BASIC SCIENCE OF THE DERMIS 13 in .NET framework

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CHAPTER 2 BASIC SCIENCE OF THE DERMIS 13
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CHAPTER 3 Fat and the Subcutaneous Layer
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Voraphol Vejjabhinanta, MD Suzan Obagi, MD Anita Singh, MS Leslie Baumann, MD
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Subcutaneous tissue, or the hypodermis, is one of the largest tissues in the human body The major components of this layer are adipocytes, fibrous tissue, and blood vessels It is estimated that this layer represents 9% to 18% of body weight in normal-weight men and 14% to 20% in women of normal weight1 Fat mass can increase up to four fold in severe obesity, which may represent 60% to 70% of total body weight2 Although gaining fat in the body is undesirable for many, losing fat in the face has cosmetic implications as well Adipose tissue gain and loss and volume changes contribute to the aged appearance of the face and body This chapter will review the importance of the subcutaneous tissue and its various functions The subcutaneous tissue is usually not given as much attention as the dermis and epidermis because pathology at superficial layers is easier to detect or diagnose by a shave or small punch biopsy Subcutaneous tissue usually must have an extensive defect before it is noticed, and in order to biopsy this area, an incision or large punch biopsy (eg, 6 mm) is required During histologic tissue processing of biopsy tissue, the triglyceride component, which is the major component of adipocytes, is removed by alcohol and xylol For this reason, subcutaneous tissue has long been ignored However, with advances in diagnostic methods and new treatments, much more has been learned about the subcutaneous layer (Box 3-1) It is important for dermatologists and cosmetically oriented physicians to pay close attention to this tissue because it has many roles in cosmetic dermatology and general appearance how brown adipocytes convert fat to energy, in order to find a way to get rid of body fat by stimulating brown fat to return5 In the past, it was believed that the number of adipocytes, which develop during the 30th week of gestation, does not increase after birth However, newer evidence has shown that adipocytes can increase in number and size in certain situations or environments In general, adipocytes are thought to have two periods of growth The first period occurs from the embryonic stage to 18 months after birth, and the second period occurs during puberty Changes in adipose tissue mass are determined by both size and number of adipocytes6 An increase in size (hypertrophy)7 usually precedes an increase in the number of cells (hyperplasia)8
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COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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ADIPOCYTES
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In the past, adipocytes in adults were considered stable, nondividing cells, like other mature cells However, recent data reveal that adipocytes in adults have the potential to increase in number or revert back into stem cells These stem calls can differentiate to other tissue, such as fibroblasts, collagen, elastic fibers, and hematopoietic stromal cells4 Fat cells are derived from undifferentiated fibroblast-like mesenchymal cells Under certain conditions, these mesenchymal cells give rise to adipose cells Adipose tissue is classified into two morphologic types: white and brown adipose tissue White adipose tissue normally appears yellow because of the accumulation of -carotene, while brown adipose tissue was named by its appearance derived from its rich vascular supply Mature white adipocytes are called round unilocular fat cells They have a copious supply of cytoplasm, which contains a single, large lipid droplet that pushes the nucleus to the border of the cell Brown adipocytes, called polygonal multilocular fat cells, have multiple small lipid droplets When observed with an electron microscope, brown adipocytes demonstrably contain much more mitochondria and smooth endoplasmic reticulum than white adipocytes In humans, brown adipocytes play a major role in nonshivering thermogenesis Brown adipose tissue can be found during the fetal and early neonatal phases, while the majority of adipocytes in adults are white adipocytes Some scientists have tried to elucidate the mechanism of
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