MISCELLANEOUS ADIPOSE CONDITIONS in .NET

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MISCELLANEOUS ADIPOSE CONDITIONS
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Cellulite occurs mainly in postadolescent women at the buttocks, abdomen, and thighs Risk factors include lack of exercise; being female, overweight/obese, elderly, and having excess hormones and poor lymphatic drainage It is characterized by dimpling and nodularity of the skin, where the skin looks and feels irregular, almost like an orange peel (Box 3-2) Cellulite largely results from changes in the dermis rather than changes in subcutaneous tissue Although cellulite is frequently found in healthy, nonobese patients, it is aggravated by obesity53 55 PATHOGENESIS The pathophysiology of cellulite is not completely understood, but many theories for the pathogenesis of cellulite have been postulated One
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process and HIV-associated lipodystrophy Aging skin is characterized by a loss of subcutaneous tissue and laxity of the anterior supporting dermis A decrease in supporting bone mass and loss of muscle tone can cause patients to look older In HIV-associated lipodystrophy, most patients are treated with highly active antiretroviral therapy (HAART) This combination therapy contains nonnucleoside reverse transcriptase inhibitors that can hinder DNA polymerase leading to adipocyte apoptosis Common areas affected by lipodystrophy are the cheeks, forehead, temporal, infraorbital, and jowl fat compartments Losing fat in some areas can affect the general appearance in other areas For example, decreasing subcutaneous fat in the malar cheeks can cause a prominent nasolabial fold, or decreasing jowl fat can cause prominent marionette lines and jowls Treatment can be performed by using synthetic filler agents or autologous fat transplantation However, many HIV patients lack adequate fat for aspiration and transplantation or their fat is very fibrous, which makes harvesting difficult Polylactic acid (Sculptra , Dermik Laboratories, Berwyn, Pennsylvania), FDA-approved for the treatment of facial lipoatrophy in HIV patients, is a very useful product that works by stimulating collagen synthesis The more recent use of higher dilutions and longer reconstitution times has led to a decrease in the formation of granulomas after injection of this agent (see 25)
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CHAPTER 3 FAT AND THE SUBCUTANEOUS LAYER
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Understanding the biology of adipocytes is important to the progress of lipolysis techniques and the possible usage of adipocytes as stem cells In addition, various methods for fat removal are being investigated, including drugs or chemicals that can stimulate lipolysis (eg, phosphatedylcholine, isoproterenal, theophylline, aminophylline, caffeine, carnitine, carbon dioxide, and herbal extracts) and device-assisted liposuction such as ultrasound (to burst fat cells) or 1064 nm Nd:YAG laser (to melt the fat cell) These new methods need to be evaluated for safety and efficacy
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BOX 3-2 Hexsel Classi cation of Cellulitea At Stage 0, the skin s surface is not altered At Stage I, skin is smooth when the individual is standing or lying down, but some cellulite appears if the skin is pinched At Stage II, skin appears dimpled without any pinching or manipulation At Stage III, skin appears both dimpled and raised in some areas
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Lipodystrophy
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Lipodystrophy is a term describing abnormality with increasing subcutaneous fat (lipohypertrophy) or decreasing subcutaneous fat (lipoatrophy) It can be congenital or acquired, and generalized, partial, or localized The two most common forms of lipodystrophy include lipodystrophy due to the aging
SUMMARY
Adipocytes and subcutaneous tissue are important subjects to which the
cosmetic dermatologist should pay attention There are cosmetic concerns related to both excess and loss of fat for which the patient will seek cosmetic intervention Advances in this field will be centered on more directed therapies of fat removal or disruption in heavy patients and on stem cell purification and injection in thinner patients It is the role of the cosmetic dermatologist to remain abreast of these changes Furthermore, cosmetic dermatologists and surgeons should take an active role in counseling patients on proper nutrition and weight management from both extremes (too thin or too heavy)
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