Biomedical Engineering Reference
In-Depth Information
Table 15.1
Nurnberger-Muller Cellulite Classifi cation Scale
Grade I
M
al
e
Fe
m
a
l
e
No or minimal cellulite based on observation
when standing, the pinch test, or gluteal
muscle contraction.
Ep
i
d
er
mis
D
e
r
m
i
s
Grade II
Irregular skin topography upon observation.
Cellulite is enhanced by pinching or gluteal
contraction. Subjects may have skin pallor
or decreased temperature and sensation.
Cellulite loops
protruding into the
reticular dermis
2.0
m
m
Grade III
Skin exhibits the classic orange peel dimpling,
“peau d'orange,” at rest. Small subcutaneous
nodularities may be palpated.
1.3
m
m
Grade IV
In addition to the characteristics described
above, there is more severe puckering and
palpable nodules.
1.9
m
m
circulating androgens may have an inhibitory effect on cellu-
lite development by contributing to a different pattern of adi-
pose tissue storage (i.e., more truncal than on the buttocks
and thighs).
Figure 15.1
High-resolution ultrasound images of male and female subcuta-
neous fat. Note the fat herniations into the dermis for the female, which are
absent in the male.
Source
: Courtesy of Dr. Agustina Vila Echague and
Dr. Mathew Avram, from Dr. Avram's chapter in Goldman MP, Hexsel D, eds.
Cellulite: Pathophysiology and Treatment
, 2nd edn. New York, NY: Informa
Healthcare, 2010.
Classification
Nurnberger and Muller developed a classifi cation system for
grading cellulite severity. For this method, the physician
accentuates cellulite dimpling by gently pinching an area of
tissue between the fi ngers and the thumb. For larger areas,
the skin of the thigh can be compressed between two hands.
This technique is referred to as the “mattress phenomenon”
as the dimpled pinched skin resembles a bed mattress. Cel-
lulite may be graded for severity on a scale of I-IV (Table 15.1)
(3,5,6).
Cellulite dimples
Epidermis
Dermis
Fat cells
energy-based treatment overview
Many of the currently accepted cellulite therapies target defi -
ciencies in lymphatic drainage and microvascular circulation.
Based on our understanding of the etiology and nature of this
condition, several treatment modalities have been developed
and can be divided into fi ve main categories: attenuation of
aggravating factors, physical and mechanical methods, phar-
macologic agents, RF energy, and laser energy (5). Treatments
such as topical creams and lotions, ultrasound, electrolipoly-
sis, iontophoresis, and mesotherapy have all been tried; while
effective for temporary, mild improvement (11), none of these
have proved to provide long-term resolution of cellulite (2).
The below sections describe the developments of multiple
devices utilizing either exclusively or in combination: RF-,
laser-, and light-based energies, many coupled with tissue
manipulation for the improvement of cellulite. Laser-assisted
liposuction for the improvement of cellulite is also reviewed
below.
Sepiae
Muscle
Figure 15.2
The organization of the adipocytes between fi brous septa (in a
crisscross pattern) results in the dimpling of the skin characteristic of cellulite.
Source
: Courtesy of Dr. Zoe Draelos, from her chapter in Goldman MP, Hexsel
D, eds.
Cellulite: Pathophysiology and Treatment
, 2nd edn. New York, NY:
Informa Healthcare, 2010.
pregnancy, nursing, menstruation, and estrogen therapy (oral
contraceptive use and hormone replacement) (10). The oppo-
site seems true for men. Although there are a limited number
of studies involving men, it is hypothesized that the combina-
tion of gender-specifi c soft tissue histology at the cellulite-
prone anatomic sites, with a relatively lower circulating
estrogen level, may be responsible for the lower incidence of
cellulite in men (3,4). Although not proved, it is possible that
Mechanical Devices
Tri-Active
Tri-Active (Cynosure, Inc., Westford, Massachusetts, USA) has
the capability to treat cellulite and postliposuction fi brosis
using a trifold treatment approach with diode laser delivery,
contact cooling, and massage, to work synergistically to restore
the body's normal homeostatic environment. It is cleared as
an over-the-counter laser cellulite treatment, for temporary
