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We should always bear in mind that ineffective or hardly effective aesthetic treatments have three inescapable consequences: clinical damage 400mg viagra plus amex where to buy erectile dysfunction pump, aesthetic injury and buy viagra plus 400 mg line erectile dysfunction treatment new drugs, more frequently, serious psychological damage. In summary, only within the last three decades has today’s society defined the ideal female and male body as youthful and almost pre-pubertal. Well-defined muscles with very little body fat being the ideal. This recent definition of beauty has led to the development of a new medical ‘‘disease,’’ cellulite. Cellulite can best be described as a normal physiologic state in post-adolescent women whose purpose is to maximize adipose retention to ensure adequate caloric avail- ability for pregnancy and lactation. Almost all women who are not cachectic have cellulite. The treatment of cellulite is extremely popular in Europe and Latin America. Sales of various topical therapies in those countries is a multimillion dollar business with an entire division of ROC (Johnson & Johnson) devoted to its sales and development. Unique to those countries is the purchasing and development of equipment to treat cellulite. It is estimated that the sales of cellulite equipment is over 10 million dollars each year. This supports the popularity of awareness of cellulite outside of the United States. The time is right for a textbook on the treatment of cellulite. This subject is not taught in medical schools or in residency programs and there is no textbook in the English language on this subject. As patients go to their physicians (mostly Cosmetic, Dermatolo- gic and Plastic surgeons) to seek advice on the pathophysiology and treatment of cellulite, physicians will need to educate themselves on this subject. To this end, this textbook represents the work of the world leaders in cellulite research. We present new ideas to challenge current medical thought on the pathophysiol- ogy of cellulite as well as a review of many different techniques for its treatment. We hope this book stimulates an interest in this underserved condition. As in many other fields of medicine and surgery, the advances in one field may be utilized in other fields. We believe that this textbook will serve this function. Goldman Pier Antonio Bacci Gustavo Leibaschoff Doris Hexsel Frabrizio Angelini PREFACE & xi & REFERENCES 1. Social Impact of Cellulite and Its Impact on Quality of Life. Definition, Clinical Aspects, Associated Conditions, and Differential Diagnosis. Cellulite Characterization by High-Frequency Ultrasound and High-Resolution Magnetic Resonance Imaging. Theory and Working Principles of BeautytekÒ in Cosmetic Medicine................................ Surgical Treatment A: Lipoplasty, Vibro-Assisted Liposuction, Lipofilling, and Ultrasonic Hydroliposuction. Belardi Department of Nuclear Medicine, Privat Hospital Santa Chiara, Florence, Italy Martin Braun Vancouver Laser and Skin Care Center, Vancouver, British Columbia, Canada Maurizio Ceccarelli Rome, Italy Stela Cignachi School of Medicine, Lutheran University of Brazil (ULBRA) of Rio Grande do Sul, Canoas, Rio Grande do Sul, Brazil Taciana de Oliveira Dal’Forno Medical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil Alberto Di Giuseppe University of Ancona, Ancona, Italy Debora Zechmeister do Prado Doris Hexsel Dermatologic Clinic, Porto Alegre, Rio Grande do Sul, Brazil Valerio Genitoni Universita` di Urbino, Urbino, Italy Mitchel P. Goldman University of California, San Diego, California and La Jolla Spa MD, La Jolla, California, U. Doris Hexsel School of Medicine, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil Camile Luisa Hexsel Internal Medicine, Henry Ford Hospital, Detroit, Michigan, U. Gustavo Leibaschoff University of Buenos Aires School of Medicine, and International Union of Lipoplasty, Buenos Aires, Argentina S.

The receptors that tie the protein molecules (signal protein) ask for a site at the extracellular matrix level order viagra plus 400mg fast delivery erectile dysfunction juice drink, formed by the polypeptidical substance identified on the figure viagra plus 400 mg sale erectile dysfunction statistics cdc. Smaller molecules (signal protein), such as adrenaline, ask for a small extracellular site. The cellular membranes are responsible for the internal organization of cells as well as for interaction with external stimuli and for ‘‘structural integrity. The extracellular matrix is represented by a complex structural entity that surrounds, nourishes, and furnishes support to all the cells. The extracellular matrix is generally described as being composed of three biomolecular classes of substances: 1. Many trials could be represented by the scheme in Figure 4, reported to be the interpretative scheme of the formation of elastin by tropoelastin. Figure 4 Interpretative scheme of the formation of the elastin from the tropoelastin. ANATOMY OF CELLULITE AND THE INTERSTITIAL MATRIX & 37 Therefore, it appears fundamental to begin to consider cellular homeostasis, both in a molecular and in an anatomic-functional biological sense, as a complex interaction of mechanisms and reactions that can begin and also evolve from the outside of the cell in the extracellular matrix (21). The cellular matrix, the fundamental substance for life, is found as a rule as a solution. These varia- tions play a role in physical, chemical, and metabolic changes, among which are the alterations typical of cellulite (22). In the dermal site and in the superficial subcutaneous site, we can have an activation of ‘‘metalloproteases-2’’ directly connected with the evolu- tion of lymphedema, lipolymphedema, and mesenchymopathies. Inquadramento nosologico e classificazione delle panniculopatie da stasi (Classification of panniculopathy by venous lymphatic stasis). Randomized, placebo controlled double blind clinical study on efficacy of a multifunctional plant complex in the treatment of the so called cellulites. Valutazione clinica controllata in doppio cieco di prodotti fitocomposti nel tratta- mento della cosiddetta cellulite (Double blind clinical study of a multifunctional plant complex in the treatment of the cellulitis). Cornelli U, Cornelli M, Terranova R, Luca S, Belcaro G. Invecchiamento e radicali liberi (Aging and free radicals). Vassalle C, Lubrano V, Boni C, L’Abbate A, Zucchelli GC. Valutazione dei livelli di Stress ossidativo in vivo mediante metodo colorimetrico ed immunoenzimatico (Valuation of oxyda- tive stress by immunological methodology). Report of CNR (recherche national center), Isti- tuto di Fisiologia Clinica, Pisa, Italy, 2001. Apoptosi e senescenza cellulare nella cute (Apoptosis and cellular skin aging). Carratelli M, Porcaro R, Ruscica M, De Simone E, Bertelli AAE, Corsi MM. Reactive oxygen metabolites (ROMs) and prooxidant status in children with Down’s syndrome. Fine structure properties and permeabilities of the lymphatic endothelium. Torino, Italy: Atti Congresso Nazionale Collegio Italiano Flebologia, 1998; 2:27–32. Negative regulation of transforming growth factor- beta by the proteoglycan decorin. Interaction of heparin cofactor II with biglycan and decorin. ANATOMY OF CELLULITE AND THE INTERSTITIAL MATRIX & 39 21. Valutazione degli effetti microcircolatori dopo terapia della matrice extracellulare in pazienti affette da flebolinfedema agli arti inferiori (Valuation of the microvascular effect in patient with limphedema). Atti 1 Congresso Nazionale Medicina Estetica SMIEM, Milano, 1999:20. Cellulite is certainly not a serious condition from the medical point of view, but it does represent the most widespread and least tolerated aesthetic complaint among women.

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