Published on 19/03/2015 by admin
Filed under Dermatology
Last modified 19/03/2015
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Bruce E. Katz, Doris M. Hexsel and Camile L. Hexsel
Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports
Cellulite consists of surface relief alterations resulting in depressions and raised areas and thus irregular appearance, such as an orange peel, cottage cheese or mattress-like appearance of the skin, located mainly on the thighs and buttocks but also on the arms, abdomen, legs, and other areas. Depressed lesions are due to the presence of fibrous septa that pull the skin surface down; raised areas result from the projection of underlying fat to the skin surface as shown on anatomical and imaging studies. Women are most frequently affected by this condition; this is due to the structure and anatomy of the subcutaneous septa compared to the structure of men. In addition, cellulite is aggravated by progressive skin laxity or flaccidity, localized fat deposition and obesity. Furthermore, other factors have been implicated in the pathogenesis of cellulite, such as hormonal, biochemical, inflammatory and circulatory factors.
Specific treatments:
Subcision, which treats the subcutaneous septae that pulls the skin down and addresses specifically cellulite depressions.
Devices that target the dermis and thus improve flaccidity and projection of fat, and devices that target localized fat.
Weight control to a normal body mass index (BMI).
Oral treatment.
Topical treatment.
Physical examination: patient in standing position with relaxed gluteus muscles. Determine morphologic characteristics of cellulite on each patient, which will help guide treatment option selection:
– presence and depth of cellulite depressions
– presence of localized fat and obesity
– presence of flaccidity and fat herniation
Pre- and post-treatment photographs (relaxed gluteus muscles)
Validated photonumeric scale: cellulite severity scale (CSS), for objective assessment of cellulite before and after different treatments
Pre-operatory investigations for subcision: PT, PTT and INR, history of coagulation disorders, use of medications that alter blood coagulation
The diagnosis is clinical. No imaging studies are required in clinical practice.
Hexsel DM, Dal’forno T, Hexsel CL. J Eur Acad Dermatol Venereol 2009; 23: 523–8.
A new photonumeric severity quantitative and qualitative scale was developed and validated; five key morphological aspects of cellulite were identified for comparison. Each item was graded from 0 to 3, allowing final classification of cellulite as mild, moderate, and severe, according to the sum of the scores of the CSS.
Hexsel DM, Abreu M, Rodrigues TC, Soirefmann M, do Prado DZ, Gamboa MM. Dermatol Surg 2009; 35: 1471–7.
Thirty female patients with cellulite depressions on the buttocks had underlying fibrous septa, which were thicker, ramified and perpendicular to the skin surface.
Hexsel DM, Mazzuco R. Int J Dermatol 2000; 39: 539–44.
Hexsel DM, Mazzuco R. An Bras Dermatol 1997; 72: 27–32.
Based on clinical assessment of pre- and post-treatment standardized photographs on 232 patients, subcision was shown to be efficacious in the treatment of high-grade cellulite. Targeted specifically for the treatment of major cellulite depressions on the skin surface of patients with cellulite through three action mechanisms: sectioning the connective tissue septa responsible for the depressions; provoking the formation of new connective tissue from blood components; and redistributing the adipose tissue and the mechanical forces between the adipose lobules.
Treatment of Skin Disease Comprehensive Therapeutic Strategies 4e
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