluating the impact of cellulite and its treatment.
... Mean values, standard deviations, medians and comparison of mean scores over all graders with Benchmark 1.5 by Wilcoxon signed-ranks test (Code D: n = 18, Code F: n = 17). ns, not significant; *, significant; P ≤ 0.05 Score: 1 = less visible cellulite compared to Day 168; 2 = more visible cellulite compared to Day 168 structural aspects of cellulite differ in morphology on the iliotibial region of the thighs and on the biceps femoris region of the thighs[1,[25][26][27]. ...
Article
Full-text available
Cellulite occurs in females and is a common condition of altered connective tissue matrix and increased adipogenicity with visible dimples and orange‐peel appearance on the skins surface. Whilst advancements in methods continue to help our understanding, attempts to correct the appearance of cellulite topically have yielded limited success. Various kinds of non‐invasive body contouring methods such as whole body vibration have been reported with demonstrable visible improvements in the cellulite condition. The aim of this study was to evaluate volume reduction and improvement of the visible appearance of cellulite as judged both objectively (AEVA‐HE phase‐shift 3‐D fringe projection, macrophotography image grading) and subjectively (questionnaires) after application of a hand‐held localized vibrational device over 24‐weeks. The study was conducted on 40 healthy female volunteers who were instructed how to use the device on defined areas of cellulite of the outside and rear of the thighs (iliotibial band, and over biceps femoris region respectively). The initial 12 weeks of continuous massage application of the study were followed by a 12 week phase in which volunteers were split into 2 subgroups – one for assessment of regression effects and one for continuous application effects. AEVA (skin surface volume) measurements of cellulite‐related dimples correlated with questionnaires and visual image evaluation scoring, in that in the iliotibial region cellulite was significantly reduced at 12 weeks. In the regression subgroup cellulite returned to initial values soon after cessation of treatment, whereas in the continuous application subgroup, cellulite remained diminished. The effect of this device to reduce cellulite as observed in this study is proves that continuous use of vibrational massage is beneficial to mitigate visible signs of cellulite.
... 3 The likelihood of cellulite developing is increased by a number of factors including a predisposing genetic background, hormonal changes or imbalances, impaired microcirculation, medications that cause water retention, a sedentary lifestyle, unhealthy eating habits, and Caucasian ethnic background. [8][9][10] Cellulite appearance is also worsened by ageassociated skin laxity. [11][12][13] In recent years, a better understanding of the etiology of cellulite has led to the development of new treatment approaches that target the underlying cause of the condition. ...
Article
Background: New treatment methods for cellulite require globally accepted scales for aesthetic research and patient evaluation. Objective: To develop a set of grading scales for objective assessment of cellulite dimples on female buttocks and thighs and assess their reliability and validity. Materials and methods: Two photonumeric grading scales were created and validated for dimples in the buttocks in female patients: Cellulite Dimples-At Rest, and Cellulite Dimples-Dynamic. Sixteen aesthetic experts rated photographs of 50 women in 2 validation sessions. Responses were analyzed to assess inter-rater and intra-rater reliability. Results: Overall inter-rater reliability and intra-rater reliability were both "almost perfect" (≥0.81, intraclass correlation efficient and weighted kappa) for the At Rest scale. For the Dynamic scale, inter-rater reliability and intra-rater reliability were "substantial" (0.61-0.80). There was a high correlation between the cellulite scales and body mass index, age, weight, and skin laxity assessments. Conclusion: Consistent outcomes between raters and by individual raters at 2 time points confirm the reliability of the cellulite dimple grading scales for buttocks and thighs in female patients and suggest they will be a valuable tool for use in research and clinical practice.
Chapter
Today demand for body contouring is increasing. Reduction of the targeted amount of adipose tissue non-invasive interventions takes over because of the long recovery time in surgical interventions. Noninvasive methods such as cryolipolysis, radiofrequency, low-level laser therapy and high-intensity focused ultrasound are available to reduce subcutaneous fat, celluloid volume. Nutritional habits are effective in body weight and celluloid formation. Individuals' dietary habits may increase the effectiveness of the applied method and ensure that current shape of body is sustainable during and after non-invasive interventions. Nutrition program should be established under the medical history. Individuals' daily energy requirement should be met at recommended level. Foods with low glycemic index, high fiber content, little or no sugar, and low total fat content should be preferred. The aim of this review is to present the basic principles of an adequate and balanced nutrition program increase the effectiveness of body shaping and celluloid treatment considering evidence-based information.
Article
Full-text available
Cellulite is characterized by dimpled contour alterations of the skin and is present in approximately 85% to 90% of postpubertal females. Although the pathophysiology of cellulite remains to be fully elucidated, experimental evidence indicates a multifactorial process involving the number and types of fibrous septae, microvascular dysfunction, subcutaneous inflammation, decreased dermal thickness with age, and fat deposition. Cellulite is a major cosmetic concern for many women, and a number of both noninvasive (eg, massage, cosmeceuticals, laser therapy) and minimally invasive techniques (eg, subcision, collagenase injection) have been evaluated to improve the appearance of the affected skin. However, evidence for many of these treatments is limited, largely due to the lack of a validated, convenient tool for the standardized evaluation of cellulite severity. Various imaging modalities have been used to characterize cellulite severity and the impact of treatment, but only 2-dimensional and 3-dimensional digital photography have been adequately validated. However, in many cases, imaging findings do not correlate with subjective measures of cellulite severity. A number of cellulite rating scales have been developed; some provide only a qualitative measure, while others do not fully capture all clinically relevant aspects of cellulite, including the perspective of the patient. There remains an unmet need for global adoption of a validated scale that can be used easily by clinicians and patients in clinical and research settings. We propose features that should be included in an ideal rating scale for assessment of cellulite severity.
Article
Full-text available
Cellulite affects 85-98% of post-pubertal females of all races. While not a pathologic condition, it remains an issue of cosmetic concern to a great number of individuals. Despite its high prevalence, there have been few scientific investigations into the physiology of cellulite. There have only been a few dozen peer-reviewed articles devoted to cellulite in the medical literature in the past 30 years. There is no definitive explanation for its presentation. This greatly complicates the ability to treat or improve it. The four leading hypotheses that purport to explain the physiology of cellulite include: sexually dimorphic skin architecture, altered connective tissue septae, vascular changes and inflammatory factors. Treatment modalities can be divided into four main categories: attenuation of aggravating factors, physical and mechanical methods, pharmacological agents and laser. There are no truly effective treatments for cellulite.
Article
The skin is one of the organs, which is influenced by sex steroids, especially estrogen and testosterone. Estrogen receptors are found in the whole skin, with the density of receptors being highest on the face, pubic region, genitalia and lower limbs. Pregnancy, menstruation and menopause modulate the skin appearance and properties, especially during menopause the skin undergoes profound changes. Postmenopausal women often complain of dry, atrophic, slack skin with increased wrinkling. The altered biomechanical properties of the skin in climacteric women cause certain disorders, such as atrophic vulvovaginitis, dysaesthetic vulvodynia, vulval lichen sclerosus, facial hirsutism, frontal fibrosing alopecia and recurrent menopausal flushing. Although skin aging is certainly no indication for the hormone replacement therapy the beneficial effect of estrogen supplementation on the skin appearance is a positive side aspect of such treatment.
Article
Venous thromboembolism (VTE) is treated shabbily in gynaecology of the menopausal period. Being a serious complication of neoplasms, operative procedures and - at last - menopausal hormone therapy (MHT), it is undoubtedly noteworthy and calls for in-depth knowledge.
Article
Cellulite is a disorder in which adipose tissue extends through the dermis, producing a cosmetically displeasing dimpling in the affected areas. While many treatments claim to be able to improve the appearance of cellulite, the long-term effectiveness of these treatments and whether the logic behind these treatments can lead to a long-term improvement has not been extensively reviewed. In the following review, our goal is to assess the various cellulite treatments and evaluate the length of time results persist and whether the science behind the treatments warrants them as reliable and effective treatments for cellulite.
Article
With recent advances in the treatment of cellulite and localized fat, a comprehensive objective method of measuring cellulite can be potentially useful, especially since important morphological aspects of cellulite are not part of the current classification. Objective To develop and to validate a new photonumeric cellulite severity. Based on standardized photographs of 55 patients with cellulite, five key morphological aspects of cellulite were identified. A new photonumeric severity scale was developed and validated. The five key morphological features of cellulite were identified and included the number of depressions, depth of depressions, clinical appearance of evident raised lesions, and presence of flaccidity and the grade of cellulite. Each item was graded from 0 to 3, allowing final classification of cellulite as mild, moderate, and severe. Results for validation of the scale are statistically significant (P < 0.05) and are as follows: intraclass correlation coefficient > 0.7; correlation item-total > 0.7, with the exception of the right buttock; intraclass correlation coefficients 0.881-0.922; Cronbach's alpha 0.851-0.989 and factor analysis 68-76%. The proposed photonumeric scale is a consistent, comprehensive, reliable, and reproducible tool for the standardized and objective assessment of the severity of cellulite. Conflicts of interest The authors hereby affirm that neither the manuscript nor any part of it has been published or is being considered for publication elsewhere.
Article
A new member of a family of proteins functioning in the regulation of lipolysis in adipose tissue has been discovered and named "desnutrin." Desnutrin is transiently induced by fasting and decreased by re-feeding. A close homolog, termed adiponutrin, has the opposite expression pattern, being induced by feeding and disappearing upon fasting. Desnutrin functions by acting as the first enzyme in lipolysis, hydrolyzing triglycerides to diglycerides, whereas the well-known hormone-sensitive lipase takes the diglycerides to monoglycerides and on to free fatty acids.
Article
The role of adipose tissue is energy storage, but there is increasing evidence that adipocytes and adipokines are involved in metabolic and inflammatory processes. This paper reviews the pathophysiology of different adipose tissue depots. Interrelationships between sex hormones, adipose tissue and risk factors are also discussed. Present study focuses on the effects of adipokines on immune system and on the mechanisms relating adiposity to cancer risk.
Pielęgnacja ciała. Częste problemy estetyczne i zdrowotne sylwetki i skóry ciała. Kosmetologia pielęgnacyjna i lekarska
  • M Ciupińska
  • M Noszczyk
Ciupińska M, Noszczyk M. Pielęgnacja ciała. Częste problemy estetyczne i zdrowotne sylwetki i skóry ciała. Kosmetologia pielęgnacyjna i lekarska. Wydawnictwo Lekarskie PZWL, Warszawa 2010; 189-209.
Cellulit -choroba czy defekt kosmetyczny? Dermatologia i Uroda
  • A Pura-Rynasiewicz
Pura-Rynasiewicz A. Cellulit -choroba czy defekt kosmetyczny? Dermatologia i Uroda 2010; Wiosna-Lato: 3-4.
Kosmetologia i farmakologia skóry. Wydawnictwo Lekarskie PZWL
  • M C Martini
Martini MC. Kosmetologia i farmakologia skóry. Wydawnictwo Lekarskie PZWL, Warszawa 2007; 300-309.