Omi Tokuya, Sato Shigeru, Kawana Seiji
Department of Dermatology, Queen's Square Medical Center, Yokohama ; Department of Dermatology, Nippon Medical School, Tokyo.
Laser Ther. 2013;22(2):131-6. doi: 10.3136/islsm.22.131. Epub 2013 Mar 31.
Cellulite is a problematic condition affecting mostly women, characterized by a bumpy or nodular skin surface. Recent approaches with laser treatment have offered some promise. The present study sought to identify possible targets for laser treatment or light therapy through an ultrastructural investigation of the condition.
Study subjects comprised 7 healthy Japanese female volunteers (Age range 37-46 yr, average 38.4) with cellulite, graded on the 4-point Nurnberger-Muller cellulite severity scale. Four patients were at grade 2 and 3 at grade 3. Three millimeter punch biopsies were obtained and routinely processed for light and transmission electron microscopy.
Microphotography of specimens from cellulite patients demonstrated the presence of fibrotic septa which divided up larger clusters of adipose tissue into smaller packets, with the septa acting as a tethering system, thus producing the typical dimpling pattern. Ultrastructural findings showed proliferation of collagen and elastic fibers down into the cellulite tissue with compression of capillaries and congestion of arterioles, resulting in poor blood flow.
The histological and ultrastructural findings of cellulite clearly distinguish the condition from simple fat deposition. The remodeling of the fat layer into lobulated packets of lipocytes sequestered by fibrotic septa with a high proportion of elastic fibers would suggest the use of a fiber-based interstitial laser-assisted lipolysis system at an appropriate wavelength which might offer benefits through disruption of the septae through a photomechanical effect and lipolysis of the sequestered lipocytes. This could be followed by a course of near-infrared phototherapy to accelerate clearance of freed lipid and debris and reestablish the vascular system.
橘皮组织是一种主要影响女性的问题性病症，其特征为皮肤表面凹凸不平或呈结节状。近期的激光治疗方法已展现出一些前景。本研究旨在通过对该病症的超微结构研究来确定激光治疗或光疗的可能靶点。
研究对象包括7名患有橘皮组织的健康日本女性志愿者（年龄范围37 - 46岁，平均38.4岁），根据4分制的纽伦堡 - 米勒橘皮组织严重程度量表进行分级。4名患者为2级，3名患者为3级。获取3毫米的打孔活检组织，并常规进行光镜和透射电镜检查。
橘皮组织患者标本的显微照片显示存在纤维化间隔，这些间隔将较大的脂肪组织簇分成较小的包块，间隔起到束缚系统的作用，从而产生典型的酒窝状图案。超微结构研究结果表明，胶原纤维和弹性纤维在橘皮组织中增生，压迫毛细血管并导致小动脉充血，进而造成血流不畅。
橘皮组织的组织学和超微结构研究结果清楚地将该病症与单纯的脂肪沉积区分开来。脂肪层重塑为被富含弹性纤维的纤维化间隔分隔成小叶状的脂肪细胞包块，这提示可使用基于纤维的间质激光辅助脂肪分解系统，在适当波长下通过光机械效应破坏间隔并分解被分隔的脂肪细胞，可能会带来益处。随后可进行近红外光疗疗程，以加速清除游离脂质和碎片并重建血管系统。
