bioplasty

Autor Prof. Dr. Miguel Francischelli Neto
Clínica Naturale
Av. Moema, 87 cj 51-52 , Moema, São Paulo - SP , Brasil
Fone 11 50511075
©Clínica Naturale 2008

a – Definition
It exists a group of alterations that affect the body aesthetics, that we called “Body Disharmony Syndrome” – BDS. These alterations were described for the first time by Miguel Francischelli Neto, MD, PhD , Head of the Naturale Clinic, with base in their researches on human aesthetics.
This Syndrome is characterized by the presence of Cellulite, Alterations of the Body Fat and Muscular Alterations that frequently appear associated.

The Body Disharmony Syndrome

• Cellulite

•          Alterations of the Body Fat
            Excess of Weight
            Excess of Fat in the Body Composition
            Localized Fat
            Regionalized Fat

•          Muscular alterations
            Muscular flaccidity
            Loss of Muscular Mass

Then, the whole Body Composition is really what determines the body form, it should be considered in the maintenance and recovery of the Body Harmony.
The Cellulite, the Muscular Alterations (Tonus and Mass) and the Alterations of the Body Fat (Weight Excess, Fat Excess, Localized Fat and Regionalized Fat ) have a paper in the Body Disharmony, with several intensities for each patient and they should be treated joints, but in a personalized way, with a treatment program drawn for each patient. In these writings we will discuss the causes of BDS and the bases of treatment.
B – The Components of the Body Disharmony Syndrome
b1-Cellulite
The Cellulite, whose medical name is Hydrolipodystrophy, is not only fat excess, it is an modified fat, that has edema (water), and that suffers the influence of the feminine’s hormones, same the normal ones . It is one of the largest complaints by patients that request our Clinic for the recovery of the body shape they are several causes.

B2-Alterations of the Body Fat
The Fat Excess can be showing in 4 ways, which may occur separately or associated:
1 - Weight Excess: the patient has weight above the normal that is reflected in a different way depending on the amount of muscle that the patient has. He can have weight and Fat Excess with normal or increased muscular mass, or weight and fat excess, with reduced muscular mass, that it is the worst possible situation.
2 - Excess of Fat in the Body Composition: the patient has a proportion of fat, larger, when compared with the thin tissues (muscles, organs and bones); this can happen with or without Weight Excess There fore, even thin patients can have Fat Excess in the body composition, with the aesthetic alterations of his body shape, and they would be call the "thin / fat."
3 - Regionalized Fat: it is the fat that is deposited in the women, preferentially in the area of the hip and of the thigh. It can happen in people with Weight Excess, with normal weight, with low weight, and even in athletes, with little fat in the body (what happens, it is that the small quantity of fat that exists is all founded in a certain place, in the woman usually in the hip and thigh). It is different from the Localized Fat because it is not characterized by a projection; it is a fat distributed in a homogeneous way.
4 - Localized Fat: the Localized Fat is a fat projection in a certain place, for instance, in the outer thighs, or in the Belly. She should not confuse the Localized Fat with the other forms of fat excess. (Weight Excess, Fat Excess in the Body Composition, Regionalized Fat)

b3- Muscular alterations
What gives form to the body, it is not the fat but the muscle!
In the Body Disharmony Syndrome the muscles can be altered in two ways
1 - Impairment of the Muscular Mass: a small amount of muscles exists
2 - Atony: the muscle is present in good amount, but it is flaccid.

c – The Combined Treatment of the Body Disharmony Syndrome - What to do????
They are a large offer of available treatments for correction of the body aesthetic alterations. In a first moment the patient feels lost among so many options published in the media. It is better a diet or is the Exercises? Is it a liposuction or the Lipolytics applications? Which exercise? Which diet? Which machine is better, Carboxitherapy? Endermology? Russian stimulation? And the first question is: What to do? How to do?
As the alterations of the Body Disharmony Syndrome are several, the treatment should also be addressed for each one of the alterations then, we performed a combined treatment where most of the methods can be used, but in a personalized way for each patient. In the treatment part we will discuss with more details each one of the methods and indications, but in the table below we can find a summary of the alterations of the Body Disharmony Syndrome and the treatments that are part of the program Corpore Naturale .

The Body Disharmony Syndrome
Alterations	Treatment
Cellulite
Cellulite stage I, II, III, IV	Alimentary Correction Aerobic Exercises Lipolytics application - Mesother apy Lymphatic drainage Complemental treatments Ultrasound - Ultrasonic Hydrolipoclasy Electrolipolisis, Endermology, Carboxitherapy Russian stimulation
Depressed areas of Cellulite	Liposculpture and Subcision
Alterations of the Body Fat
Excess of Weight	Correção alimentar Exercícios aeróbicos
Excess of Fat in the Body Composition	Alimentary Correction Lipolytics application Aerobics Exercises
Localized Fat	Liposuction Vibroliposuction Lipolight Laser-assisted liposuction Liposculpture
Regionalized fat	Alimentary Correction Lipolytics application Ultrasound Hydrolipoclasy Aerobics Exercises
Muscular Alterations
Muscle Flaccidity	Anaerobic Exercises Aerobic Exercises Muscle eletroestimulation Russian stimulation
Loss of Muscle Mass	Anaerobic Exercises Aerobic Exercises Hyperproteic feeding

2 - The Cellulite
The year was 1639, when Peter Paul Rubens painted what was the ideal of the feminine beauty at that time, the Three Graces. Women with Weight Excess with clear presence of Cellulite, that only the realism, characteristic of the Baroque period in the arts allowed to show the beauty ideal in the beginning of the third millennium however it changed and a lot the presence of fatty tissue is little accepts and the irregularities of this tissue, the Cellulite, is the modern women's fright the Cellulite, however, the great villain of the feminine beauty, is present in 80% of the western women. Every time appears earlier, doing reach young and adolescents and not respecting until the thin women the modern and managing photographers of movies, substitute of the old realistic painters, don't have Rubens' same aesthetic ideal and they characterize the feminine beauty today in types thin, athletic and without Cellulite.
a- What is the Cellulite?
     The Cellulite is showing in the fat tissue that is below of the skin. In the whole body this layer exists the normal amount of fatty tissue in the body is of more or less 20% of the individual's weight. When happens the increase of the amount of the fat tissue, they start to happen alterations, with the compression of vessels and projection of this tissue for the skin, causing the alterations known as Cellulite. However, the Cellulite is not just increase of the fat tissue, because this way, it would exist in fat men, what doesn't happen. It is, actually, a sum of alterations, current of the fat increase, but where several factors have action: as hormones, feeding, sedentary life, circulation, genetic trend, physical and other type.
b-stages of the Cellulite
      The Cellulite comes in four evolution stages. While we showed what happens in each stage we will will talk about the mechanisms of formation of Cellulite.
Normal condition
In the normal condition the fat tissue is richly irrigated, the fat cells are in size and normal ways the vessels are efficient and has normal formate. It doesn't exist edema and the Thermography (an examination that demonstrates the degree of Cellulite) is normal.
b1-Stage 1
An increase of volume of the cells of the fat tissue happens in the affected area caused by fat accumulation inside of the cell. Doesn't exist circulatory alteration and alteration of the sustentation tissues, just a discreet dilation of the small veins of the fat tissue there are no visible signs in the skin and nor pain. In Thermography it can appear the aspect called "Moucheté" that represents increase of the temperature provoked by edema and permeability of the capillaries.
b2-Stage 2
The fat cells are a little more full of fat, and the ones that are in the deepest part begin to suffer the same process. Already appears a certain fibrosis degree, that to get worse, it begins to form micronodules in the following phase the increase of the volume of the cells provokes circulatory alteration for provoking the compression of the microveins and lymph vessels the blood and the lymph (aqueous liquid that bath the cells) they are dammed. It happens a larger "swelling" of the fat cells and the toxic debris that should be eliminated begin to be accumulated. The woman's normal hormonal action increase the body liquids, that still worsens more the swelling. The contraceptive use and the gestations, still for hormonal action are going swelling the tissue and worsening the alterations. In the skin it is already possible to observe irregularities to the palpation and still doesn't exist pain. In Thermography the aspect "Moucheté" is more characteristic appearing edema and blood stasis demonstrated by areas of increased temperature.
b3-Stage 3
The cells continue increasing his volume because of the continuous fat acquisition and edema. It happens a disarrangement of the tissue and emergence of the nodules that in spite of deeper, they are seen as irregularities in the surface of the skin, even without palpation. It begins to exist a fibrosis, that is the hardening of the sustentation tissue (where they are the fibers) and the circulation is still more committed. They can appear the vases and microvaricose veins.   The skin has the aspect similar to "Orange peel." Then occurs the sensation of weight and fatigue in the legs (should remember that the Cellulite is related with circulatory functional problems at the skin and fat tissue, and in that stage the circulation in the fat tissue is already with problems). In Thermography the aspect of "Pelle di Leopard" that is the presence of countless stains appears at thermography, denoting the disorganization of the tissue, with several temperatures and the edema and venous stasis presence.
b4-Stage 4
The disordered swelling of the fat cells is accentuated, the sustentation tissue becomes more hardened (fibrosis) and the local circulation of venous return is very committed. In that stage, the Cellulite is hard and the skin is "shiny", full of depressions, with padded aspect. The legs are heavy, swollen, aching and the sensation of fatigue is frequently present, same effortlessly. In Thermography they appear the previous aspects described already and Black Holes" appear, that are areas of reduced circulation, representing a coalition of several micronodules in macronodules and the presence of significant fibrosis.
c - Location of the Cellulite
The Cellulite can be located in several areas of the body. A predilection exists for the buttocks area, the thigh's lateral area, the face interns and back area of the thigh, the abdomen, the nape, the back and lateral part of the arms and the face interns of the knees, but in predisposed people it can reach even the ankles.

d-factors that Favor the Emergence of Cellulite
d1-Family genetic predisposition
The Cellulite is not an illness, but a female characteristic. The Cellulite is for the woman, as well as the baldness it is for the man. They are characteristic of gender, associated to the hormone. As well as the masculine hormone and the genetic characteristics determine the baldness, the feminine hormones and the genetic characteristics determine the Cellulite, not in a such intense way, because it will suffer more the influence of the enviroment and of the life style , but also the genetics is present. The genetic inheritance is very important in the Cellulite and has to be taken into account. Different types of factors can be inherited that predisposes to her. (production of hormones, constitutional type and even alimentary habits), but that doesn't mean that is leaving obligatorily to develop the problem if somebody of the family has. We will suppose that two identical twins sisters, with genetic predisposition for Cellulite, be created by different families. A family worries in maintaining a healthy feeding and in doing regular physical Exercises. The other doesn't give importance for those cares. The first twin has very smaller probability of developing Cellulite. A person with hereditary trend to develop Cellulite to have sedentary life and careless alimentary habits can have even more Cellulite than other with larger trend, but that takes care.
d2-Hormonal factors
The feminine hormones are the main causes of Cellulite. Alterations of the production, use of medicines with hormones, disequilibrium between estrogen and Progesterone, adrenal hormones , can unchain or to worsen the Cellulite for several mechanisms. They interfere in the metabolism of the fats, in the lymphatic and venous circulation, they facilitate the retention of water and salt and, besides, they coordinate the fat deposition in the abdomen, hip and thighs to give to body the feminine aspect. A trend exists, in the woman, there to be larger deposition of fats in the areas of the body where the Cellulite is more frequent. Even people with little amount of total fat can concentrate the adiposity in those areas. When the woman gain weight, great portion of the fat going to these areas, and, still worse, if the fat deposition is quickly the disorder of the tissue is worse facilitating the formation of nodules of Cellulite. When losing weight, the feminine hormones hinder the withdrawal of fats of those areas. For that reason many people when lose weight lose in the arms, face, thorax, legs and muscles, but not in the areas of Cellulite. The treatments with Lipolytics and Mesotherapy seek to mobilize the fats of these specific areas so that they can be used as source of energy and consumed. Even small disorders of that complex relationship among the hormones always result in worsening of the Cellulite. If a woman has Cellulite, it doesn't always mean, that she has hormonal disequilibrium, because, even the feminine hormones perfectly balanced can provoke Cellulite, almost as a secondary feminine characteristic. This happens, because that person's fat cells have a sensibility increased to the hormones, provoking the fat deposition and then the formation of Cellulite.

d3-Bad alimentary habits
To eat more than the necessary, as well as rich diets in fats or carbohydrates or bad alimentary habits they increase the synthesis and the storage of fats, favoring the Cellulite. To take small quantity of water and to abuse of the salt hinders   change the liquid balance of the organism favoring the retention of toxic residues of the cellular metabolism (The cells work as a factory that produces several useful things, but that work all produces a garbage - toxic residue - that needs to be constantly removed).
d4-Sedentary life
The lack of physical Exercises reduces the consumption of energy a lot for the body that facilitates the alimentary surpluses that will be transformed in fat. Besides, the cells lose the capacity to produce energy taking the whole organism to be slowly more apathetic. The ancient life style didn't have the means that exist today as easy transport, appliances, channeled water, etc. A woman had at not so many years ago household chores that forced very more Exercises than today, how to remove water of the well, or to walk to do their obligations, for instance. The modern means turn obligatory the accomplishment of some extra physical activity to avoid the sedentary lifestyle o   that is very harmful for the health as a whole and not only for the body harmony.
e-Differences between the Fat Tissue of Men and the Women
The Cellulite is not only fat increase, because if it went like this, fat men would have Cellulite, what doesn't happen. Sometimes times fat men present some folds of the skin, that look like the Cellulite, but actually don't happen all the described alterations. The men don't have Cellulite, because fundamentally has a different fat tissue and it doesn't suffer the hormonal action. The men's fat tissue has septums (bars that permeate the fat cells) thicker, and these septums are disposed of an oblique way. In the women the septums are finer and disposed of perpendicular way. These characteristic do that in the men, when it happens increase of fat tissue under the skin, it is projected for the bottom. In the women when it happens the increase of the fat tissue he is projected outside. The septums hold the skin, and among the septums it happens the fat projection. The irregularity that is visible in the surface of the skin appears this way. Another characteristic that is different between men and women is the presence of the feminine hormone. The normal feminine hormone, the one of the contraceptives and the one of the gestations provoke a fluid retention, mainly in the fat tissue of the hips and thighs. This increased liquid, associate to the fat increase and the feminine anatomical characteristics are important determinant for the emergence of the Cellulite.
f-The Physical Type.
They exist, basically, two types of women when we considered the formate of the body. The women with Gynoid shape trend and the women with Android shape trend. The women with   Gynoid type have the trend to have the waist and the superior part of the body thinner and the hip and thigh with larger trend to deposit fat. The women of the Android type have a trend to deposit fat in the superior part of the body. This way, when win fat the women Gynoids put this weight more in the hip and thigh and has more Cellulite. The Android women put on weight more in the abdomen arms and breasts and less in the leg, and has less Cellulite. Therefore, the physical type also influences in the emergence of the Cellulite.

g-The weight , the number of fat cells and the Cellulite
We believed that the effects of the fat deposition can be different in patients with higher or lower population of fat cells .
The people with great population of fat cells, with trend to the obesity, that we will call type G, have a great number of fat cells, while the people with small population of fat cells, with trend to be thin has a small number of units and we will call type M. If a same amount of fat be added to the body by alimentary error or lack of Exercises, the people of the type G will have less fat by fat cell than the people of the type M. The fat cells of the people of the type G would increase less in size than in the type M. In the type M, Therefore the repercussions in the fat tissue, with the modifications that take the Cellulite, for a same fat deposition, will be proportionally larger. The same happens in the venous and lymphatic sysmall cannula that it is smaller in absolute numbers in the people of the type M in relation to the people of the type G. A same absolute increase in Kgs of the fat tissue in the population M will have larger repercussions in the fat tissue, with consequent Cellulite that in the population G. This theory can explain the several manifestations of the Cellulite, that although it presents a clear relationship with the feeding and fat deposition, sometimes surprises us with the discovery, no rare, of people with Weight Excess and without presenting Cellulite proportional to the overweight and thinner people, with important alterations. We considered that to exist Cellulite an increase of the fat deposition should exist in the fat cells, that it is what will unchain the process. The Regionalized Fat , deposited by hormonal influence, has then, important role and the total number of the individual's fat cells can be associated. Then, even thinner people can have a lot of Cellulite, even disproportionally larger than fatter people. Therefore , to treat Cellulite is more complex than only to lose weight.

3 - Alterations of the Fat
a-The Excess of Fat
A person can have the normal weight or only a little increased and however to have a Fat Excess and lack of muscular mass in the body. Then, same being apparently thin, will appear the "Syndrome of the Body Disharmony." Another person can have Weight and fat Excess and impairment of muscular mass, then the Disharmony will still be more important. The normal distribution of the Body Composition is 20% of fat and 80% of thin mass that it is formed by muscles, bones and organs. As, in rule, the bones, and organs don't change of size (safe if sick), the thin mass reflects the muscular mass. A woman of 1,59 m of height, that weighs 55 kilos, has a normal weight. But, her Body Composition goes of 35% of fat and 65% of thin mass, she presents a Fat Excess in the body and lack of muscles. This Fat Excess will contemplate in the presence of Localized Fat and Cellulite and the lack of muscles in flaccidity. Then, Will happen the Body Disharmony Syndrome , even in a thin woman. Already another patient, with 1,53 of height, that weighs 70 kilos, and that has 50% of Body Fat and 50% of thin mass, would have an ideal weight of 51 kilos. Therefore, has an excess of weight of 19 kilos, but an excess of Body Fat still larger, of 25 kilos, therefore, besides the Weight Excess exists lack of muscular mass. That composition will reach the Body Harmony in a much more intense way. The combinations of those factors (muscles and fat) can be the most different possible, and the intensity of the problem and the treatment will be different for each case.
b-The Localized Fat
The excess of Body Fat and the hormonal action can take to the deposit of fat tissue in certain parts of the body. In the man the preferential place is the Belly and the "Love Handles" and in the woman Gynoid is the area of the hip, where appears the famous "Outer Thighs fat ." In the Android woman, the deposition is in the Belly, as the Man. We already saw that the Fat Excess can exist even in people without Weight Excess, what explains the Outer Thighs or Belly presence even in women seemingly thinner. The Correction of the Body Composition can improve the Localized Fat. Small depositions can disappear, but in many cases, this fat is difficultly mobilized, even losing weight. Clinical treatments, with Hydrolipoclasy (Ultrasound) and Mesotherapy can treat Localized Fat of small volume. Already the cases of medium and big extension end up needing surgical correction, as the liposuction. The Surgery doesn't eliminate the need of Alimentary Correction and Exercises and the treatment for the Cellulite. As always, in the whole approach for Body Harmony, they are necessary complementary and combined techniques.
c-The Regionalized Fat
We called Regionalized Fat , a fat layer that is deposited in a homogeneous way under the skin, without doing projections. It is different from the Localized Fat, because this makes a projection, as in Outer Thighs and in the "Belly." the Localized Fat is a more homogeneous layer, that it deposited from the hip to the knee in the women of the Gynoid type and in the abdomen, flanks and waist in the woman of the Android type. This layer, differently of the Localized Fat, it cannot be removed easily with the Liposuction. It is intimately associated with the feminine hormones and the Cellulite. It is in this layer that the Cellulite installs. For us, to detect the Regionalized Fat , it is only to catch the thigh's skin, between the fingers , very nearby to the muscle of the leg. The more thick the volume apprehended among the fingers, larger is the Regionalized Fat volume. The Localized Fat is treated better with Liposculpture and the Regionalized Fat , with the treatments of Cellulite.
4 - The Muscular Alterations
a - What gives the form to the body?
What actually gives form to the body is the muscle and no the fat. To have harmonic lines the muscles have to present an amount (mass) and tonus (firmness) correct.
For a good cardiovascular protection it is necessary just to walk fast, without stopping, daily, for an average of 45 minutes. However, to have answer in the form of the body, only walk is not enough, it is necessary to work out and a lot. The truth is that to have an athletic body is necessary to be an athlete. If it still doesn't exist fat excess, Cellulite or flaccidity, just the Exercises and good feeding are enough. But, if the Cellulite and the Localized Fat are already present, they are necessary, besides the Exercises, the medical treatments.
b-The Exercises and the "men and women of the caves"
We will remind the evolutionary nature of the human body and to consider that if our conscience and culture are modern, the subconscious and our basic reactions are prehistoric. The effect of the exercise happens because the body respond to them as if we were "Men of the Caves." In a prehistoric scenery, if a man runs everyday is because it is seeking the hunt or it is being the hunt and he needs to flee. The body, adapted by the evolution of the species, answers. Then, happen changes in the organism that facilitate the mobilization of the fats and give more force (The increase of the muscles) and animus (The increase of the energy). The fats decrease because they are consumed and reducing the weight is easier to run to hunt or to flee. The energy increases by an increase of the corpuscles producers of energy (mitochondria). The physical activity, for this mechanism, provokes impairment of the fat tissue, the increase of the muscles and of the production of energy. That effect, called " effort’ s effect " happens only, if there is repetition along the time, at least 3 to 4 times a week. If there is not repetition the body interprets that that situation is fortuitous, not representing a real change, and continues to work accumulating fat and it doesn't produce muscular activity and increase of the energy.
To the modern men and women if they want to have mass muscular, good form, cardio-pulmonary reserves and energy, has to imitate the prehistorical conditions and to performe frequently the physical activity. The body answers differently to the several types of Exercises. As general rule all are good, but some are more efficient for a certain objective.
c-Aerobic and Anaerobic
Imagine that a runner makes a proof of 100 meters, that a champion gets in less than 10 seconds. It is not necessary to breathe a lot, because in 10second badly gives time to breath. What is necessary to the athlete is a lot of force in the legs, in other words, muscles, and she doesn't need so much of oxygen, for that , this exercise type is called anaerobic. Already a runner of long distances, as a marathon runner, needs to have a capacity of the heart and a very good lung, because it will exercise for several hours, needs a lot of oxygen and it is not necessary a lot of muscle and this exercise type, then, it is called aerobic. The anaerobic Exercises, as the lifting training , for instance, is very good to form muscles, but it develops little the heart and the lung. Already the aerobic Exercises, how to swim, to walk, to jogging, to bike is great to develop the cardio-respiratory capacity. They also form muscles, mainly, the swimming, but not as much as the lifting training. The ideal is the combination of the two exercise types. A great association is swimming and muscular activity.
For who wants to improve the form, the combination of an aerobic activity with muscular activity is the most efficient, but doesn't forget that the repetition of the activity in small intervals is so much important. The collective sports and the tennis have great action in consumption of calories and therefore weight loss, but they are insufficient to obtain cardiovascular effect and body form.
To do Exercises bring of pleasant the good form of the body and bring of useful health. Then it is the time of working out, without laziness or fear. A good orientation is indispensable and if the age goes more advanced, it is necessary medical evaluation before beginning. The Exercises are important part of the Naturale Clinic Program of Body Aesthetics, Corpore Naturale, and a personalized orientation is the ideal to obtain the results, with the treatments performed at the clinic.