CELLULITE
Season 1, Episode 4
This episode comprehensively examines cellulite, a prevalent aesthetic concern, by exploring its causes, mechanisms, and grading. The authors of this clinical guide survey the existing literature to suggest an evidence-based treatment approach. Mild cases benefit from lifestyle changes and topical treatments, while moderate cellulite responds well to noninvasive methods like radiofrequency and laser therapy. Severe cellulite may require minimally invasive procedures such as subcision and injectables. The attached article underscores the necessity of multimodal treatments for optimal results and calls for standardized assessments and further research to improve efficacy and treatment strategies.
Comprehensive Study Guide
Short Answer Questions
Instructions: Please answer the following questions in 2-3 sentences each.
What is cellulite, and what percentage of post-pubertal females are estimated to be affected by it?
Why is there a lack of consensus on the optimal treatment approach for cellulite?
Describe the primary components of the pathophysiology of cellulite.
What are the four grades of cellulite according to the Nürnberger–Müller classification system?
Explain how the Cellulite Severity Scale (CSS) categorizes cellulite and its different severity levels.
What are some hormonal factors that may contribute to an increased risk of developing cellulite?
How do methylxanthines like caffeine work in topical cellulite treatments, and what are their limitations?
Describe how radiofrequency (RF) treatments work to improve the appearance of cellulite.
How does subcision work as a treatment for cellulite, and what is the significance of needle depth?
Explain the mechanism of action of collagenase clostridium histolyticum (CCH-aaes) injectables in cellulite treatment.
Short Answer Key
Cellulite is a common esthetic concern affecting the skin and subcutaneous tissue. It's estimated that up to 90% of post-pubertal females are affected by it.
There is a lack of consensus because of the complex and multifactorial nature of its pathophysiology, differences in severity scales, small sample sizes in studies, lack of standardized outcome measures, and limited randomized controlled trials.
The pathophysiology of cellulite involves the accumulation of subcutaneous adipose tissue, changes in connective tissue structure, and alterations in microcirculation. Adipocytes enlarge, compressing blood and lymphatic vessels. Fibrous septae lose compliance, causing adipocytes to protrude.
The four grades of the Nürnberger–Müller classification are: Stage 0 (no alteration of skin topography), Stage I (skin is smooth while standing or lying, "mattress appearance" when pinched), Stage II (skin is smooth while lying, "mattress appearance" when standing), and Stage III (skin has "mattress appearance" while sitting and standing).
The CSS grades cellulite severity based on five criteria: number of visible depressions, depth of depressions, morphological appearance of skin surface alterations, grade of laxity, and the Nürnberger–Müller classification. It categorizes severity as mild (score 1-4), moderate (score 5-10), and severe (score 11-15).
Hormonal changes during pregnancy, menopause, and imbalances like PCOS can increase the risk due to the influence of estrogen and progesterone on connective tissue structure and fat distribution. High levels of estrogen are said to rearrange fatty tissues through the stimulation of fibroblasts which degrade collagen fibers.
Methylxanthines induce lipolysis through the inhibition of phosphodiesterase activity and act as antioxidants, transiently reducing the appearance of cellulite. However, they do not penetrate deep enough to affect the fibrous septa responsible for the dimpling.
Radiofrequency treatments penetrate the skin and generate heat in the subcutaneous adipose layer. This stimulates collagen production, improves blood circulation, and promotes lymphatic drainage, with the goal of tightening fibrous septae and adipose tissue.
Subcision involves the release of fibrous bands that contribute to cellulite's appearance by inserting a needle beneath the skin to sever the septae. Needle depth is crucial to avoid skin necrosis (too superficial) or disruption of surrounding structures and incomplete correction (too deep).
CCH-aaes, used in injectables, lyses septae and stimulates neocollagenesis in subcutaneous fat, leading to more compact and homogenous fat lobules. This twofold mechanism aims to smooth the skin's surface and reduce the appearance of cellulite.
Key Terms
Adipocytes: Fat cells. In cellulite, these cells become enlarged in the subcutaneous layer, contributing to the characteristic dimpled appearance.
Cellulite: A common cosmetic condition affecting the skin and subcutaneous tissue, characterized by a dimpled appearance, often found in the gluteal-femoral regions.
Fibrous Septae: Connective tissue strands that separate fat lobules. In cellulite, these septae lose elasticity, leading to the protrusion of fat and the dimpling effect.
Lipolysis: The breakdown of fats and other lipids by hydrolysis to release fatty acids.
Microcirculation: The circulation of blood in the smallest blood vessels (capillaries) within tissues. Impaired microcirculation is a component of cellulite pathophysiology.
Neocollagenesis: The process of new collagen formation. Many cellulite treatments aim to stimulate neocollagenesis to improve skin elasticity and firmness.
Nürnberger–Müller Classification: A qualitative classification system that categorizes cellulite into four grades (0-III) based on the visible appearance of the skin.
Pathophysiology: The functional changes associated with a disease or condition. In the context of cellulite, it refers to the complex biological processes contributing to its development.
Radiofrequency (RF): A non-invasive or minimally invasive treatment that uses radiofrequency waves to generate heat, stimulating collagen production and improving circulation.
Subcision: A minimally invasive surgical technique that involves releasing the fibrous bands that contribute to the appearance of cellulite.
