Cellulite

1.

2. Cellulite

From a scientific point of view, the
term “Cellulite” is incorrect, i.e. the suffix
"ite" means inflammation of the fat cells,
which is not the essence of this disease.
Therefore, the most correct term can be
considered:
liposсlerosis (fat phanerosis),
localized
hydrolipodystrophy,
gynoid lipodystrophy

3. Cellulite is

Changes in the structural organization of the surface layers of the
subcutaneous tissue, which 95% of women in the world are affected
with;
Variety of hypertrophy of
adipose tissue, which is
the result of a massive
process of fat deposition
due to imbalance between
its synthesis and
degradation that is
followed by accumulation
of water, toxic substances,
changes in the vascular
wall, damage to
surrounding tissues.

4. The following factors promote cellulite development:

Lifestyle (overeating, lack of exercise, and bad habits);
Circulatory disorders (varicose veins, lymphostasis, liver
disease);
Inflammatory diseases and
congestion in the pelvic
organs, hormonal disturbances
(puberty, pregnancy,
menopause, oral
contraceptives);
Stress;
Race;
Genetic predisposition.

5. Anatomy of the skin. Subcutaneous fat.

6. Features of fat cells

Alpha 2 receptors (lipogenesis), beta receptors (lipolysis) ,
Lipogenesis is accomplished by synthesis in adipocytes of
triglycerides from blood glucose and fatty acids, lipoproteins and
chylomicron levels.
Lipolysis is carried out under the influence of triglyceride lipase,
which is controlled by cAMP. The rate of lipolysis is determined
by energy needs of the body, nervous and humoral influences.
Skin
surface
connective-tissue
fibres
fat cells congestion

7. Features of fat cells

In women, the
number of alpha2
receptors is 6
times more in the
buttocks, hips,
abdomen, and
inner knee.

8. Cellulitis Pathogenesis

TSH
glucagon
Thyroxine
ACTH
vasopressin
cAMP
adenylate cyclase
caffeine,
adrenaline,
noradrenaline
+
B-adrenergic receptors,
G - proteins
Phosphodiesterase
(PDE )
–
Lipogenesis (fat synthesis)
Lipolysis
(fat break down)
+
–
a-2 adrenergic receptors,
neuropeptide Y
Insulin,
Salicylates,
RNA,
Nicotinic acid,
Catecholamines

9. Pathogenesis

Adipocyte hypertrophy
Adipose
(fat) cell
Capillary
Fibers of the
connective
tissue
Violation of microcirculation
Accumulation of fluid in
connective tissue of
hypoderm
Nodular sclerosis

10. Cellulite Classification

Currently, uniform classification of cellulite does not
exist.
1. According to one classification cellulite is divided into
two forms: nodular, where there are single or
multiple sites, or nodules of soft or solid
consistency; plaque, in which the nodes are
merged to form large pockets with a bumpy
surface, marked atrophy and depression in the
center.
2. Another one divides it on adipose, swelling and
fibrous forms.
3. Dieticians subdivide cellulite into the following
categories:
milk type - associated with the consumption of fatty
dairy products;
metabolic type - typical for people with low
metabolism; leading a sedentary lifestyle;
hormonal type - typical for women who are
sensitive to side effects of oral contraceptive;
hereditary type - has the most severe course.

11. Cellulite Classification

1. Thick cellulite - in young women with active lifestyles. Cellulite
manifestations do not vary depending on the position of the body.
They are often accompanied by stretch marks.
2. Soft cellulite - in the inactive women. It is accompanied by flabby
muscles. It occurs in women who have lost weight dramatically. It varies
depending on the position of the body, the skin is shaking at movements,
it's often accompanied by varicose veins and telangiectasia.
3. Edematous cellulite - manifested in the form of increase in volume of
the lower extremities. The skin is transparent, thin. There are frequent
complaints concerning feeling of heaviness and pain in the legs.
4. Mixed cellulite - most common.

12. Clinical Stages of Cellulite

1. Pre –cellulite stage or
stage (grade) 0;
2.Primary stage or
stage (grade)1 ;
3.Micronodular stage
or stage (grade) 2;
4.Macronodular stage
or stage (grade) 3.

13. Pre-cellulite Stage

Dilation of small blood vessels, stagnant blood and
lymph circulation
Inadequate excretion,
Reducing the process of
fat assimilation
No visible signs, but at this stage wounds do not heal,
there is minor swelling, and bruises occur at the slightest
bumps

14. Primary stage

Plasma and lymph accumulate in the spaces between clusters of
adipocytes. Water leaves adipocytes
Adipocytes leak
The volume of adipocytes increases
Thickening of the stromal (connective) tissues
Fibrous tissue grows
Collagen fibers split into individual fibrils and grow solid
Microcirculation is impeded
Hypoxia, acidosis
Fibroblasts synthesize hyaluronic acid that keeps water
External signs: changes in the form of "orange peel",
some pale skin in the affected areas can be seen in
the capture of the skin fold

15. Micronodular Stage

Fat cells are paired together in "clusters“.
Vascular disorders worsen.
Loose stroma turns into rough and fibrous.
Micronodules are formed on the surface of the skin, its tone and
elasticity decreases.
External signs
• clearly visible effect of "orange peel" without special
manipulation;
•skin of micronodular type;
•noticeable swelling;
•paleness and reduced skin temperature;
•spider veins;
•pain on deep pressure.

16. Macronodular Stage

Progression of circulatory disorders: venous flow is
impaired, arteries are compressed
hypoxia and acidosis are
exacerbated
Irritation of pain receptors
in the dermis
Increase in
fibrosis of
connective tissue
Adipocytes increase in
the volume of 3 or more
times
cicatricial sclerosis, when the
adipocytes form inert clusters of fat is
formed.
External signs: This is a final stage and it differs from the third one by even
more pronounced changes in the tissues. The nodes are clear, large, and
tender. They are well palpated. There are depressions and hardening areas.

17. Methods of Cellulite Diagnostics

1. Anthropometric data.
2. Anode thermography.
3. Computed tomography and magnetic
resonance imaging
4. Doppler ultrasound
5. Two-dimensional ultrasound (B-scan)
6. Histological examination

18. Prevention of cellulitis

1. Proper nutrition;
2. Break bad habits;.
3. Keep exercising;
4. Clothing and
footwear;
5. The art of
relaxation.

19. Methods of Cellulite Treatment

1. Activation of beta-receptors and stimulation of lipolysis.
2. Inhibition of alpha-receptors and depression of lipogenesis.
3. Lymph drainage and stimulation of tissue fluid outflow.
4. Stimulation of peripheral blood circulation and tone
improvement of the vessels of dermis and hypodermis.
5. "Breaking" the fat capsules, "loosening" of fat and fibrous fibers
in hypodermis.
6. Stimulation of the muscles.
7. Increase of skin elasticity, improvement of epidermis and
dermis.

20. Drugs for Oral Use

1. Antioxidants and vitamins for cellulite
treatment: E, vitamin C, A, B5, B6, F,
coenzyme Q10, carotenoids, lipoic acid and
selenium.
2. Brown algae: Laminaria and Fucus, they
contain iodine, restore water-saline balance
and are fat-splitting ones. Algae can be used
in any form.

21. Internal Use Preparations

Bioflavonoids:
1. Means stimulating blood circulation (ginkgo biloba extract,
centella asiatica, grape seed, hawthorn);
2. Means improving skin condition (evening primrose oil, horse
chestnut);
3. Means stimulating digestion (rosemary oil, turmeric);
4. Means that release water from the body (an extract of dandelion,
horsetail extract);
5. Means detoxifying the body (mate tea is a good stimulant).

22. External Use Preparations

1. Vegetable oil for cellulite: jojoba oil, sage, evening
primrose, shea butter, wheat germ oil. Oil for cellulite
treatment is better to use with a can massage.
2. Essential oils to treat cellulite: all citrus,
bergamot,chamomile, ylang-ylang, all conifers. For
aromatherapy mix no more than 5 essential oils. At the
same time take into account the rule that the wood
essential oil should be mixed with wood one, citrus with
citrus, floral with floral. Rosemary can be mixed with citrus
oils.
3. Preparations releasing excess fluid from the tissues:
ivy, horsetail, horse chestnut, arnica, grapefruit,
cranberries, and lotus.

23. External Use Preparations

4. Drugs splitting fats: caffeine and other xanthine
derivatives, cola extract, guarana, mate tea,
camphor, menthol, and pepper.
5. Algae and mud have lipolytic, lymphatic drainage,
lifting effect, nourish the skin with micro- and macroeliments and vitamins. Wraps for cellulite treatment
with seaweed are extensively used by
cosmetologists.
6. Honey used for cellulite treatment improves skin,
removes toxins and fluid from the body. It is best to
carry out manual honey massage; it gives good
results in reducing the volume of the body and
improving the quality of the skin.

24. Physical Therapeutic Methods

1. Massage;
2. Electromyostimulation;
3. Microcurrents;
4. Electrolipolysis;
5. Cavitation;
6. RF-therapy;
7. Mesotherapy and Mesodissolution;
8. Ozonetherapy;
9. Cryotherapy and cryolipolysis;
10. Hydrotherapy (showers, baths, swimming
pool, and jacuzzi).

25.

26.

27.

28.

29.

30. Obesity

It is a chronic
recurring disease,
which is
accompanied by a
significant
increase in fat
tissue.
МКБ-10 E66.

31.

32.

33.

34.

35.

Predisposing Factors of Obesity
1. Рypodinamia.
2. Dehydration.
3. Genetic factors, in particular:
Increase in activity of the enzymes of
lipogenesis;
• Decrease in activity of enzymes of lipolysis;
Increased consumption of digestible carbohydrates.
гипогонадизм
4. Endocrine diseases (hypogonadism, hypothyroidism,
insulinoma).
5. Eating disorders (e. g, binge eating disorder), in Russian
literature it's called eating disorder behaviour - psychological
disorder that leads to eating disorder.
6. Tendency to stress.
7. Lack of sleep.
8. Psychotropic drugs.

36. Classification

I.
Primary Obesity.
II.
Secondary Obesity.

37.  I. Primary Obesity. 

I. Primary Obesity.
1. Alimentary and constitutive (exogenous-
constitutional);
Constitutional – hereditary;
2. With eating disorders (night eating syndrome,
increased food intake to stress)
3. Mixed obesity

38. II. Secondary Obesity 

II. Secondary Obesity
1. With revealed genetic defects
2. Cerebral obesity (brain tumors, skull base
trauma and the effects of surgery empty sella
syndrome, skull injuries, inflammatory diseases
(encephalitis, and others);
3. Endocrine obesity (pituitary, hypothyroid,
menopausal, adrenal, mixed)’
4. Obesity on the background of mental diseases
and / or receiving neuroleptics

39. Stages and Types of Obesity

Stages of Obesity
а) progressive,
б) persistent
Types of Obesity
1. "Upper" type (abdominal), in male,
2. "lower type" (gluteal-femoral), in female.

40.

Fat Can Be Distributed:
1. In the subcutaneous adipose tissue
(subcutaneous fat)
2. around internal organs (visceral fat)
Subcutaneous fat in the abdomen +
abdominal visceral fat = ABDOMINAL FAT

41. Abdominal Fat

42.

Body mass index
Body mass index is the value allowing to estimate the extent of human
mass and his/her growth, and thus, indirectly, to assess whether a mass
is insufficient, normal or excess (obesity).
The body mass index is calculated by the formula :
where:
m — body mass in kg
h — growth (stature) in m, and it is measured
in kg/m2.
Body mass index was developed by the Belgian
sociologist and statistician Adolphe Quetelet in
1869.
Body mass index
The correspondence between theperson’s weight and growth
15 и менее
Acute weight deficiency
15—20
Body mass deficiency
20—25
Normal weight
25—30
Overweight
30—35
Obesity of the first degree
35—40
Obesity of the second degree
40 и более
Ожирение third degree

43. Four Degrees of Obesity:

I degree -- body weight of the patient exceeds the
normal one up to 20--29%;
II degree -- body weight of the patient exceeds the
normal one up to 39--49 %;
III degree -- body weight of the patient exceeds the
normal one up to 59 -- 99 %;
IV degree -- body weight of the patient exceeds the
normal one up to 100 % and more.

44. Methods of General Correction

Examination by an
endocrinologistor
gynecologist.
A diet with reduced fat,
carbohydrates intake.
Integrated programs:
purgation, drainage,
detoxification prescribed
by a doctor.
Physical exercises.

45.

Liposuction - operative method of vacuum liposuction after
mechanical or ultrasonic disruption.
In recent years, liposuction has evolved into the most common aesthetic
surgery in the developed world. For example, about 300 thousand such
operations are performed annually in the United States and in Germany
- more than 60 ,000 ones. In most cases, the main goal of liposuction is
to improve aesthetically unsatisfactory contour shapes. Moreover, very
good results are gained by liposuction in combination with other
methods of obesity treatment.
Thus, the operation "liposuction" is also
strategically important. Here, of course,
the removal of large amounts of adipose
tissue comes to the fore, not only the
correction of body contours.

46. THANKS FOR YOUR ATTENTION!

47.

Main characteristic features of drugs being used for obesity treatment
Property
Phentermine
Sibutramine
Orlistat
no
yes
yes
Used for prolonged therapy
Side effects
Irritability, dry
elevation
of
tachycardia
Contraindications*
severe hypertension, coronary heart
disease, heart failure, arrhythmias,
stroke, cases of drug addiction in
history. Patients with anxiety states are
assigned carefully.
MAO inhibitors, tricyclic
antidepressants, selective serotonin
reuptake inhibitors, drugs increasing
blood pressure or heart rate, clonidine,
guanethidine, methyldopa, thyroid
hormones
take 8 mg 3 times a day 30 min before
meal. last dose should be taken 4-6
hours before bedtime or once for 15 37.5 mg before breakfast or after 1-2
hours after breakfast
Interraction with other medications
Uses and doses
mouth, constipation, elevation of arterial pressure,
arterial
pressure, tachycardia, dry mouth, anorexia,
insomnia, constipation
decompensated severe hypertension,
heart failure, coronary artery disease,
arrhythmia, stroke
malabsorption syndromes and
cholestasis
MAO inhibitors, tricyclic
antidepressants, selective serotonin
reuptake inhibitors, drugs increasing
blood pressure or heart rate,
ketoconazole**, erythromycin**
fat-soluble vitamins, β-carotene and
possibly cyclosporins
take once a day and control blood
pressure and heart rate
take 120 mg during a meal or within an
hour after a fatty meal 3 times a day.
If the food is not fat, no need to take
any medications. Patients are advised
polivitamins. It's best to take them 2
hours before or after taking orlistat. It
is also important to remember about a
diet low in fat in order to avoid side
effects
* None of these drugs must be prescribed to the patients with anorexia nervosa or bulimia in anamnesis.
** May be interaction doesn’t have any clinical importance.
stomachache, oily stains on the
underwear, fecal incontinence, tympany,
oily stools, increased frequency of
defecations and stool volume