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IMAGES AND CONTROL OF THE EFFECT

Anthropometric evaluation of cellulite through the application of algorithms to weight, height and calculation of the body mass index using the formula of weight divided by the square height of the candidate and the body measurements is a quantitative method that can be used as an indirect measure of the thickness of the fat panniculus. Although this method can truly be useful to evaluate obesity and non-volumetric fat but not to assess gynoid lipodystrophy or cellulite with precision, since weight loss could appear with the consequent reduction in diameter although no improvement in the cellulite proper exists. (Ross-Vergnanini)⁷, (Greenway)²⁸, (Marshall JD)²⁹.

Bioelectric impendence gauge measures the resistance shown by a circuit of alternate current. Information is obtained on the percentage of lean mass (bones, muscle and entrails), fat mass and water. But it does not provide information of microcirculatory alteration of the cellulite tissue. (Ross-Vergnanini)⁷, (Gray)³⁰. Xeroradiography, through the irradiation of the skin with x-rays uses a modified electro-magnetic field via the use of selenium with electrostatic load, generating different images according to the thickness of the fat tissue. It provides information of the dermis and hypodermis, bone and muscle tissue thickness but does not evaluate microcirculatory alterations. And it is not viable due to the risks associated with x-rays.

B-scan ultrasonography, with 7.5 to 10 MHz frequency transducers allow for the evaluation of subcutaneous cell tissue. It identifies the presence of nodes and their diameter, as well as the texture of the connective tissue surrounding them and their thickness. Following the recent introduction of higher frequency transducers (20 to 40 MHz), it is also possible to visualise the papillary dermis, the reticular dermis and the oedema in this region. The use of Doppler effect ultrasounds can also allow the assessment of local microcirculation. This method is thus a non invasive resource that identifies the subcutaneous cell tissue, connective tissue and circulation alterations. (Querleux)⁹, (Towo LFR)³¹.

With a 20 MHz probe in C mode, it is possible to reconstruct the thickness of the skin and the subcutaneous cell tissue with precision in a three-dimensional manner. The characteristics of the dermo-hypodermic junction can be defined with precision, which in people without cellulite appears smooth and much more irregular in patients with cellulite. The compacted adipose lobes surrounded by rigid collagen tissue characteristic of the more advanced stages of cellulite can be measured The size of these micronodules is several millimetres. When these micronodules are grouped into macro nodules they reach a size of 2 to 20 mm. (G.W. Lucassen)³².

Thermography is a method of evaluating the surface temperature of the skin using a flexible anode made out of thermo sensitive cholesterol crystals. After a few seconds of contact on the skin, a map is displayed of colours that determines the existence of different temperatures on the skin surface and the basal temperature of the anode (28 to 31º C). Therefore, the degree of cellulite can be determined according to the map of colours obtained. (Curri)⁶.

• Homogenous images with colours from green to pink indicate grade I cellulite or the absence of cellulite.
• When an image appears with dark regions in the shape of dark holes or similar to leopard skin means that there is a more advanced degree of cellulite.

This is a convenient method but it requires that the humidity conditions and temperature of the room where it is performed be stable. Other factors that can alter the result are recent exposure to the sun, fever, smoking and the stage of the menstrual cycle.

Computerised axial tomography (CAT) and magnetic resonance imaging (MRI) measure the thickness of the fat and do not evaluate the dermis and the microcirculation. These are basically used in cases of obesity.

The histopathological examination is a direct method and very accurate, but it is invasive. It is performed via 4 mm “punch”. The most useful stains are hematoxylin and eosin, Wiegert-Van Gienson, phosphotungstic acid for polysaccharides, acid-Schiff stain for membranes, that allow for study of elastic, collagen and muscle fibres and Masson’s trichrome stain which shows good contrast between collagen and elastic fibres, as well as dermal muscles. (Amstalden)³³.

Source: http://www.scielo.org.pe

Some of the histological improvements are interpreted in the appearance of great number of horizontal bands in the fibrous tissues of the subcutaneous cells starting with the fascia and gradually decreasing towards the more superficial fat plane. Horizontal collagen bands also appear in the mid-dermal collagen. The redistribution of the vertical force vectors throughout the deposit of collagen bands arranged parallel to the surface of the skin can favour a smoother appearance of the skin and improvement in orange peel skin. These structural improvements and the subsequent redistribution of the forces appear most notably and beforehand in areas with the thickest subcutaneous cell tissue. (David Adcock)³⁴.

The dermal fibroblasts synthesise individual chains of procollagen polypeptide I and II, precursors of Collagen II and III which are polymerised in amino and carboxylic rings/p>

The structure of the fibrous septa has recently been analysed with magnetic resonance imaging and high precision ultrasounds. (Querleux)⁹.

Intrinsic skin ageing displays greater histological changes at a dermal level related to collagen alteration.

The analysis of the structural changes induced by radiofrequency in the subcutaneous cell tissue is complicated without the introduction of a device. Any prior biopsy would alter the tissue structure for the following extraction. On this basis, it seems interesting to evaluate the changes through ultrasonography (2 to 5 MHz) and confocal microscopy.

The most interesting measurements to view changes with ultrasounds could be:

• Quantitative
• Distance between the deep dermis and the first band of fibrous tissue taken in two points of the image to obtain an average (a reduction of 2.5 to 3 mm is expected after radiofrequency treatment).
• Distance between the deep dermis and the muscle (a reduction of 6 mm on average is expected after radiofrequency treatment).
• Qualitative
  Longitudinal wide view in a localised point to measure:
• Amount
• Thickness
• Quality of the fibrous bands: Quantified as continuous straight lines, discontinuous straight lines, continuous wavy lines and discontinuous wavy lines. Improvement is seen as curves to straight lines and discontinuous to continuous. Classifying the curves and discontinuous as five (the most disorganised) and the straight and continuous as one (the most organised).
• Increased echo-density augmentation of the structures that correspond to connective tissue displaying an increase in the amount of fibres and compacting of the existing fibres. (Del Pino-Rosado)¹⁹.