Cellulite: general principles of correction

Cellulite, or lipodystrophy, is a special condition of the subcutaneous adipose tissue, leading to a whole complex of cosmetic defects.

The term "cellulite" is not universally accepted, it was first used in the 20s of the last century. Only since the 80s, serious scientific research has begun and publications in the media have appeared.

By now, the clinical picture and the factors leading to the development of cellulite have been studied in some detail, the methods of its correction are constantly being offered and improved.

Pathogenesis of cellulite. At the heart of lipodystrophy are both exogenous and endogenous predisposing factors. Exogenous include hypodynamia, an unbalanced diet (unlimited consumption of fats and carbohydrates), smoking, stress, alcohol and other factors. Emphasize that a significant negative aspect is wearing a model high-heeled shoes. Among the endogenous factors, the importance of endocrine changes (leading primarily to hyperestrogenic and hypoendrogenic) and circulatory disorders (for example, the varicose symptom complex), as well as hereditary predisposition, biotype, associated diseases (for example, the gastrointestinal tract) is emphasized. It is believed that cellulite is more susceptible to women, and Caucasoid race. The predominance of cellulite among women is explained by a number of anatomical and physiological features. So, giperestrogenia and hypoandrogenia are more typical for women, for them the hypotone of the blood vessels of the skin and deeper muscles is more characteristic. From the morphological characteristics of subcutaneous fat cells, attention is drawn to larger fatty lobules in women compared with men. In addition, it is known that interlobular connective tissue septum in women are parallel to each other and perpendendicular to the surface of the skin, and in men - at an angle of 45 ° to the surface of the skin.

The complex of endo- and exogenous predisposing factors leads to an increase in the size of adipocytes and an increase in the mass of adipose tissue. An increase in adipocyte size is associated with an imbalance between the processes of lipogenesis (the synthesis of triglycerides from glycerol-3-phosphate and fatty acids) and lipolysis (cleavage of triglycerides by glycerol and free fatty acids). It is believed that it is the enlarged adipocytes that exert mechanical pressure on the fibroblasts, which is the cause of the excessive formation of collagen, i.e. Fibrosis. On the other hand, the growth of adipose tissue predisposes to disruption of circulation in various layers of the skin, which leads to tissue edema, venous and lymphatic stasis. Local hypoxia also contributes to the growth and change in the qualitative composition of collagen fibers of connective tissue. This leads to the formation of fibrous structures located perpendicular to the surface of the skin. This complex of morphological changes further aggravates the disturbance of trophism and neurotrophy of all layers of the skin.

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Symptoms of Cellulite

A complex of morphological changes leads to a thickening of the subcutaneous fatty tissue and the formation of so-called "cellulite dimples". It is accepted to distinguish the following stages of cellulite development:

• I stage - there are no external manifestations. But there is a small swelling, because of vascular disorders, there is a tendency to form a hematoma, the healing of the skin worsens.
• II stage - edema is more pronounced. Micro-nodules are formed. When bribing the skin fold, the so-called "orange peel" is revealed.
• III stage - "orange peel" visible to the eye. The temperature of the skin decreases.
• IV stage - large knots are formed, the skin is pulled in places of severe fibrosis. Because of the compression of the nerve endings, areas with a disturbed sensitivity appear, cold spots are detected on the thermogram. Some nodes are painful to the touch. At any stage, large telangaectasias can occur. They can be a consequence of impaired blood circulation in adipose tissue due to developing fibrosis, as well as a varicose symptom complex. Such patients should be consulted by a phlebologist.

Principles of cellulite correction

It must be emphasized that a successful solution to this problem is possible only with a comprehensive and individual approach. That is why in recent years specialists in the field of cosmetology of the body have given preference to the development of complex and individual programs. Thanks to such programs, the professional has the opportunity of a stage-by-stage and scientifically validated exposure to various links in the pathogenesis of cellulite, taking into account the individual characteristics of each client.

The development of a complex individual program includes several stages:

1. Initial consultation.
2. Evaluation of the clinical picture and the definition of the stage of cellulite.
3. Filling a standardized questionnaire.
4. Selection of key techniques, their combined or sequential assignment

Primary consultation

A full primary consultation is 80% of the success of achieving a stable result. It is during the initial consultation that you can establish adequate psycho-emotional contact and trust between the client and the doctor. The task of the cosmetologist is to find out the purpose of the visit, determine the motives for weight loss. If necessary, the specialist should help the client clearly articulate the motivation for going to the salon, which often helps the client at a subconscious level tune in to a positive result. Here are just some of the client's statements: "I have a smart pantsuit, but I can not wear it, because the pants are very tight hips and emphasize the area" riding breeches ", I want to get rid of this problem," or: "After pregnancy and I have sharply added weight in weight, there were expressed signs of a cellulitis, I would like to return to the former form ". As can be seen from the above statements, clients can have very different motivations and, consequently, the approach to solving their problems should be purely individual. For complete mutual understanding, the doctor needs to find out the client's opinion about his body: what he likes, what does not like, what he would like to change, how he sees his body, what he is ready to do to achieve the goal and maintain the result. It is important to bring the client to the idea of cooperation, since the next stage of the consultation is to discuss the diet. Most people mistakenly believe that if they attend cosmetic procedures, then nothing else should be done. The doctor is responsible for conducting an introductory consultation on dietary low-calorie nutrition, explaining that the process of treating cellulite is not only long-lasting, but complex, and without fulfilling elementary rules for observing nutrition regimes, replenishing liquids and salt balance can not be avoided. It should be reminded to the client that the restriction in nutrition should only concern carbohydrates and fats, and proteins, vitamins, mineral elements and water should be supplied in full amounts, otherwise the body will not break down fats, but muscle protein (the volume of muscle mass will decrease, and the fatty deposits will remain "In reserve"). In addition, the client needs to be reminded of the increase in physical activity. It is quite understandable that in our fast life we have time to visit both the beauty salon and the sports hall is almost impossible, so it is important to focus the client's attention on increasing the walking time ("not by car, but by foot to the apartment not by elevator, but by stairs ", etc.).

During the initial consultation, it is necessary to adjust the patient to two extremely important aspects of his work on self - self-esteem and self-control. They are the factors that allow the client to fully participate in the work: on the one hand, it is perceived as an interesting and easy game, on the other hand, - performing a certain job, fixing the results on paper, the client is subconsciously adjusted to a stable, positive result. Self-evaluation consists of body measurements once a week in the morning and weighing once in 10 days (these operations are often not worthwhile, since cellulite treatment is a long process and the absence of positive dynamics at first has a negative effect on the emotional state). Self-monitoring implies, first of all, keeping a food diary, counting consumed and consumed kilocalories (the difference between consumption and waste should not be less than 1200 kcal per day, otherwise fat burning processes will not be activated).

Evaluation of the clinical picture and the definition of the stage of cellulite

A careful history review is necessary before the examination. The specialist draws special attention to endocrine and gynecological diseases, pathology of the gastrointestinal tract, studies in detail the heredity and family history (whether there is a propensity to fullness in the mother, grandmother, other relatives on the female line, whether there was a large increase in body weight in childhood, in adolescence, etc.). When questioning, it is necessary to find out whether oral contraception is being conducted and to find out about its duration. If necessary, prior to the appointment of a course of treatment, consultations of specialists can be recommended.

Objective examination reflects the general condition at the time of examination, skin condition, body type, regional lymph node condition, body measurements (in cm), body weight measurement (kg), body mass index calculation, excess fat ratio (fat percentage). All listed indicators should be entered in a specially developed questionnaire (see below)

The determination of the cellulite stage is decisive in choosing the methods for the course treatment. It is known that cellulite is a complex disease affecting all the constituent elements of tissues (vascular system, nerve endings and nerve fibers, fibrous structures of connective tissue, adipocytes, etc.). A factor that somewhat facilitates the doctor's task is the gradual incorporation of tissue structures in the development of cellulite, for it is not without reason that there is a figurative expression that "cellulite creeps unnoticed". Knowing which pathomorphological links are involved in the development of cellulite, experts can use the influence of a number of physical factors to break the "vicious circle".

Morphological changes depending on the stage of cellulite and "target" for hardware techniques

Stage of cellulite	Description of morphological changes in tissues	Targets for "hardware methodologies"
I	A small increase in the volume of adipocytes, compression of the vessels (arterioles, venules, capillaries, lymphatic vessels), the yield of mucopolysaccharides in the intercellular substance, the polymerization of their water, fluid retention	Edema of tissues, increased size of adipocytes, hypoxia phenomena
II	Further increase in the volume of adipocytes, overstimulation of the cell membrane, a decrease in the sensitivity of beta receptors and, as a consequence, inhibition of lipolysis processes. The growth of intercellular edema and hypoxia affects the connective tissue fibers (elastic and collagen), the formation of the wrong, so-called "perpendicular" collagen is stimulated, "cross-links" are formed	Edema of tissues, enlarged adipocytes, hypoxia
III	Significant impairment of lymph drainage, accumulation of metabolic products, the formation of clusters of tightly adhered adipocytes, covered with a fibrous capsule ("micronodules"),	Edema of tissues, an increase in adipocyte size, microcirculatory disorders, fibrous structures, "adhesions"
IV	Formation of macerels, rigid fibrotic structures, clamping of nerve endings, disturbance of tissue sensitivity, soreness, increased disturbances of microcirculation and lymph drainage	Edema of tissues, an increase in the size of adipocytes, microcirculatory disorders, severe fibrosis, lymphostasis

The next stage of the work is the completion of a standardized questionnaire. The main demographic information about the client (last name, first name, patronymic, year of birth, contact phone number, etc.), history data, concomitant diseases and the results of an objective examination at the time of the initial examination with indication of all anthropometric data (pulse, mass body, body mass index, excess weight coefficient, etc.). In the questionnaire, you should also note the stage of cellulite. The specialist indicates the chosen treatment methods, the data of dynamic observation of the client during the therapy. Completing the questionnaire helps the doctor-cosmetologist to comprehensively assess the problem, creates prerequisites for an objective control over the dynamics of changes in his condition against the background of ongoing treatment. Important is the fact that the questionnaire compiled in the presence of the client is a medical record that reflects the objective condition of the client at the time of the first visit and against the background of the procedures. The presence of such a document, constantly stored in the cabin, provides objective information and ensures the protection of the doctor, which is extremely important in the conditions of the dawn of medical insurance.

The choice of key techniques, their combination or sequential appointment for the correction of cellulite are used: skin care, the appointment of external drugs that affect the main pathogenetic links and clinical manifestations of cellulite, diet therapy, ingestion of drugs that improve trophic and skin appearance, injection techniques, hardware techniques cosmetology.

It should be remembered that against the background of any methods of physical impact, adequate skin care is needed, including gentle cleansing and exfoliation, as well as constant moisturizing. For washing the skin, it is recommended to use gels and mousses that do not change the acidity of the skin surface. It is also possible to periodically appoint exfoliating agents for the body (once every 7-14 days). For the purpose of moisturizing, emulsions and body creams are recommended. Normalization of skin care is an important part of the complex program of cellulite treatment, as it leads to a significant reduction in dryness - the skin turgor is restored, its texture and color improves. In recent years, outdoor products have been popular, including not only moisturizing components, but also substances that improve microcirculation, lymphatic drainage (usually caffeine compounds), activating lipolysis, etc. (anti-cellulite scales of the laboratory "Vichy", "Lierac", "RoC " and etc.).

Scientific developments in recent years have shown that nutrition can play a decisive role in preventing a decrease in skin turgor and the severity of signs of cellulite. It is known that supplementing the standard diet with trace elements (for example, calcium derivatives), polyphenones of green tea, glucosaminosulfate, procyanidins and other agents can positively influence the condition of the skin and subcutaneous fat. Thus, in experimental animals, the ingestion of a large amount of calcium with food significantly suppressed the accumulation of fats by inhibiting the enzyme of the synthetase of fatty acids and increased lipolysis. In addition, calcium has the ability to bind fatty acids in the intestine and form insoluble soaps that are easily eliminated from the body. The ingestion of a large amount of calcium also contributes to the formation of calcipotriol and the expression of a specific agouti gene (agouti) in human adipocytes. This, in turn, leads to a decrease in the calcium content in adipocytes and the subsequent decrease in body weight. In this regard, a variety of biologically active food additives are very popular. In particular, the funds "Inneov Zellustech" ("Laboratoires Inneov", France) was developed by scientists to restore the structure of the skin and prevent signs of developing cellulite.

For the treatment of cellulite, various methods of aesthetic cosmetology are widely used: with the use of electric current, some factors of mechanical, temperature influence, etc. The methods of combined effect are becoming very popular nowadays.

[2], [3], [4], [5], [6], [7], [8], [9], [10], [11]

List of techniques for the treatment of cellulite, their purpose and ways of combining

Methods using electric current

1. Electrophoresis - a combined effect on the affected tissue galvanic current and drugs, which makes it possible to create a "depot" of drugs in the tissue

Directivity of the method: increased microcirculation, resorption and lipolytic action, as well as other properties, depending on the mechanism of action of the medicinal product used.

Methodology of appointment: every other day, 10-12 procedures per course, duration - 15-20 minutes.

2. Lymphatic drainage is a low-frequency impulse current on the muscles to stimulate the lymph drainage. Lymph drainage is performed using bipolar pulses, coordinated with cardiac contractions, in succession from the periphery to the center.

The method is focused on lymphatic drainage.

Method of administration: 2-3 times a week, 10-15 procedures, duration - 40 minutes.

3. Myostimulation is the impact of a variable impulse current on the neuromuscular structures for obtaining spike responses and conducting passive muscle contractions.

The direction of the method: toning of muscles, strengthening of the muscular framework.

Method of administration: 2-3 times a week, 15-20 procedures, duration - 20-40 minutes.

4. Electrolipolysis is the direct lipolytic action of an electric current on the fatty drop of adipocytes, splitting it to final products of decomposition and releasing a large amount of energy.

Directivity of the method: lipolysis

Method of administration: 1 time in 4-5 days, 10-15 procedures, duration - 60 minutes.

5. Microcurrent therapy is the use of low-power currents (up to 600 μA) and interference phenomena for the normalization of the bioelectrical potential of cell membranes, activation of metabolism and enhancement of ATP synthesis.

Directivity of the method: lymph drainage, lifting, restoration of skin turgor, anti-cellulite programs.

Method of administration: every other day, 15-20 procedures, time - 40 minutes.

Methods using mechanical factors, vacuum and temperature effects

• Ultrasound therapy - the use of such properties of the ultrasonic wave, as: the destruction of the fat droplet, the improvement of membrane transport, the acceleration of metabolic processes, the defibrizing effect on connective tissue structures. Separating fat cells into micro- and macronodules.

Directivity of the method: indirect lipolysis, restoration of elasticity and elasticity of connective tissue structures.

Method of administration: 2-3 times a week, 10-15 procedures, duration - 20-30 minutes.

• Vibrotherapy - low-frequency percutaneous action, accelerating microcirculation and metabolic processes.

The method is focused on lymphatic drainage, anti-cellulite programs. Method of administration: 2-3 times a week, 10-15 procedures, duration - 20-30 minutes.

• Vacuum action - negative pressure created in a vacuum chamber, leads to a change in oncotic and hydrostatic pressure and promotes local reduction of edema and acceleration of metabolic processes. Cyclic vacuum has the ability to destruct the fat drop.

Directivity of the method: lymph drainage, mediated lipolysis. Method of administration: daily or every other day, 15-20 procedures, time - 15 minutes.

• Pressoterapiya - alternating change in air pressure.

Directivity of the method: sequential lymphatic drainage. Method of administration: 2-3 times a week, 10-15 procedures, time -15 min.

• Thermotherapy: heat treatment and cryotherapy are used to improve microcirculation, increase the permeability of the epidermis for cosmetic products.

The method is focused on: opening pores, removing slags, improving turgor and elasticity of the skin. Method of administration: 1-2 times a week, 10-15 procedures, time - 50 minutes.

Combined methods:

• The technique of "Endermology", including 3 mechanical factors of influence on all structural units of tissues (vacuum, mechanical and roller massage, vibration).

Directivity of the method: lymphatic drainage, modeling of the figure (redistribution of fatty deposits), mediated lipolytic action, restoration of turgor and elasticity of the skin.

Method of administration: 1-2 times a week, 15-20 procedures, time - 35-60 minutes.

• Mud treatment is the application of warm mud wraps to enhance metabolic processes. The direction of the method: the restoration of the tone and turgor of the skin, the activation of metabolic processes.

The method of administration: 1-2 times a week, 10-15 procedures, time - 30-60 min.

• Mesotherapy - the introduction of microdoses of drugs in the upper layers of the epidermis to improve microcirculation, accelerate the oxidation-reduction reactions.

Directivity of the method: depending on the composition of the cocktail of medicines - lipolysis, restoration of the tone and turgor of the skin,

The set of techniques for the treatment of cellulite is quite large, so it is important to remember the priority in prescribing the procedures and the stage of the program. It is recommended to designate the stages for determining the time interval during which this or that technique has time to expand its activity (for example, for electrolysis, 3-5 procedures must be performed within 2-3 weeks to obtain the initial result). On average, the calculation of the stages of the course goes for 2 weeks - 4-6 procedures per stage. In particular, lymph drainage is carried out 2-3 times a week, thus, at the first stage 4-6 procedures are performed. This is already a significant discharge of the body from excess fluid and a good base for the appointment in the next stage of such procedures as myostimulation and "deep heat".

At the first stage, based on the pathogenesis of cellulite, the following procedures are recommended:

• Lymphatic drainage procedures to reduce interstitial edema. For this, press therapy, microcurrent lymphatic drainage, sequential electrodiffusion, endermology techniques are used. The effect of the procedure can be seen immediately, expressed in the reduction of pasteurism and the intensification of the urinary system
• Lipolitical procedures (reduction of adipocyte size, fatty leaf destructuring) - electrolypolysis, mesotherapy, electrophoresis, vacuum techniques, ultrasound therapy, endermology. At the first stage it is not recommended to conduct thermal procedures, since heat has a physical property to expand blood vessels and increase blood flow, provoking aggravation of vascular stasis.
• When treating the unfolded stages of cellulite (III-IV cent.), It is necessary to influence the connective tissue and fibrous structures. For this purpose, ultrasound therapy and endermology are prescribed.

At the second stage of the course, all the techniques are included in the phase of the developed action, while retaining the lymphatic drainage, lipolytic, ultrasound and endermological procedures in the appointment, it is recommended to attach the techniques that strengthen the muscle framework and the thermal procedures with mud wraps for the celite (I-II). And the temperature during warm procedures should not be high, so that the processes of diffusion of cosmetic products prevail over the processes of elimination of toxins (sweating). At this stage, the amount of lymphatic drainage procedures can be reduced by half.

For cellulite III-IV stage, the procedures of myostimulation and "deep heat" are introduced in the third stage (from the 4th-6th week). In addition, it is necessary to closely monitor the condition of the skin tone and, with its decrease, add endothermology, micro-current therapy, and "cold wrap" procedures to the appointments.

The course of procedures for the treatment of cellulite I-II stage should last at least 6-8 weeks + supporting stage, for the treatment of cellulite III-IV stage - it is 14-15 weeks + supporting stage. At the supporting stage, do not use endermology, myostimulation, wraps (1 every 1-2 weeks).

As the analysis of the market of cosmetology services shows, not in all the cells dealing with cellulite problems, there is a complete list of devices and techniques. Therefore, it is very important, knowing the main pathomorphological changes in cellulite, to choose other methods similar in effect.