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Body Disharmony Syndrome - BDS

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Treatment of the Body Disharmony Syndrome - BDS
Step I - Medical Evaluation
Step 2 – Orientation
Step 3- Treatment of BDS
Step 4 - Maintenance
More about BDS

FAQ - On Cellulite

FAQ - Frequent Asked Questions about Body Disharmony Syndrome and the Cellulite

1- Thin women could have Cellulite?

Yes. A lot of women who have the normal weight, or even below the normal, can present an alteration in the balance between the fat amount of the body and the muscular mass. Then, a thin woman can have a larger proportion of fat and smaller of musculature, maintaining normal or low her final weight. This fat excess, associated to the action of the feminine hormones and alterations in the microcirculation and in the lymphatic will end up generating Cellulite.

2-The patients that seek treatment for Cellulite always have excess of Weight?

In our Clinic most of the patients that seek treatment for the Cellulite has the normal weight, until decreased, or just slightly increased, but when we performed Bioimpedance  that is an exam that can determine the composition of the body, we found fat excess in all the patients that has Cellulite. What happens then is that the patient with Cellulite can be thin or normal in the weight, but she always has fat excess when we evaluated the composition of the body, and that is the factor that unchains the process of Cellulite appearance.

3-Why even some athletes, who have a low body fat, can have Cellulite?

In these patients, assiduous and diligent visitors of academies and even professional athletes, and that paradoxically has Cellulite, there is an increase of the regional fat.  That means, that she has normal weight, normal body composition, but the little amount of fat she has is concentrated in the hip. The action of the feminine hormone contributes to this regional deposition of fat that ends up generating the modifications that take to the Cellulite.  That is the reason we know that the Alimentary Correction and the Exercises are important part of the treatments for Cellulite, but it is also necessary to associate the treatments of the Clinic of aesthetic medicine, that can reduce this feminine trend of depositing fat in certain areas.

4- Why even very thin models who we presuppose to have a restricted feeding can have Cellulite?

As we saw, what interests is not the weight, but the composition of the body and the distribution of the fat. A model can be thin in the weight, but also present few muscles. What we observed in a high frequency is that in patients with natural trend to be thin, the worry with Exercises and with feeding is lower. Those patients have few fat cells, and some fat that accumulates is distributed by these few cells, altering expressively the fat tissue, compressing the micro veins and then determining the emergence of Cellulite. We can say that in a thin person, a small fat concentration will produce Cellulite even more than in people with trend to be fat that has more cells to divide the excess.

5- What reason have we sometimes observed people with weight excess who don’t have so much Cellulite?

It is that! A small amount of acquired fat for a thin person with few fat cells in the body and the same amount acquired for a person with trend to the obesity with many fat cells in the body can cause a Cellulite even larger in the thin person than in the fat person. It happens because each cell from the thin person will have more fat than each cell of the fat person, having then, larger tissue alterations. Of course if a person with trend to the obesity keeps winning weight, he or she will start having much more serious Cellulite.

6- When should thin people who are interested in winning a larger shape eat more?

A frequent mistake in people naturally thin happens when they want to win a larger physical shape so they begin eating more. Yes, they will win weight, but they will win fat tissue, with Cellulite and alterations in the body harmony. If a very thin person, wants a larger physical shape, this person should keep feeding with good nutritional orientation and perform exercises to win muscle, something that will give him/her the required physical shape, but with more beautiful lines and harmony and without Cellulite.

7- How to treat thin patients who has BDS - Body Disharmony Syndrome?  Is it necessary Alimentary Correction and Exercises?

In treatment of these very thin patients with BDS will be necessary the Alimentary Correction in spite of the bass weight, to correct the body composition. It should be associated with practice of Exercises, mainly of the type lift training, for earning of muscular mass.  A diet with more protein is desirable to create the nutritional base for the earning of muscular mass. It is as if we changed fat for muscle. In other words, we maintain or we increased the weight, reducing the fat and increasing the muscular mass. However, only Exercises and Alimentary Correction are not enough. This Regionalized Fat, usually present in hips and thigh is liberated with so much difficulty, because of the action of the feminine hormone. Therefore, the need of treatments in the Clinic of aesthetic medicine, which uses methods as the Application of Lipolytics, helps to eliminate this fat. Besides, the microcirculation that is already altered with edema (swelling) also needs to be gotten better. With the treatments of aesthetic medicine, the fat from the place where the Cellulite is will be more easily eliminated, the microcirculation and the edema will be gotten better and the Cellulite will be controlled this way.

8-Why don’t men have Cellulite?

That is really the truth, and the cause of this difference is the key for the understanding of the process of Cellulite. This aspect was well demonstrated in recent researches performed in Belgium and in the United States . Men don't have Cellulite because the men's fat tissue and the women’s are essentially different. In the women there are septums (small fibrous strings that separate portions of fat cells) finer and with straight orientation and in the men the septums are thicker and resistant and with oblique orientation. These characteristic make the tissue expands towards the surface and to the skin in the women and towards the muscle and to the depth in the men. This is the difference in the microanatomy that makes the Cellulite to be present in the women and not in the men, even if the men win a lot of weight. Another difference is the action of the feminine hormone, clearing present in the woman and absentee in the man. The alteration provoked by the excess of fat tissue deposited in the woman's preferential areas, driven by the hormonal action and with consequent compression in the veins and lymphatic and the alteration in the micro vascular veins provoked by the hormonal action take to the vicious cycle of emergence of Cellulite.

9- Does cellulite only happen for having acquired fat?

Of course the earning of fat tissue has important role in the Cellulite, but it is not the only one.  We can say that the Cellulite happens because of the increase of the fat in an area, that as we saw is the predisposed for cellulite and it is only present in the women. The fat increase appears by errors in the feeding, but, above all, for hormonal action, that drives the fat excess for preferential areas, typical of the women. The fat in excess from determined places takes compression to the micro veins and lymphatic, that is already with its capacity to transport liquids altered by the hormonal action. Then the Cellulite is a process where many factors are involved, because of that it needs several procedures of treatment.

10- We’ve always heard that Cellulite is a circulatory problem, then, did this change?

In the past we believed that the circulatory alteration was the base of the process of Cellulite, this belief was much reinforced because we found a lot of patients without weight excess and with Cellulite. But today we know that even the patients without weight excess have Cellulite and presents  fat excess in the body composition or in a certain area. These scientific works that I’ve already mentioned performed in the United States and in Belgium and in experiments very well performed, practiced at the countries of the North of Europe, through sophisticated micro perfusion methods, where the circulation of the fat tissue was evaluated in patients with Cellulite, they didn't show any alteration in the arterial blood flow or in the constitution of the vessels. What happens is that the increase of the volume of the fat tissue compresses the veins and lymphatic and associate to the hormonal action it provokes the edema, still taking an increased vicious circle, increase of the tissue volume, increase of edema, larger compression of the vessels and more Cellulite. The edema in the tissue with Cellulite was confirmed in a research, still initial, performed in the University of Campinas, which demonstrated that the women with Cellulite have in the attacked area, on average, the double of the water that the men have.

The tissue with an extra load of fat, and with the same circulation behaves as if it lacked circulation, it is with capacity to perform the reduced normal metabolism, and appearing colder zones in the skin, detectable by Thermography, that is an examination that we used exactly to determine the degree of compromising of the fat tissue with Cellulite.

Then the circulatory alteration is really present, in the veins and lymphatic, provoked by the compression of the fat and action of the feminine hormone, but it is an alteration just of the function  and no an illness of the vessels. Therefore the circulatory alteration can be regressed treated the causes of this bad function.

What changed was that the cause of the process is now not the circulatory alteration, but the woman's micro anatomic predisposition to have Cellulite.  The process begins with the fat deposition and hormonal action and the circulatory alteration is present, it worsens the process, but it is the consequence of the other factors.

11- Are there relations between Cellulite and Localized Fat?

The Cellulite, the Localized Fat, the Muscular Flaccidity and the Excess of Body Fat are part of what called BDS - "Body Disharmony Syndrome “, that are series of alterations that are present, always together, in the patients that seek the clinics of aesthetic medicine for treatment. Localized Fat is different from Regionalized Fat. The Localized Fat is a protuberance of fat tissue, as the outer thighs or the Love Handles, that are difficult to eliminate with the medical cares and they usually need surgery for correction. The Regionalized Fat is a fat regularly distributed for the whole hip and the patient's thighs, without necessarily to form protuberances. The process of emergence of Cellulite, Regionalized Fat  and of the Localized  Fat have similar causes, because they are linked to the action of the feminine hormone and the fat excess in the body composition, but they are different processes with different treatments also. Then to correct the body shape is necessary to correct all those alterations. It is not only to treat the Cellulite, or only to do a surgery for the Localized  Fat or only Exercises for the flaccidity or only Alimentary Correction, is necessary a global treatment, of all of the alterations that the patient presents, using the available methods in a personalized way.

12- What about the Muscular Flaccidity?

The Muscular Flaccidity, as we saw, is also part of the Body Disharmony Syndrome. There isn’t a direct relationship between the Cellulite and the Muscular Flaccidity; they are processes that reach body tissues completely different. However, these situations frequently appear together. As we commented on, the patients with Cellulite have fat excess not only showing in the weight excess, but also in a composition change. If a patient has fat excess in the body composition, he could have, consequently, smaller amount of muscular tissue, what is reflected in flaccidity. The treatments are then different, but they should be performed at a same time.

13- Are there some exams which detect the Cellulite?

A correct evaluation before the beginning of the treatment is very important. Bioimpedance is an examination that determines the body composition. Thermography is an examination that can determine the stage of the Cellulite, and with the Clinical evaluation it helps to establish the prognosis (the result) of the treatment. Superficial evaluations don't have value in the treatment, because they don't get to determine all of the situations related to the problem. A correct evaluation includes the classic consultation, where the physician will evaluate besides the Cellulite, the presence of Muscular Flaccidity and Localized Fat, it includes Bioimpedance to evaluate the body composition, an ultrasound, if necessary to evaluate the Regionalized Fat, Thermography, which helps to determine as the problem already moved forward. A questionnaire of life habits, measured anthropometrics, pictures and evaluation of the patient's profile and adaptation to the several treatments, they are also necessary. Other complementary examinations are used eventually to evaluate the function of the ovaries and of the thyroid and other alterations of health with implications in the patient's treatment. We considered this very important as an initial evaluation. We are contrary to the indication of the same standardized treatments for all the patients based on a fast physical examination and the indication of the same machines. The people are different, the cases are different, the manifestations of body disharmony are also different and, therefore the treatments should also be different and adapted for each case in a personalized way.

14- What are the favorite methods for treatment of the Cellulite?

We used the combined treatments in the program Corpore Naturale. We didn't only treat the Cellulite, but also the other components of the Body Disharmony Syndrome that are the Excess of Body Fat, the Muscular Flaccidity and the Localized Fat. After the evaluation with exams, with we’ve already mentioned, we elaborate a program that is individualized, in other words, each patient will have a different orientation in agreement with the individuality, the physical type, the hereditariness, the age, and mainly, a realistic objective. Of course a 16 year-old adolescent's treatment has a different objective and bases also different from a 55 year-old lady.

We began with alimentary orientation and sporting orientation that are also personalized and driven for each patient, and for each problem.

The main method of treatment of our Clinic is the local application of medicines. Substances that have lypolitic effect are applied directly in the area of the Cellulite. These lypolitic substances liberate the fat from the cell, and they leave the space among the cells ready to be consumed. The consumption of liberated fat is obtained by the practice of vigorous Exercises that were already guided. Having control with the feed, the liberated fat is consumed and won’t be restored. The feeding that we’ve indicated is with high protein levels, with little fat and little carbohydrate, that forms a base for the musculature construction that will be obtained with the practice of Exercises.

Then, these three healthy procedures act quite synergic. The application of medicines performed at the Clinic reverts the trend to the deposition of regional fat, that it is the basic cause of the Cellulite, which now can be liberated to be consumed. The Exercises consume the fat, the diet with a lot of protein forms the base for the increase of the muscular mass, that lets the muscles stronger, with tonus, improving the lines of harmony of the body, and occupying the space left by the fat, then avoiding the flaccidity. The diet with little carbohydrate and few fats won't restore the liberated fat. This is the beginning of the treatment that we planned. We associated the lymphatic drainage to correct the edema and to improve the circulation, we used complementary methods of treatment in agreement with the needs, including, Carboxitherapy and Electrolipolisis in elapsing of the treatment, if they are necessary. We also used the muscle stimulation. With these procedures we obtain the improvement of the Cellulite, the Regionalized Fat, the muscular tonus and the fat excess.

15- What about the surgery, when is it used?

It is indicated for the component Localized Fat, which is also part of the Body Disharmony Syndrome. When the Localized Fat  is in small volume, a small outer thighs fat, a small belly, the fat sets itself up in inner  thighs or in the "banana bag", that it is the  fat layer that is at the beginning of the thigh, right below the buttocks, we obtain important improvement just with the clinical procedures, being possible to avoid the surgery in the lightest cases. On the other hand, when the Localized Fat is in high or medium volume, the surgery will be necessary. With the clinical procedures, we have the improvement, but not the elimination of the Localized Fat of larger volume. We can perform the Liposuction, and if there is the presence of the depressions of Cellulite, the “holes”, we performed body Liposculpture, that is the fat treatment with the Liposuction at the place where there is fat excess, localized fat, and the application of this fat in other areas. The other surgery that we performed for Cellulite is simple Subcision, which is the liberation of the skin from the fat tissue and from the septums that keep it depressed forming the holes. When these depressions are shallow, just the simple Subcision is done at the own clinic, with local anesthesia, in a process that lasts few minutes and that is enough, but when the depressions are deeper, it will be necessary Subcision and Liposculpture, which is the injection of the fat, in the empty space of the cellulite’s depression.

16- What must be done in first?  The surgeries, the clinical corrections with aesthetic medical treatments, alimentary correction or exercises?

We believe that the correction of the problems that took to the body disharmony should be corrected before any surgical method to be applied. Many cases, the light ones can be corrected without the help of the surgery. The most advanced cases will be gotten better certainly with this measures , and the surgeries eventually necessary will be smaller and with smaller postoperative risks, and consequently with  better results. Some patients, with more advanced cases of Localized Fat are satisfied with the improvement obtained, and they give up the surgical correction. Other doctors, however, prefer to operate first and to install the clinical procedures later. The two ways, if applied correctly, can offer good results.

17- When should I make a Surgery in order to improve the body appearance?

The Surgery is used with wide indications in body aesthetic treatments such as the surgeries for breast, Abdominoplasty, known more commonly as a “tummy tuck” and liposuctions. We also used the vascular surgery that corrects the varicose veins, which is a problem that also could be improved to reach the beauty of the body. However in this matter, which we call Body Disharmony Syndrome, that is the presence of Cellulite, Flaccidity, Localized Fat and Excess of Body Fat, there is the need to associate many resources to get better results. As we saw, BDS depends on several factors. Just a treatment type is not capable to correct completely these problems. The association of treatments is the most effective. Subcision and Liposculpture for the depressions (holes) of Cellulite and the liposuction are used frequently in BDS. But we reaffirmed, it should not only be applied to surgical treatment and also not just treatments without surgery, the combination of the methods, and the personalized choice of each treatment, clinical or surgical is the best for the patient. 

18- Is a single treatment capable to improve the Body Harmony and to correct the Cellulite?

Any treatment separately will correct the Syndrome of the Body Disharmony. The patients' impression that a single treatment resource or technique is enough to correct everything is the cause of many frustration and dissatisfaction. The correction of the lost Body Harmony needs effort and the doctor's competence, but also with the patient’s effort and dedication. Of course if a patient submits to all the treatments and surgeries indicated, but continue with bad alimentary habits and sedentary life that was the cause of the problem, she won't get to the goal nor maintain the intended results, the small progresses, if there are some, soon will be lost.

19- Does the patient frequently abandon the Cellulite’s treatment?

In our Clinic we performed the process of Consultation and Orientation that we commented on and it takes 2 hours on average, and always with the presence of an experienced doctor in the aesthetics area. This Consultation evaluates, it prognosticates and it informs the patient on his/her problem, the difficulties of the treatment, and the expected results. We defined what the Clinic can do and what the patient should do to obtain good results. We make it very clear that there is the need of Alimentary Correction and Exercises, associates to the treatment. Only Alimentary Correction doesn't solve the problem, Only Exercise also doesn’t, only treatment in Clinic of Aesthetic Medicine will also give only partial results. The Surgery can correct the Localized Fat, as outer thighs and belly, but it corrects the Cellulite just partially and doesn't correct the Muscular Flaccidity, that is what gives the body outline and it doesn't correct the body composition. On the other hand, the use of all these procedures together brings excellent results. The patients, when see that the results are clear and visible, totally adhere to the program, and they don't abandon the treatment. However, we frequently received patients that used "miraculous" methods, and that seek us with great discouragement regarding his problem. These methods that promise immediate results and without any effort for change of habits on the part of the patient are responsible for the discredit that many still have in the results of the treatments. Taking care of the Body Disharmony Syndrome and the Cellulite is very difficult and it is a great challenge, for doctors and patients and if it is faced with responsibility, it will bring the intended results.

20- What is the main factor to appear the Cellulite?

The simple fact of being woman. As we already commented on, the woman's fat tissue is predisposed naturally to have Cellulite and the feminine hormone have an important role in the process. These characteristics are normal in the woman, and we can consider that the presence of Cellulite, although a process that inconveniences a lot the women, is almost a natural situation, although not obligatory to the feminine condition. Therefore it is so difficult to treat the Cellulite, because the woman will continue, of course, being woman and the conditions for the emergence of the Cellulite will keep presenting. The cares for good feeding and Exercises should be maintained for a lifetime, and even after the discharge of the clinic, we advised periodic visits, of maintenance, when the nutritional conditions and the sporting practice are revalued and to revert  the trend to Regionalized Fat's deposition, if necessary the Application of Lypolitic are performed.

21-When should I begin to prevent and to treat the Cellulite?

A correct feeding and the control of the weight excess are important in any age. It is not only for aesthetic matters, but for health. In the adolescence, when the feminine hormones appear, the process of Cellulite begins settling, if it is present the Excess of Body Fat. In this initial phase, if the Cellulite comes still in the first stage, just the Alimentary Correction and the Physical Exercises are enough to control the problem. However, if it is a more advanced process of Cellulite, from second to fourth stage it is already present, the treatments and orientations in Clinic of aesthetic medicine will be quite necessary.

22- What are the suitable Exercises for the Women’s health and body form?

The Exercises should be considered in agreement with the patient's objective. If the intention goes to the improvement of the cardio respiratory conditions and the prevention of the circulatory illnesses, just to walk daily, for about 45 minutes, vigorously, in the street or in machine; that is enough to obtain this aim. When the concern is with the body form, and the musculature obtaining, just walk is not enough, it is necessary to work out, and a lot. The formula 5x3 that is the composition of 5 aerobic activities (swimming, race or ergo metric bike) with 3 anaerobic activities (Muscular activity, Body Pump or Lifting Training) a week, is the ideal. The formula 4x2, and 3x2 also present good results, although slower, what can be necessary options for the women with many commitments and with little available time for the Exercises. This is a base of the sporting orientation that we suggested; differences and individual adaptations are always necessary, considering age, objectives, aptitude, motivation, readiness of time, of place and other particularities that turn the treatment of the body harmony, including the sporting orientation, a process always personalized. The third objective, in practice of Exercises it is the competitive, with specific orientations for performance in sporting competitions. Of course one includes the other, the sport of competition bring  benefits for the body form and the health, the sport performed with objective also brings the advantages of cardio circulatory problems’ prevention. But the light sports, as the walk, although very useful for the prevention of the circulatory illnesses, is insufficient for the obtaining a body shape.

23- Are there machines that substitute the Exercises?

Muscle stimulation is a process that promotes the muscular contraction through machines; it is then possible to obtain effect similar to the Exercises, artificially. It is indicated for the component of Muscular Flaccidity of the Body Disharmony Syndrome, it is less useful for the Cellulite specifically. The process is simple and a stream passes for the muscle through electrodes put in the surface of the skin and it provokes contraction. As a matter of fact, if there is repetition of the process with regular frequencies of applications, it is possible to obtain improvement in the tonus of the muscular groups. Several machines of several complexities are available, but the results are similar.  However, this method is only efficient while it is being used. When we stop applying, the obtained tonus will disappear. We used the method in the initial phase of the treatment, to obtain faster results for the flaccidity, while the process of result of the conventional Exercises indicated didn't still appear (The results of the Exercises take from 60 to 90 days to be frankly visible). At a long term we didn't consider the process of muscle stimulation very useful, because the patient would need to come to the Clinic to apply the method frequently during the whole life. We found much more practical, useful for the health and viable the practice of conventional Exercises especially guided, that can and should be performed during a lifetime of the healthy individual. Therefore, the muscle stimulation is a method that efficiently substitutes the Exercises, but useful just in the beginning of the treatment, after a period of time, when the effects of the Exercises are settling down, we suspended the use and we only maintain the conventional Exercises. The so called passive gymnastic, effortlessly muscular, performed in beds that are moved, is useless for the body form.

24- Why after the weigh loss, some women complain of flaccidity?

The skin is the most superficial layer, below the skin there is the fat tissue. Below the fat tissue is the musculature and inside of the musculature the bone. Then, in a simplified way, that is way the buttocks and thigh's anatomy is formed and also the leg. The sum of all these tissues, give the circumference of the inferior part of the body. What forms the beautiful and harmonious lines of the body is the muscular tissue. When the fat decreases, the skin retracts to a certain point, but from a determined point it doesn’t retract more and this is the flaccid skin. If the patient doesn’t take care with the Exercises, the muscle will also continue flaccid. Then, even if the patient does a diet, the appearance of the body, although improved from the previous situation, will be flaccid and without harmonious lines. However, if we associate the Exercises, the increase of the obtained muscular tissue will occupy the space that before was the fat’s, and the result will be a flat skin, firm, with firm musculature, that it is what the collective unconscious asks when analyzes the beauty of a feminine body. Then, wanting to give emphasis in this important aspect, I reaffirm that the combined treatment, with alimentary education, practice of Exercises, treatment in Clinic of aesthetic medicine and surgeries like Liposculpture and Subcision are the most suitable for the treatment not only of the Cellulite, but in the body as a whole.

25-Why does fat excess happen to the body? Is it only caused by fats’ excess in the feeding?

The Excess of Body Fat always has origin in feeding with larger amount than the necessary of calories. The fat excess ingested is deposited in the fat form, but the excess of carbohydrate (sugars and flours) is also transformed in fat and it is also deposited.

26- What is the role of each food type to the Cellulite’s origin and to the body disharmony?

We ingested besides the water, carbohydrate, proteins, fats and vitamins. Of course the food is necessary; we cannot create the idea that to eat is bad. Eating is good and it is necessary, bad are the excesses. Speaking in a simplistic way, the proteins and the vitamins are the base of the defenses, construction and function of all of the important functions of the body; they are the foods par excellence. The carbohydrates and the ingested fats, although they also possess some nobler functions in the body, they are the "fuels." The "fuels" are used for the body to "work", and they are burned in this work, that include the basal metabolism (the whole function of the body, even in rest), the Lifting training performed in the normal activities, that it varies of a person for other (a cutting of cane spends much more than a bank employee), and the extra activities that are the Exercises. If  a person eats more than wears out, this excess is transformed in fat and it will be deposited in some part of the body. If that person eats less than wears out, the body will use what had kept already, and it happens the fat loss. This equation is unalterable. Then if there are excesses in the feeding, so much fats, as carbohydrate, these excesses will be deposited and they will alter the body composition with the consequent Cellulite and Localized and Regionalized Fat.

27- What are the best and the worst food for the patients with Cellulite?

The Alimentary Correction is part of the treatment of the Cellulite.  The ideal for the body form and for the Cellulite it is a rich diet in proteins and with few carbohydrate and fat. A diet is indicated based in ingestion of white fleshes prepared without fries.  Good aliments are the fruits, vegetables and green vegetables, milk and skimmed yogurt, ricotta, cheese cottage, and skimmed milk. Also fruit juices prepared with a lot of water, the use artificial sweeteners, substitution of the soft drinks for dietetic soft drinks, a lot of water and also a little, just a little of the Brazilian  rice and bean, masses and whole wheat bread with dietetic jelly. Creativity in the preparation of the foods, with tasty incomes, but dietetics, besides varied, form the base of the feeding that we extolled, clear here presented in a simple and fast way, that should not substitute the correct evaluation and it completes nutritional orientation.

28- Does the use of coffee and soft drinks with caffeine provoke Cellulite?

No, that is a myth. The caffeine is even good for the Cellulite. It is important to say that coffee with sweetener will treat Cellulite and certainly won't be badly.  The soft drinks with caffeine in the composition, since dietetic; don't make any harm as well.

29- Why when we lost weight, without other treatments, we could continue with the Cellulite?

The fat presence is an important factor for the Cellulite, but it is not the only factor, as we already commented on. The weight is not important, what is important is the amount of fat in the body composition and the fat that is present in the area with Cellulite. The woman deposits fat in preferential areas, as in the hip. This fat is difficultly removed. When happens the weigh loss, the fat can be eliminated of other parts of the body and it keeps present in the area of Cellulite, and the Cellulite keeps present. That is the role of the treatments in the Clinic of aesthetic medicine, which will stimulate through the enzymes and lypolitic substances the elimination of this altered fat. In addition, also there is the edema (swelling) and the alterations in the micro circulation, which are also treated at the Clinic of aesthetic medicine. And once again we demonstrated the importance of the associated treatments.

30- The acceptable average in percentile usually is 20% of body fat in the organism. How can we explain those people with body fat below 20% in the exams of Bioimpedance and even athletes of high performance have Cellulite?

The first analysis that we do is that other weight reflects the body as a whole, includes the bones, the organs, the skin, and the fat. The second analysis is the body composition, that divides the body in thin mass that are the bones, organs and muscles and the total body fat, that is the volume of fat of the body. As the bones and organs don't change of size, variations in the thin mass can be interpreted as variation in the muscular tissue, and we do then in practice. Already the Regional Fat, is the fat that is present in a certain area of the body, it reflects the fat distribution. Then it is easy to notice that to use the weight as indication factor is not a good procedure. For instance, a weightlifting athlete would have a great muscular mass, very little fat tissue, and because of the increased weight, because muscle also weighs, it would be classified as obese. Bioimpedance that considers 20% of fat in the body as a ideal body composition, has already improved this evaluation, but it divides the body in two parts, the fat and the rest, but it doesn't consider the distribution of this fat. For instance, a patient can have 16% of body fat, what is even better than the ideal, but great part of this fat is regionalized in the hip, then the patient will be "a Regional fat", with the consequent development of Cellulite and Localized Fat.  That regional fat can be evaluated with anthropometrics procedures and also with ultrasound of image, which shows the size of the fat layer in the preferential area of Cellulite.

These considerations answer the question. A patient with low total body fat, even an athlete of high level, which has 5% of body total fat, can have Cellulite, if great part of this fat be located in the hip. Therefore it is necessary treatments in Clinic of aesthetic medicine, to mobilize this regional fat, besides the Exercises and of the Alimentary Correction.

31- How to explain the fact that women with weight excess and, sometimes with bulky abdomen, don't have Cellulite, in the proportion that would be waited and other women with fine waist, thin,  have Cellulite very developed in the hip?

There are two basic types of body in the woman. The Android type, where happens a trend to the fat deposition in the superior part of the body, in the trunk. Those women have larger shoulders, trend to have larger breast and to deposit fat in the abdomen.  The type Gynoid has smaller shoulders, trend to have smaller breasts, finer waist and the widest hips, with trend to the fat deposition in the hip and in the thigh.   The hip and the thigh of woman with the Android type has little regional fat, the fat excess tends to go for the area of the abdomen. Little fat is found in this area, so, there will be less Cellulite.  On the other hand, the woman of the type Gynoid will concentrate the fat in the area of the hip, and although she can have a waist very thin, and fine trunk and face, with thin aspect, it will present serious alterations of the fat tissue with the presence of Cellulite in the hip and thighs.

32- What happens with the organism when we make lymphatic drainage?

The lymphatic drainage is a process that can be manual or mechanical; it eliminates water and toxins of the tissues. The lymphatic drainage is used in several medical illnesses as the lymphatic problems; the lymphatic problems after mastectomy (consequence of the treatment of the breast cancer) can also be useful in the treatment of the Cellulite. The patient with Cellulite has a content of water in the increased fat tissue, and worsening with the drainage for the veins and lymphatic provoked by the increase of the volume of the fat cells and hormonal action. Reducing this edema, it reduces the pressure in the tissues; it eliminates water and toxins and has a role in the improvement of the Cellulite. However the lymphatic drainage is not capable of treating separately the Cellulite, here is a need of associating the other methods.

33- Does the pregnancy worsen the Cellulite?

Yes, the pregnancy alters the feminine hormones. Those hormones even with normal action increase the fat deposition in certain areas, they alter the circulation in the veins and micro veins, it keeps water in the body, which are alterations that has important role in the emergence of the Cellulite.

34- How to avoid worsening the body during the pregnancy?

Of course a good prenatal is important for the mother's health and for the child, and that presupposes a correct attendance for the doctor obstetrician, and also a good adhesion to the orientations on the part of the mother. A good prenatal reduces the risks during the gestation and improve the mother's health and the child’s, reduce the undesirable aesthetic alterations of the gestation period.

A pregnancy well driven won't provoke very important aesthetic alterations, that easily they can be corrected, but if there is disarray to feed with consequent weight excess, then the alterations will be more difficult to correct.

35- Could we do some treatment for the body during the gestation?

The prenatal should include a good nutritional orientation, control of the weight and light Exercises, always with the obstetrician's attendance, and with authorization. With these cares, the alterations will be very smaller and they can be corrected later with more easiness.

Treatment is not indicated for the Cellulite during the pregnancy, but a consultation for orientation can be useful in the prevention of this and other aesthetic problems.

36- What about the other aesthetic problems that can appear during the pregnancy as striae or varicose veins?

Cares to avoid striae, varicose veins and fall of the breast can also be guided by doctor in a Clinic of Aesthetic Medicine that possesses the specialists of the several areas. In the case of the varicose veins, a consultation with the vascular surgeon is important. And if there are more extensive varicose veins, we advised an evaluation in the beginning of the gestation, other around the sixth month, and other immediately before the childbirth. Preventive orientations will be supplied not only to avoid the aesthetic problems, but for also to prevent the serious thromboembolic complications that can put in risk the mother's life during the childbirth and postpartum. The most serious varicose veins should have the vascular surgeon's company even during the internment for the normal childbirth or cesarean.

In the case of striae, moisturizing creams should be used in the skin of the breast, hips, belly, and thighs during the gestation. To avoid weight increase beyond the expected or programmed by the obstetrician. Therefore after the childbirth, when appears the milk, the breast has a fast volume growth, at this time is that the striae appear. Maintain the use of moisturizers even in the breast after the childbirth, what increases the elasticity of the skin and it reduces the risk of emergence of striae.

To prevent Mammary Ptose (the breast's fall) it should be used protecting for the breast, reinforced, that it maintains the suspension during the gestation and during the breast-feeding. These protectors even should be used during a lifetime, to sleep, and in the routine of the day by day. It should be left the most beautiful and sensual soutiens for the social occasions or for the intimacy of the couples. These simple cares decrease and they delay the breast’s fall a lot, with their aesthetic indispositions, and they should be applied from the adolescence. We are leaving a little of the subject Cellulite and body disharmony , but I think these are information on aesthetics preventive, simple, easily applicable and that can be useful for the readers.

37-Does birth-control pill provoke Cellulite?

Yes, the hormones of the birth-control pill provoke alterations similar to the one of the pregnancy, although in a very smaller level.

38- Do people that have P.M.T (Premenstrual tension) have larger trend to the Cellulite?

In a research that we did, we found an association relatively large among patients that have PMT and that also have Cellulite. PMT is associated to the maxim hormonal action of the cycle and in this period happens retention of liquids, what is associated with the emergence of Cellulite.

39- Does the hormonal replacement of the menopause worsen the Cellulite?

The hormonal action always worsen the Cellulite, and also the varicose veins , however the benefits of the hormonal replacement in the menopause are important, and a treatment well driven will bring few repercussions for the Cellulite and for the varicose veins. In addition the one that are doing a replacement, then the effects won't be much larger than the action of the woman's normal hormone. The replacement should always be made with a lot of criterion and rigorous medical attendance. If the patient has strong trend to the Cellulite and the venous illnesses, the cost benefit of the replacement hormonal treatment should be considered; and even not do this treatment in some cases. But of course Cellulite is not alone hormonal action, there are the other factors. If the woman has Cellulite, and this is inconveniencing her, she should seek the treatment.

40- What is the relation between the varicose veins and Cellulite?

The varicose veins reach more women, and they appear on the puberty for hereditary trend, they receive strong negative influence from the feminine hormones, the use of the birth-control pill and the pregnancy. Although there is a relationship between the veins of the micro circulation and the formation of the Cellulite, the varicose veins of larger caliber and well visible, nothing has to do with the Cellulite. In our clinic, 90% of the patients with Cellulite also possess spider veins (vases) and micro veins. We performed the treatments for the varicose veins as aesthetic importance with the treatment for the Cellulite, what reduces the number of times that the patient needs to move around to the clinic. We use Cryosclerotherapy, and the cosmetic surgery techniques for correction of the problem. On the other hand, when the varicose veins are of larger caliber, characterizing an illness, we prefer treating the varicose veins first, with surgery in day hospital and later we begin the body treatments as Liposculpture. That care reduces a lot the risk of circulatory complications that happens mainly in the plastic surgeries for the body.

41- Does cellulite cause pain?

Some patients with advanced Cellulite complain about pain, which is always light. It brings a true indisposition and it is bad for the self-esteem. If there is a very strong pain that inconveniences, probably the cause is other and it should be investigated.

42- Those who work sat down during a long period of time or standing have a larger probability of having Cellulite?

Theoretically yes, but there isn’t any scientific work that proves this possibility.

43- Why are those "holes” visible in the area with Cellulite?

The depressions of Cellulite, which are the holes, are part of the process of development of the Cellulite. The increase of the fat volume and the presence of the septums provoke the unsightly irregularities, which are better treated with simple Subcision or Subcision with Liposculpture.

44- Are there some difference among white and black skin in relation to the Cellulite?

The Cellulite is a process of the fat tissue, which is below the skin. The skin is only reached secondarily. The color of the skin doesn't have influence in the process. In skins of darker shade, the process can be a little less visible.

45- Do children have Cellulite?

No, the children can have excess of fat tissue, and skin folds similar to Cellulite, but it is not the same process.

46- Where should the patients seek treatment for the Cellulite and body shape?

As we can see, the Cellulite is a complex problem, and it is not at the hairdresser on the corner, or in the neighbor that knows how to do a massage, or with a "magic" machine, or with a cream that somebody brought from some place in the world, or even that “cheap” professional that somebody said it will work out. Seek a doctor that has formation in Aesthetic Medicine that works with seriousness who is member of one of the societies from the area, as the Brazilian Society of Aesthetic Medicine. Some professionals are not doctors, as the beauticians, people with good professional formation in technical level and they can aid in the treatment performed at the clinics, but we advised that it should be always under a doctor's attendance. Avoid the unprepared people that can make a great evil. All the capitals of the states and great cities of the country already have medical professionals of the area of Aesthetic Medicine. The complications we sometimes see published in the press is no longer justified for treatments of Cellulite badly done and performed for unprepared professionals.

47- Which treatment to use for each case?

Like you saw, the options are many, and we should choose the best procedure for each case. But it is clear also the complexity of the treatment. What we present here is what we prefer; in a personal way based on our experience and in the one of other professionals, it doesn't mean that other treatment programs are not efficient. But we emphasized, that any procedure separately is capable to solve these problems, there is no magic solution. To believe in imaginative treatments just takes to the patient's frustration and an undeserved discredit of the professionals that work in the aesthetics area with competence and scientific base. Choose the doctor or Clinic well to perform an aesthetic treatment.

48 – Finally, what does the Dr. suggest that a woman who has Cellulite can do to reduce it or even never appear it any more?

When the Cellulite and the Body Disharmony Syndrome are already present, the correct evaluation, orientation of the Exercises, of the feeding and the choice of the most suitable treatments performed by experienced doctors of  the area of Aesthetic Medicine is important. We suggested, therefore, a consultation. For the patients who don't have Cellulite or didn’t notice it still in time, in a light way and in a general way for all the ones who have a good Body Harmony and they want to maintain it, we advise that those people must have a healthy feeding, make Exercises regularly, must not have addictions as alcohol, cigarettes or use of drugs, must have a good attitude with life, without working in excess, reserving a time to take care of itself.

A good mind, a beautiful body and a good health can only bring well to the individual growth. In fact, it is not a modern objective; the Greeks already pursued it in the classic history. We believed, and this is the slogan of our life, following the Greco-Roman classic teachings, that the beauty and the health associated to the culture represent the best of the human condition.

We can affirm emphatically that:  - To do Exercises and to have good feeding bring pleasant, good form to the body and bring a useful health, therefore, to take care of the body, a futile activity should not be considered the appropriated, but the practice of great preventive medicine.

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