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AN IMPORTANT AESTHETIC PROBLEM: CELLULITE

It is a cosmetic problem that occurs with defects in the subcutaneous tissue. It affects 90% of women, especially after puberty. It is a clinical condition that significantly affects the quality of life of patients.

Although there are many theories about its causes; In short, we can say that it occurs with the deterioration of lymphatic and microvascular circulation in the subcutaneous adipose tissue.

It can occur in any body area where adipose tissue is present: breast, hips, thighs, lower abdomen and upper arms.

Orange peel appearance and various sized bumps or pits occur in the affected area.

triggering factors;

Female gender, Caucasian race, family history, sedentary lifestyle, smoking and alcohol use

Choosing tight clothes, using high-heeled shoes

Diet: excessive consumption of salt and carbohydrate-heavy foods

Hormonal changes such as pregnancy, obesity

Classification:

Although there are various types of classification, severity can be defined morphologically in this way:

1. No clinical findings
2. When the skin is tightened or muscle contraction, an orange peel-shaped image appears. There is also a loss of elasticity. Vascular involvement is less.
3. Even at rest, there is an image in the form of an orange peel. Lumps under the skin are noticed on examination. Vascular involvement has also increased. Therefore, pain, tenderness, pallor of the skin and decrease in temperature are observed.
4. There are bumps and pits that are larger than the image. Since nerve and vascular pressure is more in this period; decrease in skin temperature, pain and discomfort are also more. It is the stage with the least response to treatment.

TREATMENT OPTIONS:

1. lifestyle changes: regular exercise and diet control

1. topical products : caffeine, retinoic acid and vitamin A derivatives and botanical products such as Ginkgo biloba, Centella asiatica, Ruscus aculeatus, Carica papaya, Vitis vinifera, Glycyrrhiza glabra and Aesculus hippocastanum lipolytic, that is, fat burning, providing lymphatic drainage, and reducing collagen edema by stimulating microcirculation. It also supports the treatment by showing collagen-enhancing effects. But; It does not have the effect of opening the fibrous structures between the cellulite lumps.

1. Pharmacological:It is stated that some herbal products taken orally increase microcirculation and provide tissue oxidation.

1. Noninvasive treatments

1. Mechanical stimulation or vacuum therapy ; It is one of the old methods used to reduce cellulite by supporting lymphatic drainage. By applying positive or negative pressure to the skin and subcutaneous tissue, it reduces lymphedema by regulating the microcirculation of the subcutaneous tissue and provides a better skin contour by damaging adipocytes, ie fat cells.

1. Acoustic wave therapy: Conduction of acoustic waves to the subcutaneous tissue is actually a technique commonly used in urology to break up kidney stones. It has been shown that these shock waves break the wall of adipose tissue cells, which we call adipocyte, while promoting fat breakdown, improving local blood flow and enabling lymphatic drainage with reduction of lymphedema. Likewise, it stimulates the production of collagen and elastin by increasing skin elasticity.
2. Radiofrequency devices: The heat released into the subcutaneous layer is absorbed by adipocytes. It stimulates dormant fibroblast cells and initiates collagen production. Thus, it provides a tighter and better clinical appearance.

1. Infrared light and intense pulsed light (infrared light and IPL): The heat created by the light on the skin causes relaxation in microcirculation and lymphatic drainage and an increase in collagen synthesis. Collagen is denatured by heating; It stimulates contraction, thickening and then skin tightening.

1. Focus ultrasound: The thermal energy released by ultrasonic waves promotes disruption of the adipocyte cell wall. This system, known as cavitation, reduces the volume of adipose tissue.

1. Invasive treatments:

a) Fractionated CO2 Laser: This procedure is used to fight excess body fat, cellulite, body and facial aging, sagging, varicose micro-veins and reduce scars and stretch marks. Moreover; It is also used as a post-operative treatment for liposuction or plastic surgery to correct skin irregularities, prevent fibrosis, and improve results.

• Improves blood and lymphatic flows that facilitate drainage.

• It improves the elasticity of the skin.

• It reduces oil deposits.

Improves microcirculation by reducing fibrosis and restores skin elasticity (reduction of characteristic dimples)

b) Mesotherapy and enzymes:

It is the method of subcutaneous injection of various enzyme compounds such as collagenases, caffeine, hyaluronidase, carnitine, aminophylline, phosphatidylcholine, lipase, amylase, catalase, cathepsin.

Another current option is neocollagenesis by injections of biodegradable calcium hydroxyapatite microspheres, ie through skin filling. Calcium hydroxyapatite microspheres stimulate the body’s own collagen and elastin formation, improving microcirculation locally and providing long-term good skin quality.

c) Subcision is an effective surgical technique used to divide the bands or subcutaneous fibrous septa and release the underlying skin, resulting in a smoother and softer cutaneous topography. It is applied with FDA-approved devices that offer an improved subcision system in cellulite treatment.