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      Cellulite Pathophysiology and Psychosocial Implications

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          Abstract

          BACKGROUND

          Cellulite is a highly prevalent aesthetic condition in postpubertal women.

          OBJECTIVE

          The objective of this article was to describe the latest data on the pathophysiology of cellulite and to highlight the psychosocial aspects that should be considered when treating cellulite.

          METHODS

          A roundtable meeting was convened to discuss and share views on the latest data on the pathophysiology and psychosocial aspects of cellulite. The participants' experience helped guide a narrative review on this topic.

          RESULTS

          The pathophysiology of cellulite primarily involves fibrous septal changes. Strategies targeting the fibrous septa have shown the most consistent efficacy, while showing inconsistent or short-term results when targeting the other components of cellulite, such as decreased dermal thickness, vascular alterations, and inflammation. Female sex, increased age, and high body mass index contribute to cellulite pathophysiology.

          CONCLUSION

          Patients seeking treatment for cellulite are willing to endure numerous treatments, high cost, temporary and/or delayed results, and invasive procedures with potential adverse effects. Psychological discomfort has been reported among patients with cellulite, and understanding their behaviors and psychological characteristics can help clinicians provide better care to these patients seeking treatment.

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          Most cited references41

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          A validated photonumeric cellulite severity scale.

          With recent advances in the treatment of cellulite and localized fat, a comprehensive objective method of measuring cellulite can be potentially useful, especially since important morphological aspects of cellulite are not part of the current classification. Objective To develop and to validate a new photonumeric cellulite severity. Based on standardized photographs of 55 patients with cellulite, five key morphological aspects of cellulite were identified. A new photonumeric severity scale was developed and validated. The five key morphological features of cellulite were identified and included the number of depressions, depth of depressions, clinical appearance of evident raised lesions, and presence of flaccidity and the grade of cellulite. Each item was graded from 0 to 3, allowing final classification of cellulite as mild, moderate, and severe. Results for validation of the scale are statistically significant (P 0.7; correlation item-total > 0.7, with the exception of the right buttock; intraclass correlation coefficients 0.881-0.922; Cronbach's alpha 0.851-0.989 and factor analysis 68-76%. The proposed photonumeric scale is a consistent, comprehensive, reliable, and reproducible tool for the standardized and objective assessment of the severity of cellulite. Conflicts of interest The authors hereby affirm that neither the manuscript nor any part of it has been published or is being considered for publication elsewhere.
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            Demographic features of patients seeking cosmetic surgery.

            The demographic features of 415 patients seeking cosmetic surgery were investigated from a psychiatric point of view. Of the 415 patients, 198 (47.7%) were found to have mental disorders according to ICD-10 including: 17 with schizophrenia, 20 with other persistent delusional disorders, 33 with depressive episode, 47 with neurotic disorders, 42 with hypochondriacal disorder, five with paranoid personality disorder and 14 with histrionic personality disorder. The rate of subjects with poor social adjustment was 56.0%. It was noteworthy that such a considerable number of patients with mental disorders or with poor social adjustment had sought cosmetic surgery. Distinct gender differences were found: male subjects were characterized to have a greater number of mental disorders, especially dysmorphophobia (other persistent delusional disorders plus hypochondriacal disorder) and showed the narrow age range between teenage and young adult age when they were preoccupied with their 'deformity', and poor social function. A history of frequent operations was not considered to be an indicator for mental abnormality. The diagnostic issue in dysmorphophobia is briefly described.
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              So-called cellulite: an invented disease.

              The anatomic basis of so-called cellulite, the hormonal basis for the clinical condition, the prevalence of it, the essential normality and inevitability of it in women, the supervention of it in hormonally feminized men, and the near futility of treating the non-disease are explored in this paper.
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                Author and article information

                Journal
                Dermatologic Surgery
                Dermatol Surg
                DS
                Ovid Technologies (Wolters Kluwer Health)
                1076-0512
                1524-4725
                2023
                April 2023
                March 13 2023
                : 49
                : 4S
                : S2-S7
                Affiliations
                [1 ]Bass Plastic Surgery, PLLC, New York, New York;
                [2 ]Division of Plastic Surgery, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York;
                [3 ]Schweiger Dermatology Group, New York, New York;
                [4 ]Moradi MD, San Diego, California;
                [5 ]LUXURGERY, New York, New York;
                [6 ]Washington University in St. Louis, School of Medicine, St. Louis, Missouri;
                [7 ]Real World Solutions, IQVIA, Parsippany, New Jersey.
                Article
                10.1097/DSS.0000000000003745
                37000912
                a3ddb983-bc31-47e4-8b12-b95aad1278c3
                © 2023
                History

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