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[Dermatology Reports 2017; 9:7352] [page 41]
Considering the hypothesis
of the pathophysiology
of cellulite in its treatment
José Maria Pereira de Godoy,1
Ana Carolina Pereira de Godoy,2
Maria de Fatima Guerreiro Godoy3
1Cardiovascular Surgery Department,
Medicine School; and FAMERP and
CNPq (National Council for Research
and Development), São José do Rio
Preto, SP; 2Faculty of Medical Sciences,
Santa Casa de São Paulo; Researcher
Group of the Clínica Godoy, São José do
Rio Preto, SP; 3Occupational Therapist;
Medicine School (FAMERP); and
Research Godoy Clinic, São José do Rio
Preto, SP, Brazil
Abstract
The aim of this study was to evaluate
perimetric reductions in the clinical treat-
ment of cellulite (aesthetics) using the
Godoy method in a randomized retrospec-
tive clinical trial. The medical records of
150 patients treated for cellulite in the peri-
od from 2006 to 2011 in the Clinica Godoy
were revisited. Treatment comprised manu-
al and mechanical lymph drainage and cer-
vical stimulation for one hour per day over
10 days. The paired t-test was used for sta-
tistical analysis, with an alpha error of 5%
(P-value <0.05) being considered accept-
able. This study was started after being
approved by the Research Ethics
Committee of the Medicine School in São
José do Rio Preto (FAMERP - no. 395-
2010), Brazil and after being registered as a
clinical trial.
The mean reduction of the 150 patients
was 3.81±2.76 g (P-value <0.0001; 95%
confidence interval: 3.408-4.223).
A significant reduction in size was seen
with the clinical treatment of cellulite giv-
ing an improvement in the physical appear-
ance. Pathophysiological mechanisms such
as regional skin lymphostasis seem to be
involved in the formation of cellulite.
Introduction
Cellulite, characterized by changes in
the skin surface relief, is a complex cosmet-
ic problem common to many women.1
Cellulite, which appears like orange peel or
cottage cheese, with ripples in the skin of
the thighs and buttocks, is a complex multi-
factorial cosmetic disorder of the layer of
subcutaneous fat and the overlying skin sur-
face.2Although the extracellular matrix and
lymphatic system disorders can enhance its
appearance, cellulite results essentially
from an excessive storage of fat in adipose
tissue, which exerts considerable pressure
on the surrounding tissue of the skin and
creates an appearance of irregular dimples.3
Recent studies suggest that changes in
the lymphatic system and the production of
substances within the interstitial space may
be the physiopathological cause of cellulite.
As a result, regional skin lymphostasis leads
to their accumulation as this aggravates the
mobilization of these substances.4-6 Another
study evaluating 25 gene polymorphisms
associated with aesthetic cellulite identified
two, the ACE (rs1799752) and HIF1A
(rs11549465) genes as having significant
correlations.7However, therapies used to
treat cellulite do not always deal with the
pathophysiology of the disease. The aim of
this study was to retrospectively evaluate
the clinical outcomes of patients with cel-
lulite treated using the Godoy concept and
technique.
Materials and Methods
The medical records of 150 patients
treated for cellulite from the total treated in
the Clinica Godoy between 2006 and 2011
were randomly selected by lottery for this
quantitative retrospective study.
Routine evaluations included an investi-
gation of the patient’s history, physical
examination, perimetry and photography
before and after treatment. The three largest
differences in diameters along the legs were
considered. Patients with cyclic edema were
treated before starting treatment for cellulite
and patients with a body mass index greater
than 30 (obese) were excluded.
Treatment was based on manual lymph
drainage with one session per day for 10
days using the technique developed by the
author. This technique is characterized by
movements that compress and subsequently
slide along the route of the lymphatic ves-
sels, in particular the great saphenous lym-
phatic chain, up to the corresponding lymph
nodes. Fifteen minutes per day of cervical
stimulation. was associated to this as was
one hour per day of mechanical lymph
drainage using the RAGodoy® device.8The
paired t-test was used for statistical analy-
sis, with an alpha error of 5% (P-value
<0.05) being considered acceptable. This
study was started after being approved by
the Research Ethics Committee of the
Medicine School in São José do Rio Preto
(FAMERP) and being registered as a clini-
cal trial.
Results
The mean age of participants was 34.49
years with a minimum age of 18 years and
a maximum of 58 years. A significant mean
reduction of 3.81±2.76 grams (P-value
<0.0001; 95% CI: 3.408-4.223) was detect-
ed. Figure 1 shows the perimeters before
and after treatment and the mean reduction.
Discussion
The current study used lymph drainage
in the treatment of aesthetic cellulite to
reduce the perimetry of the leg and thus
improve the aesthetic appearance. One-hour
sessions of lymph drainage were performed
for 10 days over two weeks.
The authors believe that the cause of
cellulite is changes in the lymphatic system
and the production of substances within the
interstitial space with the consequence the
regional cutaneous lymphostasis. Thus, the
advantage of this approach is that it directly
interferes in the pathophysiology of cel-
lulite. The hypothesis of the authors is that
stimulation of this system relocates macro-
molecules in the interstitial space to the cir-
culation. Thus the macromolecules are
redistributed around the body. This hypoth-
esis is supported as intensive treatment for
four hours per day cause reductions of
between 6 to 10 cm in the perimeters of the
legs but without changing the body
weight.4-6 The patients selected for intensive
treatment were not obese and did not have
lipedema and edema. However, in the clini-
cal practice it is common to see an associa-
Dermatology Reports 2017; volume 9:7352
Correspondence: José Maria Pereira de
Godoy, Cardiovascular Surgery Department,
Medicine School; and FAMERP and CNPq
(National Council for Research and
Development), Avenida Constituição, 1306
São José do Rio Preto-SP, Cep: 15025-120,
Brazil.
E-mail: godoyjmp@gmail.com
Key words: Cellulite; Godoy method; evalua-
tion.
Received for publication: 12 August 2017.
Accepted for publication: 5 September 2017.
This work is licensed under a Creative
Commons Attribution-NonCommercial 4.0
International License (CC BY-NC 4.0).
©Copyright J.M. Pereira de Godoy et al., 2017
Licensee PAGEPress, Italy
Dermatology Reports 2017; 9:7352
doi:10.4081/dr.2017.7352
[page 42] [Dermatology Reports 2017; 9:7352]
tion of obesity, edema, lymphedema and
lipedema with cellulite. This fact raises
doubts about the pathophysiology of differ-
ent diseases. Obesity is an aggravating fac-
tor for lipedema, lymphedema and even for
cellulite.
Patients with lymphedema associated
with cellulite who treat the lymphedema
using manual lymph drainage, compression
therapy and mechanical lymph drainage
using the RAGodoy device, in addition to
the reduction in lymphedema have
improvements in the cellulite. Obese
patients who lose weight have reduced peri-
metric measurements similar to in the treat-
ment of cellulite.
In this study the mean perimetric reduc-
tion of cellulite was around 0.2 to 0.3 cm
per hour. However, the result is time- and
technique-dependent with the evaluations
being made after 10 sessions.
The main improvements in our knowl-
edge over the last few years are the hypoth-
esis of the pathophysiology of cellulite,
which has since been clinically proven4-6
and its genetic association.7All diseases
have a pathophysiology and treatment
should interfere in this physiopathology.
The identification of genetic changes sug-
gests that cellulite is a disease, even though
it is common to most women.
The therapeutic proposal to stimulate
the lymphatic system, based on the assump-
tion of regional cutaneous lymphostasis,4is
a symptomatic approach as genetic changes
have been detected. However, at the
moment we believe this approach with clin-
ical principles appropriate. However,
comorbidities such as edema and obesity
are key to achieving the expected results in
the changes that led to regional deposits.
One of these associations is idiopathic
cyclic edema, a common disease in patients
with much edematous cellulite, where con-
trol is essential in order to have a good
result in the treatment of cellulite.
With this technique the reduction of cel-
lulite is maintained for years (at least five)
as long as the body weight is controlled and
the individual does not have edema or
lipedema. The swelling in patients with
idiopathic cyclic edema must be controlled
over the long term to prevent relapse.
Conclusions
By interfering in the pathophysiological
mechanisms of cellulite such as regional
cutaneous lymphostasis, satisfactory clini-
cal results can be achieved in the treatment
of cellulite.
References
1. Terranova F, Berardesca E, Maibach H.
Cellulite: nature and aetiopathogene-
sis. Int J Cosmet Sci 2006;28:157-67.
2. Emanuele E, Minoretti P, Altabas K, et
al. Adiponectin expression in subcuta-
neous adipose tissue is reduced in
women with cellulite. Int J Dermatol
2011;50:412-6.
3. Vogelgesang B, Bonnet I, Godard N, et
al. In vitro and in vivo efficacy of
sulfo-carrabiose, a sugar-based cos-
metic ingredient with anti-cellulite
properties. Int J Cosmet Sci
2011;33:120-5.
4. de Godoy JM, de Godoy Mde F.
Physiopathological hypothesis of cel-
lulite. Open Cardiovasc Med J
2009;31:96-7.
5. Godoy JMP, Almeida EMMZNM,
Silva SH, Godoy MFG. Pilot study of
the intensive treatment of cellulitis.
RBM Especial Clínica Geral
2010;67:30-2.
6. de Godoy JM, Groggia MY, Ferro Laks
L, Guerreiro de Godoy Mde F.
Intensive treatment of cellulite based
on physiopathological principles.
Dermatol Res Pract 2012;2012:
834280.
7. Emanuele E, Bertona M, Geroldi D. A
multilocus candidate approach identi-
fies ACE and HIF1A as susceptibility
genes for cellulite. J Eur Acad
Dermatol Venereol 2010;24:930-5.
8. de Godoy JM, de Godoy Mde F.
Evaluation of the prevalence of conco-
mitant idiopathic cyclic edema and cel-
lulite. Int J Med Sci 2011;8:453-5.
Article
Figure 1. Box and whisker plot of the reduction in perimetry comparing before and after
treatment for cellulite.
