Cellulite is a pathology of adipose tissue, in which the skin takes on the appearance of an “orange peel”, and at later stages there is also a characteristic tuberosity with dimples. In professional language, this disease sounds like – “gynoid lipodystrophy” or “hydrolipodystrophy”. Effective treatment is possible only in the early stages, but many women get to a specialist too late, when it is no longer possible to completely eliminate the symptoms. What cellulite looks like – you can see in Fig. 1-3.
It should be noted that women have a genetic predisposition to the development of this disease, while cellulite in men is a rare occurrence. The reason lies in the differences in the structure of adipose tissue in men and women. For example, in men, the share of collagen fibers that give the skin strength and elasticity significantly exceeds the number of elastic fibers. Women have a slightly different ratio of collagen and elastin, which, on the one hand, makes their skin more elastic, but on the other hand, makes it easier to “protrude” the lobules of adipose tissue.
The second difference is that in women, the direction of the connective tissue fibers is mainly perpendicular to the skin surface, which contributes to the “protrusion” of the adipose tissue lobules upward between them. In men, the fibers of the connective tissue have a more diagonal direction, which creates a kind of strong mesh frame. Considering all this, a man can gain a lot of weight, and this will not cause changes on the surface of his skin, and in women, weight gain will almost certainly lead to protrusion of lobules of adipose tissue and the appearance of an “orange peel”.
Therefore, cellulite on the bottom and legs is almost exclusively a female problem, and if it occurs in men, it is usually associated with hormonal disorders (for example, with an excessive amount of female sex hormones in the body).
Causes of cellulite in women –
Despite the innate predisposition of women to the development of cellulite, there are a number of factors against which this predisposition begins to manifest itself. We are talking about a sedentary lifestyle and unhealthy diet – especially when, against their background, there is also a third factor – an imbalance in the system of female sex hormones. So, it is customary to distinguish the following 3 main causes of cellulite:
1) Hormonal factor –
an imbalance in the system of female sex hormones (an excess of estrogen and prolactin, a lack of progesterone), a violation of the ratio of estrogen and testosterone – leads to a violation of fat metabolism in women, and the predominance of lipogenesis processes over lipolysis. This means that the metabolism of fat cells will be geared towards the accumulation of fatty acids. That is why cellulite develops especially rapidly in women during periods of hormonal changes – this is the period of puberty, the 2nd half of pregnancy, menopause, with dysfunction of the ovaries.
Another interesting factor is that growth hormone is an activator of lipolysis, i.e. it promotes the breakdown and elimination of fatty acids from adipocytes. Growth hormone is produced in the anterior pituitary gland during the long sleep phase, and therefore lack of sleep leads to a decrease in the production of this hormone and, accordingly, to inhibition of lipolysis and weight gain. In addition to all this, there is another very important hormone, which is the most powerful activator of lipogenesis – this is insulin, but we will talk about it in the paragraph “unhealthy diet”.
Menopause period –
separately, it must be said about the menopause period, during which there is a low concentration of estrogen, which in turn leads to an automatic increase in vascular permeability and a decrease in the tone of the vascular wall. As a result of these processes, microcirculation is disturbed, which is an important factor predisposing to the development of cellulite. In addition, estrogen deficiency leads to a decrease in the production and content of collagen type I and III fibers in the skin, which also contributes to the development of cellulite.
In addition to all this, with age, women experience a decrease in the number of beta receptors located on the membranes of adipocytes (fat cells). It is this type of receptor that is responsible for the activation of lipolysis, i.e. for the removal of fatty acids from fat cells. It turns out that in women with age, the number of alpha-adrenergic receptors responsible for fat accumulation (lipogenesis) begins to significantly prevail over the number of beta-adrenergic receptors. Accordingly, the physiological process of fat metabolism in the body will be arranged in such a way that lipogenesis will dominate over lipolysis.
2) Unhealthy diet –
unhealthy diet includes, for example, overnutrition, as well as an unbalanced diet, in which carbohydrates and fats significantly prevail over proteins. You should understand that not only the consumption of fat leads to the accumulation of fatty acids in fat cells (adipocytes), but there is also a mechanism in the body that transforms excess carbohydrates into fatty acids.
In addition, high peak blood insulin concentrations lead to fat accumulation. The fact is that insulin is exactly the hormone that activates lipogenesis, i.e. the process of accumulation of fatty acids in fat cells. And here 2 points are very important. Firstly, high peak insulin concentrations during meals, which are caused by the consumption of foods with a high hyperglycemic index (these are boiled potatoes and carrots, rice, starch, sugar and many other foods). And the second important point is the diet.
The situation when you eat rarely, but a lot – leads to high peak concentrations of insulin in the blood, and as we said above – insulin is one of the activators of lipogenesis. In addition, the body in conditions of irregular nutrition seeks to keep excess carbohydrates “in reserve”, and you help it a lot in this. But eating often and in small quantities will not lead to high peak insulin concentrations, which means it will not actively stimulate the processes of fat accumulation by fat cells.
3) Physical inactivity –
sedentary lifestyle, sedentary work causes impaired blood flow in the limbs and lower body. As a result, microcirculation of blood is disturbed in the subcutaneous fat (venous stasis occurs), an increase in vascular permeability occurs and, as a result, interstitial edema of fatty tissue is formed, and lymphatic drainage is impaired. Violation of microcirculation, interstitial edema of adipose tissue and lymphostasis – these are the triggers for the development of cellulite.
If we impose on these processes factors that stimulate lipogenesis, i.e. hormonal factor + unhealthy diet, then you get your cellulite. Well, we also forgot to note that too tight clothes (tight jeans) also affect the development of cellulite, because in this case, blood microcirculation is disturbed and tissue hypoxia occurs. Also, one of the factors can be called the love of high heels, which are the cause of impaired venous outflow.
Important : well, speaking about the predisposition of women to cellulite, it is also worth remembering that during the period “from the beginning of PMS to the end of menstruation” – there is always physiological interstitial edema of adipose tissue. What if such a regular physiological edema is complemented by an inactive lifestyle, unhealthy diet and excess body mass index? And what will happen when the physiological edema of adipose tissue is summed up by constant pathological interstitial edema of adipose tissue (arising against the background of microcirculation disorders) …
The relationship between cellulite localization and alpha receptors –
To make everything finally clear for you, let’s summarize all the information on lipogenesis and lipolysis activators. Fat cells have alpha and beta adrenergic receptors on their membranes, which are responsible for the activation of lipogenesis and lipolysis, respectively. Stimulation of alpha-adrenergic receptors leads to the activation of lipogenesis, i.e. to the accumulation of fat in adipocytes (fat cells). As you already understood – the main activator of lipogenesis includes such a hormone as insulin, as well as estrogens and prolactin.
Stimulation of beta-adrenergic receptors leads to the activation of lipolysis, i.e. there is an activation of the processes of cleavage of triglycerides (complex fatty acids) into monoglycerides, and the removal of the latter from fat cells. Hormones are responsible for this – first of all, it is glucagon, as well as growth hormone, testosterone and cortisol (the hubbub of stress). That is why, during stress, a person usually loses weight. In addition, it should be noted that in women in the thighs, abdomen and buttocks, adipocytes have 5 times more alpha-adrenergic receptors responsible for lipogenesis than beta-adrenergic receptors.
Those. these are nothing more than the so-called “fat traps”. That is why it is 5 times easier for women to accumulate fat tissue than to lose it later. And if a woman then goes on a diet, goes to the gym, then she will lose weight primarily in the area of the face, chest, i.e. where fat cells have more beta-adrenergic receptors. And that is why, in addition to sports and diet, in order to reduce the volume of fat in the area of ”fat traps”, local effects are already required in the form of injections of lipolytics, as well as using the methods of hardware cosmetology (24stoma.ru).
Based on the foregoing, it should become clear why cellulite first of all occurs on the legs and butt, and not somewhere else. As we already understood, this is due to the large number of alpha-adrenergic receptors responsible for the accumulation of fat in these areas (against the background of a small number of beta-adrenergic receptors in the same area).
Cellulite stages: photo and description
In this section, we will list the stages of cellulite formation, and as you will see below, at the very first stage, it is not at all possible to visually see its presence, because such a characteristic symptom as an orange peel on the skin is still absent. The following 4 stages of cellulite can be distinguished, which correspond to its severity:
1) Venous stasis (panniculopathy) –
at this stage, there is a violation of blood microcirculation in the subcutaneous fat and dermis. Venous stasis should be understood as a violation of venous outflow against the background of normal blood flow through the arteries. This leads to an increase in the pressure inside the capillaries and an increase in vascular permeability. Visually, at this stage, the skin is still even and smooth, and the problem can only be identified by a decrease in skin temperature in problem areas.
2) Interstitial edema (Fig. 5) –
interstitial edema should be understood as edema of the intercellular space. Violation of venous outflow and an increase in vascular permeability at the first stage – lead to the gradual development of interstitial edema. Swelling of the intercellular space leads to compression of the vessels of the microvasculature, further aggravating the violation of venous outflow, and also causing lymphostasis. At this stage in the development of cellulite, when we fold the skin into a fold, we see the “orange peel” symptom. The pinch symptom (soreness) is negative.
3) Fibrosis (Fig. 6) – the
body always fences off the zones of interstitial edema and inflammation with the help of fibrous capsules. Fibrosis is also promoted by hypoxia of adipose tissue, which occurs already in the first two stages – due to a violation of microcirculation and the function of gas exchange in the capillaries. Due to the proliferation and compaction of connective tissue fibers (fibrous septa) in adipose tissue, micronodules are formed, i.e. groups of adipose cells adhered to each other, limited by fibrous capsules.
At the same time, the increased fat cells of such micronodules (which have absorbed a lot of fatty acids) “bulge” into the dermis, which gives it a characteristic “orange peel” appearance – even when we do not fold the skin into a fold. The pinch symptom at this stage is mildly positive, i.e. mild soreness will be present.
4) Sclerosis (Fig. 7) –
patients at this stage always have an increased body mass index. At this stage, an even greater thickening of the interlobular fibrous septa occurs, as well as the fusion of micronodules into macronodules. Visually, we see a full set of cellulite symptoms – orange peel, tuberosity, dimples, a positive pinch symptom. In addition, in the area of problem areas, the skin will be colder, with a bluish tint.
The total number of mesotherapy procedures will depend on the stage / stage of cellulite development. If at the first or second stages 4-6 and 8 procedures are enough, respectively, then the third stage of cellulite will require at least 12-16 procedures. And at the fourth most difficult stage, an acceptable result can be obtained only after several courses of 15-16 procedures. At the same time, if in the first two stages only mesotherapy will be enough for us, then at 3-4 stages we will need to connect other methods of treatment in parallel.
Clinical forms of cellulite –
There are several types of cellulite in the clinic. The most basic type is associated with the excessive development of adipose tissue – let’s call it conditionally “fat”. Further, the “dry type” can be distinguished – these patients have little adipose tissue, but a lot of fibrous adhesions, skin irregularities. Another type is “atonic”, which is characterized by pastiness, atonicity, flabbiness of the skin. They also distinguish the “edematous form”, which is characterized by pronounced swelling of adipose tissue (most often this form happens against the background of some pathology – diseases of the cardiovascular system, kidneys).
Cellulite on the legs and bottom: treatment
Cellulite treatment always takes place in 3 stages. At the first stage, it is important for us to restore blood microcirculation, improve venous outflow, activate lymphatic drainage, and also reduce interstitial edema of adipose tissue. At the second stage, we will be engaged in active lipolysis, and also try to slow down lipogenesis, i.e. the process of fat accumulation. Well, at the last stage, we will be engaged in tissue lifting and stimulation of neocollagenesis, trying to increase the elasticity of the skin.
Naturally, all this should take place against the background of nutritional correction and sports. Below we will consider in detail the stages of treatment, but first we will list the contraindications to the use of lipolytics in the treatment of cellulite. Absolute contraindications will be –
- age up to 16 years,
- pregnancy and lactation,
- chronic diseases in the stage of decompensation,
- uncompensated type 1 diabetes mellitus,
- renal and hepatic impairment.
The last point is very important because the use of drainage preparations against the background of interstitial edema of adipose tissue will lead to an increase in the load on the kidneys. And in turn, lipolytic drugs create a load on the liver, because The point of using lipolytics is to get fatty acids from adipocytes (fat cells) and transport them through the blood vessels – to the liver, where they will already be processed. Those. the final stage of lipolysis does not take place somewhere out there, but in the liver.
The first stage is the restoration of microcirculation
At the beginning of each procedure of stage 1, we first have to make a major vascular obstruction (capillary mesotherapy) using the combined preparation “GAG Complex DVL Capyl” – based on the extract of gingo biloba and troxerutin. Based on the composition, it is a vascular drug that affects precisely the microcirculation. But, if we also need pronounced drainage properties, then we can add a couple of ml of preparations – “Artichoke” or “Rutin + Melilot extract” to the syringe with this preparation.
The main vascular cut is done along the lines along the spine, including the paravertebral lines, as well as along the legs, i.e. on the lateral outer and inner surfaces of the thighs and legs (stripe technique), with a step of 1.5 cm. Usually we need 5.0 ml of the drug for this. Our goal is to activate metabolism, microcirculation and lymphatic drainage not only locally, but also throughout the body. After that, we are already moving on to working with local problem areas.
Working with problem areas – the
optimal preparation for this is “GAG Complex DVL E”, which, in addition to gingo biloba extract and troxerutin, also contains an artichoke with yohimbine. Artichoke has drainage properties, relieving interstitial edema, and yohimbine is a lipolytic of combined action. Yohimbine simultaneously acts on the alpha-adrenergic receptors of fat cells, thereby reducing lipogenesis, as well as on beta-adrenergic receptors, activating lipolysis in the fat cells.
Thus, this drug will allow us in areas with cellulite to improve microcirculation with lymphatic drainage, relieve edema, as well as activate lipolysis and suppress lipogenesis in fat cells. Problematic areas (for example, buttocks and thighs) are punctured in a checkerboard pattern with a step of 1.5 cm. At stages 1-2 of cellulite, we can take about 8-10 ml of the preparation “GAG Complex DVL E” -4 stages – use already from 10 to 15 ml of this preparation.
All procedures are carried out once a week. The total number of procedures for this stage of treatment for stage 1-2 of cellulite is 4-6 procedures. It turns out that if you only need the prevention of cellulite, or you have only 1 stage of cellulite (in the absence of an increased body mass index) – 1 stage of treatment can be limited. If you have stage 1 against the background of an increased body mass index, or already stages 2-3-4 – in any case, we proceed to the second stage of treatment, i.e. active lipolysis.
The second stage of treatment is lipolysis activation
As before, at the beginning of each procedure of stage 2, we continue to make the main vascular obstruction, using the combined preparation “GAG Complex DVL Capyl”, and, if necessary, adding “Artichoke” or “Rutin + Melilot extract” to it. The technique of the main obkol was briefly described by us above. After that, we again turn to work with local problem areas, the purpose of which is to activate lipolysis and inhibition of lipogenesis in adipocytes (fat cells).
For this we need mild lipolytics. On the one hand, they will act on beta-adrenergic receptors, stimulating the breakdown of complex fatty acids “triglycerides” – to “monoglycerides” (with their subsequent removal from fat cells). On the other hand, they will act on the alpha-adrenergic receptors of fat cells, blocking the accumulation of new portions of fat in them. Those. we need lipolytics to activate lipolysis and suppress lipogenesis.
There are a fairly large number of drugs for these purposes, but as an example, we cite the drugs from Mesopharm (this does not mean that they are better than others, but in any case they are good drugs in terms of price / quality ratio). Preparations with such a composition are used for lipolysis not only against the background of cellulite, but also for the correction of local fat deposits.
1) Estetic Form “Phyto Slim” –
- L-carnitine,
- caffeine,
- rutin and melilot extract,
- organic silicon 1%.
The drug is more suitable for patients with stages 1-2 of cellulite. In this preparation, the lipolytics L-carnitine and caffeine are combined together with the vascular-drainage complex “rutin-melilot extract”. Injections are carried out to a depth of 6 mm, in a checkerboard pattern (with a step of 1.0-1.5 cm) over the area of problem areas. For one procedure, we can take up to 15 ml of this drug. But it should be borne in mind that the drug contains caffeine, and therefore it is not recommended to use it in such volumes towards the end of the afternoon.
2) Estetic Form “Lipo Stop” –
- L-carnitine,
- caffeine,
- yohimbine,
- minari extract,
- organic silicon 1%.
The combination of lipolytics in this drug is already stronger than in the previous one – due to the content of another lipolytic (yohimbine), and therefore this drug will be indicated for patients with stages 3-4 of cellulite. Both caffeine and yohimbine tend to increase blood pressure – this drug should also not be used towards the end of the afternoon, and should also be used in patients with diseases of the cardiovascular system. For 1 procedure – no more than 10 ml. Organic silicon in the composition – tends to inhibit the fibrosis of the connective tissue.
Preparations containing deoxycholate –
it should be noted that we can use more severe preparations for lipolysis against the background of cellulite – in particular, containing lipolytic deoxycholate (PHDC preparation), which irreversibly destroys the membranes of fat cells. But its use makes sense only if the patient has an increased body mass index against the background of cellulite and we also need to work on reducing the volume of local fat deposits. The depth of deoxycholate injection will be 12-13 mm.
The introduction of deoxycholate in places with a not too large volume of subcutaneous fat often leads to a focal decrease in its volume. In this case, small dents may be visible on the skin in the area of the injection, and this is especially the case when drugs with deoxycholate are placed on the thighs. Still, the safest areas to work with this lipolytic are the abdomen and sides.
The introduction of lipolytics at 3-4 stage of cellulite –
At 3-4 stages of cellulite, nodes (micronodules or macronodules) are already formed in the fatty tissue. The nodes are groups of adipose cells adhered to each other, surrounded by dense fibrous capsules. As we said above, such fibrous capsules around groups of fat cells are formed due to prolonged interstitial edema of adipose tissue and the state of cell hypoxia. In the presence of such nodes, the classical injection technique for the administration of lipolytics is no longer effective enough, because fibrous capsules prevent the diffusion of lipolytic solutions.
With cellulite, starting from stage 3, the introduction of lipolytics with a cannula will be more effective. The latter is a blunt-pointed needle with a hole on the side wall next to the spout (for removing the solution). The difference between a cannula and a needle is that a pointed needle cuts tissue, including blood vessels and nerves, while a blunt cannula expands / loosens tissue. With regard to cellulite, this will mean that with the help of a cannula we can separate the fatty tissue by breaking the fibrous capsules of micro- and macronodules.
Accordingly, the lipolytic solution will penetrate evenly into all areas of adipose tissue, including areas of adipose tissue enclosed in fibrous capsules. For this technique, we use long cannulas 7-10 cm long. After inserting the cannula through a puncture of the skin, we perform a series of reciprocating movements along its entire length, radially along the vectors. The lipolytic solution is injected along the vectors after we have performed the separation of the subcutaneous fat. We will use the same drugs – “Phyto Slim” or “Lipo Stop”.
Who has the right to administer politics with a needle or cannula –
The cannula technique is more complicated than the injection technique, and only specialists with higher medical education are entitled to use it. To do the usual injections of lipolytics with a needle – myotherapists with a secondary medical education have the right. But keep in mind that mesotherapy is often carried out illegally by people without medical education at all – these are the so-called “esthetician cosmetologists” who, by law, have the right to give you only massage, peelings and various care procedures.
However, many small training centers, in an effort to earn money, teach mesotherapy to people without medical education and then issue them illegal diplomas, which, according to the law, do not give them the right to engage in this type of activity. If you get an appointment with a mesotherapist with secondary medical education, then in addition to the diploma of secondary education, this specialist must undergo the following two advanced training courses – 2) “nursing in cosmetology”, 2) a training course on mesotherapy.
Let me draw your attention to the fact that the right to engage in mesotherapy does not appear after any training course in mesotherapy, but only if it is a standardized course that corresponds to the program approved by the Ministry of Education. Such a course must last at least 32 hours, and after its completion, a certificate of the established (state) sample is issued on paper with watermarks (Fig. 13). All other courses and certifications do not qualify for this activity.
The introduction of lipolytics at 3-4 stage of cellulite –
At 3-4 stages of cellulite, nodes (micronodules or macronodules) are already formed in the fatty tissue. The nodes are groups of adipose cells adhered to each other, surrounded by dense fibrous capsules. As we said above, such fibrous capsules around groups of fat cells are formed due to prolonged interstitial edema of adipose tissue and the state of cell hypoxia. In the presence of such nodes, the classical injection technique for the administration of lipolytics is no longer effective enough, because fibrous capsules prevent the diffusion of lipolytic solutions.
With cellulite, starting from stage 3, the introduction of lipolytics with a cannula will be more effective. The latter is a blunt-pointed needle with a hole on the side wall next to the spout (for removing the solution). The difference between a cannula and a needle is that a pointed needle cuts tissue, including blood vessels and nerves, while a blunt cannula expands / loosens tissue. With regard to cellulite, this will mean that with the help of a cannula we can separate the fatty tissue by breaking the fibrous capsules of micro- and macronodules.
Accordingly, the lipolytic solution will penetrate evenly into all areas of adipose tissue, including areas of adipose tissue enclosed in fibrous capsules. For this technique, we use long cannulas 7-10 cm long. After inserting the cannula through a puncture of the skin, we perform a series of reciprocating movements along its entire length, radially along the vectors. The lipolytic solution is injected along the vectors after we have performed the separation of the subcutaneous fat. We will use the same drugs – “Phyto Slim” or “Lipo Stop”.
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Who has the right to administer lipolytics with a needle or cannula –
The cannula technique is more complicated than the injection technique, and only specialists with higher medical education are entitled to use it. To do the usual injections of lipolytics with a needle – mesotherapists with a secondary medical education have the right. But keep in mind that mesotherapy is often carried out illegally by people without medical education at all – these are the so-called “esthetician cosmetologists” who, by law, have the right to give you only massage, peelings and various care procedures.
However, many small training centers, in an effort to earn money, teach mesotherapy to people without medical education and then issue them illegal diplomas, which, according to the law, do not give them the right to engage in this type of activity. If you get an appointment with a mesotherapist with secondary medical education, then in addition to the diploma of secondary education, this specialist must undergo the following two advanced training courses – 2) “nursing in cosmetology”, 2) a training course on mesotherapy.
Let me draw your attention to the fact that the right to engage in mesotherapy does not appear after any training course in mesotherapy, but only if it is a standardized course that corresponds to the program approved by the Ministry of Education. Such a course must last at least 32 hours, and after its completion, a certificate of the established (state) sample is issued on paper with watermarks (Fig. 13). All other courses and certifications do not qualify for this activity.
Hardware methods of cellulite treatment –
The situation with the hardware methods of cellulite treatment, which are offered in beauty salons, is such that the effectiveness of most of these methods is only insignificant and makes it possible to achieve improvement, as a rule, for a period of no more than 3-4 months (after which everything returns to its original state ). We are talking about such techniques as electrical stimulation, pressotherapy, electrolipolysis, microcurrent therapy, phonophoresis, ultrasonic cavitation, LPG massage.
Most clinics and beauty salons buy inexpensive, ineffective equipment, trying to keep prices reasonable and work out of the flow of patients. For example, a super effective ultrasonic cavitation apparatus UltraShape (Syneron), which uses focused low-frequency ultrasound technology, costs about 2-3 million rubles. And at the same time, a large number of devices for ultrasonic cavitation based on unfocused ultrasound are being sold – only 10,000-20,000 rubles each. Believe me – in this case the price of the device matters.
