Cellulite on the legs and buttocks
RADIAL PROTOCOL
Medical Information
Cellulite is defined as a localized metabolic disorder of the subcutaneous tissue.
Its main clinical symptom is a change in the skin’s surface topography, which develops a rough appearance with dimpling. Diagnosis is based on clinical symptoms. Microscopically, cellulite is characterized by infiltration of subcutaneous fat into fibrous connective tissue, giving the skin an orange peel or padded appearance.
This condition mainly affects the pelvic region, lower limbs, and abdomen in women, and is divided into four stages:
1 – The first stage affects the skin’s microcirculation, with no visible changes on the surface.
2 – During the second stage (secretory phase), vasodilation leads to the release of fluids into the extracellular space, and the skin begins to develop the characteristic “orange peel” texture.
3 – The third stage (fibrous proliferation phase) is characterized by an increase in both the quantity and size of adipose cells, which form micronodules. The hypodermic septa become thicker and inflamed. The spongy appearance of the skin becomes evident even in a lying position.
4 – The fourth stage (sclerotic phase) can be considered a worsening of the fibrous proliferation phase, in which the hypodermic septa harden and become even more inflamed. Skin irregularities, dimpling, and bulging are visible to the naked eye.
The etiology of cellulite is multifactorial, with the following factors playing a significant role:
Genetic predisposition
Sex (significantly higher incidence in women than in men)
Ethnicity (significantly higher incidence in Caucasian women than in Asian women)
Lifestyle (a diet excessively rich in carbohydrates may cause hyperinsulinemia and promote lipogenesis; sedentary habits or prolonged standing may lead to microcirculatory alterations in areas prone to cellulite)
Pregnancy
Other contributing factors include localized tissue vascularization, hormonal influence, and post-inflammatory changes. However, the actual differences between the pathophysiology of cellulite and “normal” fat tissue remain largely unclear.
Approximately 85% to 98% of postpubertal women present some degree of cellulite, although there is no definitive explanation for this prevalence. It appears that affected women tend to have fewer hypodermic fibrous septa, predominantly arranged perpendicularly, whereas in men and unaffected women these septa are more abundant and display a crisscrossed arrangement.
Radial shock wave therapy (rESWT®) has demonstrated effectiveness in stages II and III (EbM Level IIB), with an improvement of approximately one stage lasting for several months.
Level IIB: Evidence obtained from at least one experimental study of another type.
STUDIES
Schlaudraff KU Radial shock wave therapy to treat cellulite, abstract ATRAD World Congress 2010, p.18
Schlaudraff KU, Kiessling MC, Császár, Schmitz C Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite. Clin Cosmet Investig Dermatol. 2014; 7: 171-183. Refer to the study.