The Body Disharmony Syndrome  - Part 2

Part 1

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

5 - Corpore Naturale, the Program of Treatment of the Body Disharmony Syndrome 
The treatment of the Body Disharmony Syndrome   (Alterations of the Fat, Cellulite and Muscular Flaccidity) can be divided in two parts:  the one that depends on the patient and the one that depends at the Clinic of aesthetic medicine. 

a   - What depends on the patient?
What depends on the patient is important and it is the most difficult, because if a person wants to change body shape should change their habits. You are that you live. Who likes of good life and a lot of food and drink will have the body outline associated to that life style. Who has healthy feeding and practices Exercises will have the body outline associated to those healthy habits. The mind doesn't owe if it dissociates of the body. Health and beauty should walk together to compose with the healthy mind and the culture an ideal of life quality. The binomial healthy feeding and Exercises are the base of the good health and of the good appearance and without a doubt it is not easy to practice.  With certainty it is not impossible to have an attitude of healthy life, because a big one and every time larger portion of the population makes it, doing take in years recent to an increase of the life expectation. To treat the Body Disharmony Syndrome, then, has an important reflex in the life quality as a whole and those measured will be certainly beneficial for the whole body and not only for surface.

b - What depends of the Clinic?
Corpore Naturale is the Program of Treatment of the Body Disharmony Syndrome   developed by researches of the Naturale Clinic. The basis is   the global and personalized treatment. In other words, all the  alterations of the  Body Disharmony Syndrome  , including the  Cellulite, the  Localized  Fat, the  Muscular Flaccidity and the  Excesses of Fat,  are assisted (global), but in a personalized way (for each patient  is drawn a treatment program). 
Corpore Naturale is based on four phases:  In the phase 1 a consultation and exams is performed by a physician. In the  phase 2, a wide orientation is given including Alimentary Education , sporting orientation, explanations on all of the  available treatments and it is established a personalized program and the  prognosis for each case.  In the phase 3 the treatments are performed, the most modern, but with rigorous scientific base, and personalized for each patient, depending on the found in the exams and consultation. In the phase 4 maintenance is performed, because it is not enough to obtain the results, but they have to be maintained.
All of the phases of the treatment in the Naturale Clinic are performed by specialized physicians.  Notice that the treatments are performed by physicians and personalized for each patient, considering their problems, characteristics and objectives. The pattern here established it is a base on which vary the combinations proposed by the physician of the clinic.
b1-Phase 1 - Physician Consult   
The Medical Consultation is important part in the treatments of body aesthetics, because it allows establishing a treatment program personalized for each patient. During the consultation it is made a careful examination by a physician, which through a questionnaire studies the lifestyle, including alimentary habits and the practice of the patient’s Exercises. Anthropometrics Measures are performed  including weight, height, breast , waist, hip, bilateral outer thigh , high thigh, low thigh, calf, ankle, indexes waist / hip and waist / bilateral outer thigh, that will determine the  physical type and the  degree of disharmony  of the  body shape. They are performed pictures that allow the determination together for the patient and for the physician of the present alterations and establishment of the objectives and attendance of the results. They are appraised the  presence of the  components of the  Body Disharmony Syndrome   that are the  Cellulite, the  Excess of Body Fat, the  Muscular Flaccidity and the  Localized  Fat, and also the  presence of Striae, Varicose ,  Micro varicose and spider veins   that frequently are also present. Two specific examinations are performed, Bioimpedance, that gives the composition of the body and Thermography that is useful for determines the prognosis.  They can be requested in some cases Ultrasound to evaluate the  thickness of the  fat layer and laboratory examinations to evaluate the  function of the  thyroid and of the  ovaries.
b2-Aesthetic Complementary Exams
We performed two aesthetic examinations, Bioimpedance and Thermography.
Bioimpedance
 The Body Composition can be evaluated using several methods, easily. In our Clinic we used Bioimpedance.  The factor Body Fat of the Body Disharmony Syndrome can be showing in several combinations of four conditions. Excess of Weight, defined for IMC, Excess of Fat in the  Body Composition, defined for Bioimpedance , Localized  Fat mainly for the  physician's examination, and that are fat collections that make prominence in a certain area (as the  outer thighs) and Regionalized Fat , this defined as the  deposition of fat in a homogeneous way, without protuberances, in the  area of the  hip and thigh, that they can be availed by  Ultrasound, and in a simpler way evaluating the  depth of the  fat with the  fingers. Therefore, a patient with Weight Excess can present or not, associates, Localized Fat, Regionalized Fat and Fat Excess in the Body Composition. And in another situation even a patient with Total Body Fat very low, as for instance, an athlete, can present Regionalized Fat. This Regionalized Fat can determine emergence of alterations of the fat tissue in the hip and thigh, even in thin patients and with Total Body Fat very low. It is explained then, because even athletes, with Total Body Fat low, they can present Cellulite. What happens is that the little of fat that is present, is deposited, influenced by hormonal factors, in the hip and thigh, as Regionalized Fat. 
    Bioimpedance  is an examination that is done through a machine that generates a very low electric stream (no perceptible for the  patient)The  stream rides faster for the  thin tissues that has more water and electrolytes and walks more slowly for the  tissues with fat. In that way it is possible to determine the content in fat of a body in percentage. It is then, possible saying that a person has, for instance, 32% of fat mass and 68% of thin mass. 
    The  interesting, is that this examination helps to detect the  so called thin-fat, in other words, thin people in the  weight, and with fat composition increased in the  body, that provoke the  body disharmony  (Cellulite, Flaccidity, Localized Fat and Excess of Fat).  .
    It is because of this altered composition, that even people with the normal weight can have the alterations caused by fat excess. Other patients with Weight Excess, if they have the composition also altered, they will present alterations still worse in the body appearance.
    This examination is very important, because it helps to determine the alimentary correction, which it is necessary sometimes, even in people with the normal weight, to recover and to maintain the body form. 
Thermography
    It is a no invasive exam, performed with a thermograph created in Italy, and where leafs with Liquid Crystals of Cholesterol, that has the capacity to change the emission of colors in solid and predicable bases. This way is possible to determine temperature changes in the surface of the skin, and to observe, with the clinical consultation, the stage of the Cellulite. Each stage has own characteristic that can be observed in Thermography. To know the stage of the Cellulite is important for the prognosis. They vary from 1 to 4.  If the  stages are more initial is possible to wait complete disappearance of the  problem, with the  treatment, if they are more advanced is possible to wait a considerable one gets better, but no the  total recovery. The stages 1 and 2 are considered initials and the stages 3 and 4 considered advanced. Thermography, in a very simple way, just applying the  double leaves with the  cholesterol crystals on the  skin, and accomplishing a digital picture, it can determine the  stage of the  Cellulite, and to contribute for the  determination of the  components of the  . BDS - Syndrome of Body Disharmony.

b3-Phase 2 Medical Orientations -   Nutritional and Sporting
Nutritional Orientation  
The recovery in the body shape and the correction of all the components of BDS - Syndrome of Body Disharmony is difficult and they depend on the aesthetic and surgical treatments, but also of Exercises and good feeding.
We changed the word “diet”, which presupposes a passing attitude, by Alimentary Education, that it is an action for the whole life. Alimentary Education is a change of habits and it is one of the keys to have a beautiful body profile, free from Cellulite and Localized Fat and mainly with great health.
   The man, there is no many millenniums lived in the jungle, in caves, and, as animal more important of the creation, suffered the alterations provoked by the evolution. The man was adapting to the middle in that he lived, but many of the human reactions continue as in the time of the caves. In the prehistoric times there was difficulty to get food. The man needed to hunt and to seek for fruits and roots. A lot of times it was exposed to the intense climatic alterations, which changed the offer of foods, putting the life in risk. There is no way of as keeping the hunt, that deteriorated with easiness and the permanent search of food was, therefore, main and vital activity. Then the nature created in the man a reservoir of food that is the fat tissue. When the food was abundant, the man ate as it was able to and that food in excess was accumulated in the fat tissue. If the  foods, abruptly, lacked, the  ones that had plenty accumulated food in the  body would survive until that the  conditions got better, while the  ones that didn't have surplus fat, they perished. Of course for the modern man this reservoir is not necessary. It is more practical and efficient to keep the food in the storeroom,    in the refrigerator or even to leave in the supermarket, to it buy just when it is necessary. To maintain exaggerating reservation of fat in the body is nonsense and only does badly to the aesthetics and the health. The necessary should be eaten, without the excesses that worsen the Cellulite in the women, they accumulate fat and they deform the body, originating the Body Disharmony Syndrome.
         A healthy diet is based on proteins and natural vitamins, with few fats and carbohydrates. Fruits, green vegetables, white  fleshes, milk skimmed and derived of the  milk skimmed, as yogurt and white cheeses and , in The  Brazilian diet, only a little of the  bean  with a little rice, they form the  base of a good feeding.
 The Body Disharmony Syndrome   has several causes and it is not just fat excess, but the alimentary disarray is a fort component in the emergence of this problem type. She should not fall in the mistake of considering the food as a bad thing, the feeding is quite necessary, but with quality and without excesses, these ones, harmful.
The hereditariness, the hormonal action and the sedentary life are also important causes of Cellulite and loss in the body shape. Little can do in relation to the hereditariness and to the hormonal action, but the Exercises and the Alimentary Education are useful and fundamental in any treatment.
Some of the  treatments more used in aesthetic medicine mobilize the  fats of the  areas in that they are more fixed in the  woman, but these fats should not be recovered eating  in excess. The situations are different, the demand degree varies for each case, but all of the people that has Cellulite or a loss of the body harmony and intend to get better, need to do an alteration of alimentary habit.
When the alteration in the body shape goes initial and light, just Exercises and Alimentary Education are enough for the correction, but when a more important alteration is already present, the medical treatments, as Application of Lipolytics, Electrolipolisis, Lymphatic Drainage, Endermology, Ultrasound, Liposcupture, Liposuction and Subcision need to be used depending on each case. These treatments are undeniably more efficient when associates to the Alimentary Education and Exercises.
Good alimentary habits and Exercises are the base to have a good body appearance, what is pleasant, but they are also a requirement for the good health, what is quite useful. Therefore, to take care in the body shape is not only a vanity subject; it is also an attitude of preventive health.  

Sporting orientation
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. In short, the truth is that to have an athletic body is necessary to be an athlete. If still doesn't exist fat excess, Cellulite or flaccidity, just the Exercises are enough. But if the Body Disharmony Syndrome   is already present is necessary to associate treatment in Clinic of aesthetic medicine and a good nutritional orientation. The Exercises are very useful, but, only the Exercises, separately, don't eliminate the Cellulite and the Body Disharmony Syndrome. For who has Syndrome of Body Disharmony, the recovery in the body shape depends on the combined action of Aesthetic Treatment in the clinic, Exercises and Alimentary Education.
To have a beautiful and healthy body is not easy, but it is possible to the ones that make an effort. Maybe for recognizing the difficulty well to get and to maintain a body care it is that makes the body wife well done so valued. But why the exercise changes the bodies, which are the alterations that happen?
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 when there is repetition. The body interprets as if we were "Men of the Caves." Then, in prehistoric scenery, if a man runs everyday is because it is seeking the hunt and the food that should be difficult, or it is being the hunt and he needs to flee. In these conditions, the  body, adapted by the  evolution of the  species, answer and then  happen changes in the  organism that facilitate the  mobilization of the  fats giving  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 because there are the augmentation of the intracellular mitochondria that are corpuscles producers of energy. Then, the physical activity 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, however, if there is repetition along the time, at least 3 to 4 times a week. If there is not repetition, the body interprets that situation is fortuitous, not representing a real change and it continues to work accumulating fat and it doesn't produce muscular activity and increase of the energy.
The men and modern women if want to have muscular cardiovascular and energy answer, has to imitate the conditions prehistorically and to do physical activity frequently. The body answers differently, to the several types of Exercises. As general rule all are good, but some are more efficient when a certain objective is wanted.
Imagine that a runner makes a proof of 100 meters, which a champion gets in less than 10 seconds. It is not necessary to breathe a lot, because in 10 second almost do not have necessity of breath.    The necessary to an athlete is a lot of force in the legs, in other words muscles and she doesn't need so much of oxygen, for this exercise type, that is called anaerobic. Already a runner of long distances, as a marathon runner, needs to have a capacity of the  heart and one   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 muscular activity for instance, age very well to form muscles, but it develops little the heart and the lung. Already the aerobic Exercises, how to swim, to walk, to run, to bike is great to develop the cardio-pulmonary capacity. They also form muscles, mainly the swimming, but not as much as the calls localized Exercises or muscular activity. The ideal is the combination of the two exercise types.
Recommended aerobic Exercises:  the characteristic should be considered of each one, but to swim, to walk, to run, bike  or ergo metric bike  are the  aerobic Exercises par excellence, they mean health and they also improve the  body shape .
Anaerobic Exercises:  the  lifting training , muscular activity, are the  ones that have better effect in the  formation of muscles, that is what gives the  body outline, but it should be very well guided because it is the  exercise  that provokes more lesions when badly done. Body Pump and Lifting Training present good results, but they should be performed with a physical education teacher's attendance very closely.   For who wants to improve the  shape , the  combination of an aerobic activity with lifting training  activity is the  most efficient, but doesn't forget that the  repetition of the  activity in  small intervals  is very important. The  collective sports and the  tennis have great action in consumption of calories and,  therefore, to  weight loss, but they are insufficient to obtain cardiovascular effect and body shape .To do Exercises bring  of pleasant the  good form of the  body and bring  of useful health. Then it is hour of working out, without laziness or fear. Not to forget that a good orientation is indispensable.

b4-Phase 3 - Treatments of the Body Disharmony Syndrome   
The treatments of the Body Disharmony Syndrome   are several. Clinical or Surgical Techniques are used depending on each case. This way, in the Clinical consultation and with the analysis of the aesthetic exams, it is drawn a treatment program personalized for each patient. They will be suitable the treatments that can provide the better results, and heard the patient’s opinion, which will be applied. In the table below they are the treatments more frequently used. In our clinic, we used the most modern treatments, since they have a scientific acceptance. For many treatments, there  is a   lack of scientific confirmations, and they won't be used.

The Application of Lipolytics
An important technique to treat Cellulite and the Body Disharmony Syndrome   is the application of Lipolytics with derived techniques of Mesotherapy. It is a controverted theme. Is an efficient method?   For the one what does intend? What is Mesotherapy exactly?
If a medicine is supplied orally or by injection, it circulates on the vascular system reaching all of the organs. Although a product can concentrate more on certain organs, in a general way they are distributed by the whole body.  Only a small part of the medicine is going to the target   organ, where the problem exists. Therefore, of the received total dose, just a fraction arrives at the place that it is sick. For instance, if a patient has an "inflammation" in the knee and receives an anti-inflammatory, the medication will distribute for the whole body, reaching the lungs, the liver, the other knee, finally the whole organism, and only a small portion will reach the sick knee. The dose of the medicine is made on calculations based in the portion that acts in the point that is sick, and the remaining ends up being useless.
The basic beginning of the local application is the administration of medicines, close to the place where will act. Then if the medication is applied at the place, it will be present in the target point in high doses, and when it is absorbed and distributed by the organism, was diluted and has effect very decreased to the other organs. Then, a small amount applied in the target place will have a strong action in this place, and when absorbed and distributed in the rest of the organism there will be a dilution and the possible side effects will be much decreased.
It is obvious that this technique doesn't substitute any of the conventional treatments, but has some very specific applications where it can be useful.
Therefore, Mesotherapy, local application of Lipolytics, Intradermotherapy , are just a way of administration of medicines. It can be excellent, or useless or even harmful depending on whom accomplishes the treatment (that should always be a trained physician and habituated with the technique), of the type of applied medicine, of the problem to be treated and of the target organ where was made the application.
The used medicines are Lipolytics, in other words, they liberate the fat of the tissue. This fat has to be consumed. The exercise provokes the consumption of this liberated fat, that it won't be restored because of the alimentary Education. But, if the fat is liberated with Lipolytics, and it doesn't happen the consumption with Exercises, she returns to the fat tissue. It is also if they continue to happen the alimentary, new fat it is deposited. In this case the application liberates and the bad alimentary error.  A bad alimentary habit restores the liberated fat, turning useless the treatment. Therefore, the local application of medicines only is efficient associated to the Alimentary Education and to the practice of Exercises.
The local Application of Lipolytics, although very useful, separately is not capable to solve the problem of the appearance of the body, they are necessary, another measured. This is the reason for which this method, as any other method is sometimes put in doubt. No method used without the other ones was shown efficient to return the Body Harmony, but the discerning use of several methods, including Mesotherapy, Intradermoterapia and Lipolytics application with the participation of the patient in the Exercises and in the Alimentary Education presents excellent results.

Lipostabil / Phosphatidylcholine   
Lipostabil, whose basic substance is the Phosphatidylcholine, is a product capable acting on the fat tissue. His action on the cholesterol there is a long time is well known, and it has been used as supporting treatment of some alterations of the fats in the blood.
More recently, it was observed that local application can reduce the fatty tissue.
In spite of being a treatment relatively recent, has shown useful in the treatment of Localized Fat, as the “outer thighs" of the hips and the “Love Handles" of the abdomen. It has also been used for the treatment of the bags of fat of the eyelids and of the sub chin fat, the so called “double chin."
Important observation:  the lipostabil was used in Brazil in an experimental way, being a promising method. However, it still was not liberated by Ministry of Health, and his use is prohibited now at the country. Other similar medicines can be used with good results.

Lymphatic drainage
The Lymphatic Drainage is a type of massage that facilitates the drainage of the lymphatic liquid (that is among the cells and it is rich in fats) until the lymphatic ganglions, that it drains for the circulation. This procedure is very useful in the treatment of the Cellulite. The Lymphatic drainage can be made in a manual way or with equipments. The manual Lymphatic Drainage is a procedure done by professional especially trained for that, and is irreplaceable and fundamental in the control of the Cellulite. In our Clinic we give preference to the manual method of drainage, that we found more efficient, in spite of existing machines especially servants for the procedure.
Carboxitherapy
It is a new technique that uses applied CO2 under the skin, it improves the Cellulite, and it has been a lot used in the world and now it begins his application in Brazil. In this Technique the carbonic gas (CO2) is used on subcutaneous. The Treatment should be performed exclusively by physician. CO2 is a scentless gas, to which the organism is habituated, therefore it doesn't provoke allergies. Used correctly is exempted of complications and it doesn't present toxicity. CO2 is applied in the subcutaneous through a small needle, very fine. He will act in the affected zone of the   Cellulite and then, after some time, the gas is eliminated completely. Weekly sessions are performed. It is a promising treatment, but it should be used with other treatment and measures for the Cellulite.

Eletromyostimulation
Feminine Body harmony is integrated by curves and consistencies, which are supplied by the muscles. The thigh’s beautiful formate or the projection of the buttocks is consequence of good muscular mass, well developed and with tonicity (it is a state of muscular contraction in rest that gives an aspect of firmness). If a woman corrects the fat excess, doesn't mean that reached the Body Harmony. The need exists of correcting the muscular part. Any remedy or application is capable to increase the muscular mass or the tonicity. The artificial machines of muscular stimulation are capable to give tonicity, but they are only efficient while used. The ideal is to accomplish Exercises. We indicated the association of aerobic activity (Swimming, to Jogging, Ergo metric Bike) and Anaerobic (Muscular activity) or mixed (Lift Training). The electronic muscular stimulation is used in the treatment, while the Exercises are being initiate; being later, we only maintained the Exercises.   
    The so called Russian streams are capable to promote the artificial contraction of the musculature. This contraction is capable to promote the muscular tonus, and to leave to a   firmest musculature. However, the effect only exists while the stimulation is being made, repetitively. To stop the applications gets the lost of the effect. Because of this fact, in our Clinic we used these techniques in the beginning of the treatment, but we give emphasis to the practice of Exercises, that is still healthier and it can be maintained by a long time after having finished the treatment. Therefore, the electric streams are used in the treatments, but they don't substitute the practice of Exercises.

Electrolipolisis
A machine is used that generates a soft electric stream altering the fat cells. Those cells lose the capacity to keep the fat that is liberated to be consumed. Needs the use of very fine needles that are disposable and similar to the used in acupuncture. Unlike what it seems, it is not very painful, and it is very well accept, because of the quality of the acupuncture needles. 

Vacuotherapy -   Endermology
They are technical that use machines that make a strong suction on the skin. Older equipments exist of vacuous and now the most modern derived of Endermologie, a French technique very used as aiding in the treatment of the Cellulite. This technique accomplishes a strong massage and it is obtained an improvement of the granular aspect of the surface of the skin with Cellulite.

Ultrasonic Hydrolipoclasy
     This treatment is used for the treatment of the Cellulite and Localized Fat of small volume. Their waves penetrate from 3 to 4 cm of depth; they agitate the particles of water of the area that collide with the fat cells provoking strongly elimination.  The called Hydrolipoclasy technique is efficient in small Localized Fats. For larger volumes we preferred the liposuction. However, we stood out that the  application of the  Ultrasound directly in the  skin it is not capable to bring good results, it is necessary also the  application of liquids, through very fine needles, those liquids are usually associated with Lipolytics.

Treatments of Plastic Surgery
Liposuction
The main surgical technique used in the Treatment of the Body Disharmony Syndrome   is the Technique of the Liposuction. The Liposuction is a surgery performed with very fine cannulas that remove the Fat Excess where is located. It can be performed in several areas of the body.   It widely used in the aesthetic treatments.
The Liposuction is one of the surgeries more performed in body aesthetics in the world. The technique, relatively recent, found a great global development. The basic beginning of the Liposuction is the   realization of a small incision, through where penetrates a small cannulas. The  small  cannulas  receives a negative pressure, a suction, and while the  surgeon performs  movements, that liquefy the  fat, the  suction removes of the  body. This simple procedure is the base of a revolution in the Cosmetic surgery.
More recently the technological evolution added new details of the technique.
New even finer small cannulas, with orifices especially drawn and built with special materials as the titanium were the first acquisitions.
The  development of the  tumescent technique, that  provokes an exaggerating hydration of the  fat cells, with the  local anesthesia allowed to the  rational use of the  anesthesia and  facilitated the  withdrawal of the  fat, under day hospital ambulatory procedure.  
In the treatment of the Body Disharmony Syndrome, the liposuction is especially suitable for the treatment of the component of the Localized Fat. The technique of Liposuction has a lot of variants, but that in their bases don’t differ a lot of the original technique. Among the variants we can mention Liposcupture, Liposcupture with Subcision, Lipolight, Laser-assisted liposuction, VibroLiposuction, HLPA VibroLiposuction. It is important not to be seduced by the modernity of the names. All of the techniques are basically Liposuctions, and the variants are on respect to some detail that adds value, but it doesn't invalidate the other techniques. It is then, that a patient should not leave seeking a certain technique, but to seek a Clinic in what he trusts, and after a   physician's careful evaluation, will to determine together the technique that better adapts to the case. In our clinic, we practiced all the techniques, and we will, then, be able to choose the most beneficial for each patient. We will make an abbreviation summary of each technique.

Liposcupture and Subcision  
Recently it was published a surgical technique that it is especially indicated for the  depressions (small "holes"), provoked by the  most advanced Cellulite, that usually appear in the  buttocks area and in the  thigh's inferior  face. This technique is called Subcision.   Can be performed separately or accompanied by Liposcupture.
Subcision is performed at the own Clinic under local anesthesia, and the patient returns home immediately after the procedure. The technique consists of separating the skin, of the fat with Cellulite that has traction forces. An imported special needle is used, that possesses a special lancet. After the local anesthesia, with the micro lancet, the surgeon separates the skin that is adhered to the fat tissue with Cellulite that originates the depression. The procedure is repeated in each one of the “holes." the process is very fast, taking on average of 2 minutes to correct each depression.
Subcision is suitable for the most recent and shallow depressions. For the oldest and deep depressions, exists the need of associating to Subcision, the technique of Liposcupture.  Subcision is performed, as already described and it is then removed fat, with the liposuction technique, of areas with fat excess. The area habitually chosen as donor is the “outer thighs", or the knee, that then, at the same time can be corrected. The fat obtained, is injected to fill out the space between the liberated skin and the fat with Cellulite, in the depression. Subcision with Liposcupture removes fat of the area with excess and it applies to correct the areas where depression of Cellulite exists, correcting the two problems at the same time. The result of the technique is very well, having, however differences of results, that is individual.
This surgical treatment doesn't eliminate the need of the other cares for the body form. Should have Alimentary Correction, Exercises and the other cares that we described in the beginning of this article.
Isolated Subcision and Subcision with Liposcupture are complementally technical very useful for the care of that unpleasant and sly villainous, that it is the Cellulite, that insists on reaching the modern woman's body form. 
Liposcupture
Liposcupture is the practice of the liposuction with the application of the fat removed at other places, as for instance, in the holes formed by the Cellulite, or to increase the buttocks.

HydroLiposuction HLPA
HydroLiposuction or HLPA is the practice of the conventional liposuction, only that it comes preceded of the application of Ultrasound of three MHz. The Ultrasound liquefies the fat, in such a way that if it turns easier withdrawal for small liposuction small cannulas.
VibroLiposuction
In this variant it is used an equipment, the VibroLiposuction Machine, that provokes a vibration that helps to liquefy the fat to be removed. In the process of conventional liposuction, the physician makes movements for the withdrawal of the fat. The VibroLiposuction Machine accomplishes these movements mechanically, and as acts in a way more standardized, leaves the most regular results and the accomplishment of the fastest and easy technique, reducing the time of surgery.

laser-assisted liposuction – Laselipolisis  
Laser-assisted liposuction an evolution of the  classic technique. Finally the technology LASER, with use in a lot of areas of the medicine, arrived to the Liposuction.
The so called Technique of Laserlipolisis uses a LASER Nd:  YAG, especially drawn, that it emits the LASER through an optic fiber.
The LASER that is applied previously in the area to be operated provokes alterations in the fat tissue that it facilitates the withdrawal of the fat and the postoperative. One of the main reasons so that the Laser is used in the liposuction is the coagulation. With the Laser, the blood vessels and lymphatic responsible for the swellings and edemas - they are coagulated and that reduces as much the pain as the bleeding and the swelling. In that way, we have the advantage of accomplishing the procedure in a field with less blood allowing one to see the details of the surgery, improving the result.
Laser-assisted liposuction is a European technology, where was created the LASER used in the technique. Used with success in Italy, Germany, Argentina and Brazil.
The used Anesthesia is local, tumescent, that leaves   more fragile fat cells in the   area that receives the LASER, transmitted by a fiber of 1 mm of thickness. The fat cells of the area to be treated, receive a small cannulas of titanium very thin, which complements and removes the liquefied fat. The great advantage is a larger easiness of the procedure that happens with smaller bleeding and better recovery.

Lipolight
Lipolight is a small Liposuction with local anesthesia, performed in ambulatory way (without internment). As it is a small liposuction, and can only be performed in patients that have small fat collections. We cannot use Lipolight to treat patients with great volumes of Localized Fat.

b5- Phase 4 - Maintenance of the Results
After the treatment and recovery in the body shape, where we used the techniques and the most modern approach for these objectives, be with methods clinical or surgical, we should remind that although corrected the alimentary mistakes and the sedentary life, and treaty the aesthetic problems, they still stay in action two factors that we cannot eliminate, that are the hereditariness and the hormonal action. Therefore, periodic visits to the Clinic are necessary to correct eventual alimentary deviations or mistakes of Exercises and for the application of treatments. We advised periodic visits, in intervals that it will depend on the problem of each one. In these visits, when it is made antropométrica revaluation, nutritional and sporting revaluation, and proposed measures as sessions of lymphatic drainage and Lipolytics application, and / or use of complementally equipments and treatments .

6 – FAQ - Frequent Asked Questions on  Body Disharmony Syndrome  and the Cellulite
1- Thin women could  have Cellulite?
Yes. A lot of women that has the normal weight, or even below the normal, can present an alteration in the balance between the amount of fat 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, associate 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 Biompedance  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, it 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 emergence of the Cellulite.

3-Why  even some athletes, that has 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, it happens an increase of the regional fat.  That means, that she has normal weight, normal body composition, but the little of fat that 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.  It is for that that 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, that we  presuppose to have a restricted feeding can have Cellulite?
Because as we saw, the one that 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 weobserved in a high  frequency  is that in  patients with natural trend to  be thin , the worry with the Exercises and with the feeding is lower . Those patients have few fat cells, and some fat that accumulate, is distributed by these few cells, altering the fat tissue a lot, compressing the microveins and then determining the emergence of Cellulite. We can say, that in a thin person, a small fat concentration will already produce Cellulite even more important than in people with trend to be fat, that has more cells to divide the excess.

5-for what reason  we sometimes observed people with weight excess and that  doesn'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, therefore with many fat cells in the body can cause a Cellulite even larger in the thin than in the fat. Because each cell of the thin will have more fat than each cell of the fat, having then larger tissue alterations. Of course if a person with trend to the obesity  continue to win weight will start to have a much more serious Cellulite.

6-when the thin people want to win a larger physical shape , should they eat more?
A frequent mistake in people naturally thin, it is that when they want to win a larger physical shape, they begin to eat 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, to want a larger physical shape, should continue to feed with a good nutritional orientation  and to performe  Exercises to win muscle, what will give him wanted physical shape, but with more beautiful lines and harmony and without Cellulite.

7-How to treat the thin patients that 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.  Should be associated the practice of Exercises, mainly of the type lift training , for earnings of muscular mass.  A diet with more  protein is desirable, to create the nutritional base for the earnings 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 a lot of difficulty, because of the action of the feminine hormone. Therefore the need of the treatments in the Clinic of aesthetic medicine, that  uses methods, as the Application of Lypolitics, to help 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 of the place where is the Cellulite will be more easily eliminated, the microcirculation  and the edema will be gotten better and the Cellulite will be controlled this way .

8-Why  men don't 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.  The men don't have Cellulite because the man's fat tissue and of the woman it is essentially different. In the woman exist 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 do that the tissue expands towards the surface and to the skin in the woman and towards the muscle and to the depth in the man. This difference in the microanatomy that makes the Cellulite to be present in the woman and not in the man, that is resistant to her, even if wins 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 microvascular veins provoked by the hormonal action take to the vicious cycle of emergence of Cellulite.

9-cellulite only happen for having won  fat?
Of course the earnings 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 is only present in the woman. The fat increase appears by errors   in the feeding, but, above all for hormonal action, that it drives the fat excess for preferential areas, typical of the women. The fat in excess in determined  places takes compression to the micro veins  and lymphatic, that are 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 needs several measures for treatment, that to go for each altered factor.

10- We  always hear that the 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 faith was very 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 and that has Cellulite presents  fat excess in the body composition or in a certain area. These scientific works that I 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 microperfusion  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 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, that 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 lacked circulation , it is with capacity to performe  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 consequence of the other factors.

11- Does exist 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 a series of alterations that be 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 of difficult elimination 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 has similar causes, because they are linked to the action of the feminine hormone and the fat excess in the body composition, but they are processes different with treatments also different. 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, it is also part of the Body Disharmony Syndrome  . A direct relationship doesn't exist 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 a consequent smaller amount of muscular tissue, what is reflected in flaccidity. Thre are a frequent association. The treatments are then different, but they should be performed at a same time.

13- Does exist some exams that detects the Cellulite?
A correct evaluation before beginning the treatment is very important. Biompedance  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 of Localized  Fat , it includes Biompedance  to evaluate the body composition, an ultrasound, if necessary to evaluate the Regionalized Fat , Thermography , that helps to determine as the problem already moved forward. A questionnaire of life habits, measured antropometrics , 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 a  initial evaluation. We are contrary to the indication of standardized same treatments for all the patients based on a fast physical examination and the indication of this one or of that other  machine. 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-Which is  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, that we 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 medecines. Substances that has lypolitic effect are applied directly in the area of the Cellulite. These  lypolitics 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 are consumed and  won't be restored. The feeding that we 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 measures ages  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, that 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 leaves the strongest muscles, 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 measures we obtain the improvement of the Cellulite, of the Regionalized Fat , of the muscular tonus and of the fat excess.

15-What about  the surgery, when is it used?
It is indicated for the component Localized  Fat , that it is also part of the Body Disharmony Syndrome  . When the Localized  Fat  is of small volume, a small outer thighs fat, a small belly, the fat presence in inner  thighs or the "banana bag", that it is the  fat layer that is at the beginning of the thigh, soon below the buttocks , we obtain important improvement just with the clinical measures, being possible to avoid the surgery in the lightest cases. Already,  when the Localized  Fat  is of great or medium volume, the surgery will be necessary. With the clinical measures it is obtained the improvement, but no the elimination of the Localized  Fat of larger volume. We can performe  the Liposuction, and if there is the presence of the depressions of Cellulite, the “holes”, we performed body Liposculpture, that it is the fat treatment  with the Liposuction of the place where it is in excess, localized , and the application of this fat  in other areas. The other surgery that we performed for Cellulite, is simple Subcision , that it is the liberation of the skin of the fat tissue and of the septums that kill her depressed forming the holes. When these depressions are shallow, just the simple Subcision  done at the own clinic, with local anesthesia, in a process that lasts few minutes  is enough, already when the depressions are deeper,  it will be necessary Subcision and Liposculpture, that is the injection of the fat, in the empty space of the cellulite’s depression.

16-What must be   done first?  the surgeries or the clinical corrections, with aesthetic medical treatments, Alimentary Correction and Exercises? 
We defend  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 physicians, however prefer to operate first and to install the clinical measures later. The two ways  if applied correctly can offer good results.

17-when should I  make a Surgery to improve the body appearance?
The Surgery is used with wide indications, in body aesthetic treatments. Among them 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 , that it is a problem that also could be improved to reach  the beauty of the body.  However in this matter, that we called Body Disharmony Syndrome  , that it is the presence of Cellulite, Flaccidity, Localized  Fat and Excess of Body Fat exists 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 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, it is the cause of a lot of frustration and dissatisfaction. The correction of the lost Body Harmony needs effort and the physician's competence, but no less effort and dedication to the patient's. Of course if a patient submits to  all  the treatments and surgeries indicated, but continues with bad alimentary habits and sedentary life that went  the cause of the problem, won't get to reach and nor to maintain the intended results, the small progresses, if there are, soon will be lost.

19-Is frequent the patient to abandon the treatment of the Cellulite?
In our Clinic we performed the process of Consultation and Orientation that we commented on and that it takes 2 Hs on average, with the presence always of an experienced physician in the aesthetics area. This Consultation evaluates, it prognosticates and it informs the patient on his  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 left very clear that there are the need of Alimentary Correction and Exercises, associates to the treatment. Only Alimentary Correction doesn't solve the problem, Only Exercise also no, 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 it doesn't correct the Muscular Flaccidity, that it is who gives the body outline and it doesn't correct the body composition. Already to the use of all these measures together brings excellent results. The patients when see that the results are clear and visible, they 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 the responsible for the discredit that many still have in the results of the treatments. To take care of the Body Disharmony Syndrome  and of the Cellulite, one of their manifestations, is very difficult and a great challenge, for physicians and patients, that if faced with responsibility will bring the intended results.

20-Which 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 , it is almost a natural situation, although no obligatory, of 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 continue presents. The cares with 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 Lypolitics  are performed.

21-When should I begin to prevent and to treat the Cellulite?
A correct feeding and the control of the weight excess is important in any age. Not only for aesthetic subjects, 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 a more advanced process of Cellulite, of second to fourth stage it is already present, the treatments and orientations in Clinic of aesthetic medicine will be quite necessary.

22-Which is the suitable Exercises for the health and the body form in the women?
The Exercises should be considered in agreement with the patient's objective. If the intention goes to the improvement of the cardiorespiratory conditions  and the prevention of the circulatory illnesses, just to walk daily, for about 45 minutes, vigorously, in the street or in machine  it 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, it 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 in a body way also bring    the advantages of prevention of cardiocirculatory problems. But the light sports, as the walk, although very useful for the prevention of the circulatory illnesses, it is insufficient for the obtaining a  body shape .

23- Do exist 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. Really, 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  stop to  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 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 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 it is the fat tissue. Below the fat tissue is the musculature and inside of the musculature the bone. Then, in a simplified way, this way the buttocks and thigh's anatomy is formed and also of the leg. The sum of all these tissues that gives the circumference of the inferior part of the body. What forms the beautiful and harmonious lines in the body way 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 was not taken care with the Exercises, the muscle will also continue flaccid. Then just if does the  diet, the appearance of the body, although improved of 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 of the fat, and the result will be a skin flat, 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  fat excess happens in the body? Is it only caused by   excess of fats 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-Which is the role of each food type in the appearance  of the Cellulite and of 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. To eat is good and it is necessary, what is 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 that one eat more than wears out, this excess is transformed in fat and it will be deposited in some part of the body. If that one eat is 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 with fats, as with carbohydrate, these excesses will be deposited and they will alter the body composition with the consequent Cellulite and Localized and Regionalized  Fat.

27-Which are the best and worse foods 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 is the  fruits, vegetables and green vegetables, milk and skimmed yogurte, ricotta, cheese cottage, and skimmed milk. Also fruit juices prepared with a lot of water, use of artificial sweeteners, substitution of the soft drinks for soft drinks dietetic, a lot of water and also a little, very 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- Do the  use of coffee and soft drinks with caffeine provoke Cellulite?
No, that is a myth. The caffeine is even good for the Cellulite. Unintentionally to say that to take coffee will treat the Cellulite, but certainly, with sweetener, won't be badly.  The soft drinks with caffeine in the composition, since dietetic they don't also make any badly.

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 it 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 continues present in the area of Cellulite, and the Cellulite continues present. That is  role of the treatments in the Clinic of aesthetic medicine, that will stimulate through the enzymes and  lypolitics substances the elimination of this altered fat. In addition  also exists the edema (swelling) and the alterations in the microcirculation , that are also treated at the Clinic of aesthetic medicine. And  once again we  demonstrated the importance of the associated treatments.

30-The  average in percentile accept usually is of 20% of body fat in the organism . How does  to explain that people with body fat below 20% in the exams of Biompedance  and even  athletes of high performance have Cellulite ?
The first analysis that we do is that othe 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 it divides the body in thin mass that are the bones, organs and muscles and the total body fat, that it 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 it is not a good measure. 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. Biompedance  that considers 20% of fat in the body as a ideal body composition, already improves well 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 antropometrics measures and also with ultrasound of image, that show 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, that 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, what 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?
Two basic types of body exist in the woman. The Android type, where it 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 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 had in this area there will be less Cellulite.  Already the woman of the type Gynoid , will concentrate the fat in the area of the hip, and although can have a waist until very thin, and trunk and fine 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, that it eliminates water and toxins of the tissues. The lymphatic drainage is used in several medical illness  as the linfatic problems , the the linfatic problems after mastectomy (consequence of the treatment of the breast cancer) and it 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 of 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 separately to treat the Cellulite, the need exists 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, that are alterations that has important role in the emergence of the Cellulite.

34-how to avoid to worsen the body during the pregnancy?
Of course a good prenatal is important for the mother's health and of the child, and that presupposes a correct attendance for the physician obstetrician, and also a good adhesion to the orientations on the part of the mother. A good prenatal is going besides to reduce the risks of the gestation and to improve the mother's health and of the child, to 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-We could 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 Physician 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 besides the expected and programmed for 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-people that has P.M.T.. (Premenstrual tension) does have larger trend to the Cellulite?
In a research that we did we found an association relatively large  among patients that has PMT and that also has Cellulite. PMT is associated to the maxim hormonal action of the cycle and it is in that period that 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 worsening 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, and same should be considered if not to do in any to the replacement cases.   But of course Cellulite is not alone hormonal action, the other factors exist. If the woman has Cellulite, and this is inconveniencing her, should seek the treatment.

40- What the varicose veins  have to do with Cellulite?
The varicose veins  reach more women,  and they appear on  the puberty for hereditary trend, they receive strong negative influence of the hormones feminine, same normal, of the use of the birth-control pill and of the pregnancy. Although there is a relationship between the veins of the microcirculation  and the formation of the Cellulite, the varicose veins  of larger caliber and well visible nothing has to do with the Cellulite. What happens and that some of the causal factors as the feminine hormones, and the population more reached, the women, it is the same, having then concomitance of presence. In our clinic, 90% of the patients with Cellulite also possess spider veins  (vases) and microveins. We performed the treatments for the varicose veins  of aesthetic importance with the treatment for the Cellulite, what reduces the number of times that the necessary patient to move around to the clinic. We used Cryosclerotherapy , and the cosmetic surgery techniques for correction of the problem. Already when the varicose veins  are of larger caliber, characterizing an illness, we preferred to treat 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 happen mainly in the plastic surgeries for the body.

41-Does cellulite cause pain?
Some patients with advanced Cellulite  complain about pain, that is always light. The true indisposition and in the self-esteem. If there is a very strong pain that inconveniences, probably the cause is other and it should be investigated.

42- does who work very seating or standing  have  a larger probability of having Cellulite?
Theoretically yes, but there is any scientific work that  proves this possibility.

43-Why  it is visible those "holes " in the area with Cellulite?
The depressions of Cellulite, that 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, that are better treated with simple Subcision  or Subcision  with Liposculpture.

44-Is there some difference among white and black skin in relation to the Cellulite?
The Cellulite is a process of the fat tissue, that it is below of the skin. The skin is only reached secondarily. The color of the skin doesn't have influence in the process. The one that can happen is that in skins of darker shade the process can be a little less visible.

45-Do the children have Cellulite?
No, the children can have excess of fat tissue, and skin folds similar to Cellulite, but it is not to 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 in the hairdresser of the corner, or in the neighbor, that knows how to do a massage, or with a "magic" machine, or with a cream that brought of some place of the world, or with an another that is selling with the ads, or even in the professional "cheap" that somebody offers that it will be solved. Seek a physician that has formation in Aesthetic Medicine, that works with seriousness, that is member of one of the societies that they assist the area, as the Brazilian Society of Aesthetic Medicine. Some professionals no physicians, as the beauticians, possess good professional formation in technical level and they can aid in the treatment performed at the clinics, but we advised that it is always under a physician's attendance. Avoid the no prepared , 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. is not justified more the complications that we sometimes see published in the press, for treatments of Cellulite badly done performed for non well prepared professionals .

47-Which treatment to use for which 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 presented here, it is what we preferred, in a personal way based on our experience and in the one of other professionals, what 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 physician, or Clinic well to performe  an aesthetic treatment.

48 - To end, what the Dr. suggests that a woman with  Cellulite does for the problem to reduce or even never appear?
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 physician of  the area of Aesthetic Medicine is important.  We suggested, therefore a consultation. For the patients that doesn't have Cellulite or that notice it still in the  beginning in a light way and in a general way for all the ones that have a good Body Harmony and they want to maintain her advised that have a healthy feeding, make Exercises regularly, don't have addictions as alcohol, cigarettes or use of drugs, have a good attitude with the life, without work 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 be and individual growth, In fact, 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  of pleasant the good form of the body, and bring  of useful the health, therefore to take care in the body way a futile activity it should not be considered, but the practice of great preventive medicine.

7 - The Choice of the Physical Exercises
The number of academies throughout Brazil and the entire world  has been increasing a lot. The available statistical data are not exact, an organ that coordinates and regulate that activity not existing in Brazil. However, it is every time larger and easily perceptible the presence of these structures directed  for the practice of the physical exercise in great and small centers, what happens certainly in response to the also crescent interests of the population.

The main objective for somebody to seek the physical education in academies seems to be the aesthetic, but some other reasons can be identified as:  physical fitness complementation for athletes of high level;  athletes  preparation for amateur competitions;  the  complement for weigh loss programs;  prevention and basic cares of health;  medical treatment and leisure.
As well as the reasons to seek an academy are several, the frequenter are also different in several aspects as:  sex;  age;  weight;  height;  physical type;  previous physical conditioning and general aptitudes for the sport.
The physical activity can be characterized in five categories as occupational (manual work), of lifestyle (to take care of the house, to go to foot for the purchases, to go up stairways), recreation (to fish, to dance), care with the body (race, academies, swimming, gymnastics), sport as pastime (informal games), competitive sport (competitions).
Analyzing the statement that "when the physical activity is promoted, it would be important for the teacher to know the behavioral context and personal psychological aspects involved for the ones that practice"  and that "the determinant of the physical activity are different for each one of the five categories ", we observed in practice of the day by day, that sometimes, a same frequenter , that seeks different academies, with the same purpose, receives several orientations.
 In the programs there is no great adhesion, having abandonment, rotation, and frequent frustration on the part of the frequenters, when they don't reach the intended objective.
Maybe one of the reasons of there not being always good results, be it that a lot of academies don't offer driven programs in a personalized way, leaving for the frequenter the choice of the program, a lot of times inadequate, and that it suffers influence of myths spread by the media and among the people.

Such verification is not compatible with the good professional and scientific formation and the positive involvement with the work of the professionals great majority that work with the area, being very more fruit of the lack of specific studies of the role of the physical education in the human aesthetics, that we considered to be the main reason, I admit or no, of the search of the academies for the population.
Analyzing these aspects, sees himself the need to gather information scientifically based, above all in how to apply the appropriate exercise to each individual, respecting their objectives, and consequently, to motivate the frequenters to the permanent and regular practice of the physical exercise. If for the other areas of the physical education, the knowledge are already wide and with great scientific base, still a lot of publications don't exist approaching the physical education under an optics of the human aesthetics, a phenomenon in the days today.
The Physical education uses, a lot of times, the knowledge of the sporting acting to apply in the human aesthetics, but a frequenter of the academy can be interested in the development of a part peculiar of the body with aesthetic objectives and not in sporting competitions.

It is then that a new field of performance appears, involving these areas of the sciences, that it is the development of the Human Aesthetics. The knowledge need adaptations then to answer to these new longings. The patterns of the Medicine, of the Nutrition and of the Physical education, for their basic areas of performance, they can be adapted and new techniques and concepts be assimilated.
The Medicine created the Aesthetic Medicine and the Nutrition was in charge of developing nutritive foods but with low calories, and offer of proteic complements, vitamin and caloric. Programs of Physical education, with the aesthetic connotation and under scientific bases  need to be developed. Few researches exist in this specific area, and the one that observe is the use of the concepts already existent to assist the aesthetic objective.

An interaction among the Medicine, the Nutrition and the Physical education in a synergic way seems to be the best way to assist to the interest of the enormous portion of the population that seeks help to improve the self-esteem.
We will discourse, based on the available literature, and using the common sense, on aesthetic benefits that can be acquired  with the help of the several sporting modalities.

a-  Some attributes for the body aesthetics of several sporting modalities.

Several available sporting modalities exist, each one with certain attributes, These characteristic  can be used in the body aesthetics. We will talk about what can be acquired as aesthetic benefit by the frequenters and it is clearly more perceptible in the sporting practices habitually applied.

Spinning
 Allows to simulate the conditions of a bicycle of highway competition. The spinning controls the progress speed continually, simulating mountain and the resistance of the air. Of the aesthetic point of view, the spinning works inferior members, developing legs, thighs and buttocks , besides being an aerobic activity and of great caloric expense. It is insufficient as only activity for the aesthetic objectives. Associated to  the Lifting training can be a good program with aesthetic objectives.

Jogging
 It is an aerobic activity. It begins when an individual moves to a speed and in a way that results in a flight period among the shocks of the feet against the soil. Of the aesthetic point of view, the jogging aids in the reduction of the total body fat and it develops the musculature of the inferior members, however, although it is an average activity and high intensity, as only activity it is insufficient for the aesthetic objectives. Associated the Lifting training can be a good program with aesthetic objectives.

Step
 Strengthens the musculature of the inferior members, legs, thighs and buttocks. It improves the muscular resistance, and it reduces the total body fat. Of the aesthetic point of view, the step aids in the reduction of the total body fat and it develops the musculature of the inferior members, however, although it is an average activity and high intensity, as only activity it is insufficient for the aesthetic objectives.

Walk
 The objective of the walk is to get that the people become at any moment active proposing an activity and for any one, young or senior. If the walk if it turns a progressive activity, the zone of the white cardiac frequency it is reached. When performed with long duration, the walk is effective part of a program of weight control. Of the aesthetic point of view, the walk aids in the reduction of the total body fat, however, although it is a starting point to begin a program of aerobic development in race is, as only activity, insufficient for the aesthetic objectives.. It can be used as starting point in frequenters that were sedentary, passing progressively for light race, with objective of aerobic development.

weight training
Main anaerobic activity. Works the musculature of the superior and inferior members, could be adopted, with aesthetic objectives, with the purpose of muscular hypertrophy or physical conditioning. Of the aesthetic point of view, the Lifting training is an effective exercise for the maintenance of the muscular tonus and increase of the muscular mass, although it is an anaerobic exercise, as only activity, insufficient for the aesthetic objectives. Associated to an aerobic activity, it can be an excellent program option with aesthetic objectives. The largest search for the practice of the Lifting training was for the period of the night and for the frequency of three weekly trainings, tends as objective, in most of the cases, the physical conditioning, following for the body aesthetics.

Swimming
Works aerobic resistance and the whole body musculature. aids in the caloric expense, maintaining then the muscular tonus. Of the aesthetic point of view, the swimming aids in the reduction of the total body fat and it maintains low muscular activity. Although works the whole musculature, as only activity, it is insufficient for the aesthetic objectives. Associated the Lifting training can be a good program with aesthetic objectives.

Physical conditioning
Develops the aerobic resistance, it aids in the reduction of total body fat and it maintains the muscular tonus. Of the aesthetic point of view, the physical conditioning aids in the weight reduction and it strengthens the musculature, meantime with aesthetic objectives it should be associated with other activities.

Localized  gymnastics
 It is an anaerobic activity . Increases the force and the resistance of the main muscular groups. However, programs of exercises elaborated to increase the muscular resistance don't have effect in the increase of the force. Of the aesthetic point of view, the located gymnastics is an effective exercise for the maintenance of the muscular tonus and increase of the muscular mass, meantime with aesthetic objectives it should be associated to other activities.

Mountaineering
It is an anaerobic activity. With the regular practice it develops superior and inferior member. Of the aesthetic point of view, the mountaineering is effective for the maintenance of the muscular tonus and muscular development, however, with aesthetic objectives it should be associated with other activities.

Squash
Strengthens superior and inferior members, acquiring muscular resistance and aerobic resistance.Of the aesthetic point of view, the squash aids in the weight reduction and it strengthens the musculature, although it is an aerobic activity of high intensity. with aesthetic objectives, it should be associated with other activities.

Judo
Works superior and inferior members, acquiring force and agility and it aids in the reduction of total body fat. Of the aesthetic point of view, the judo aids in the weight reduction and it develops the musculature, mainly of the inferior member. Although it is an aerobic activity of high intensity, with aesthetic objectives it should be associated with other activities.

Mini Tramp
 Aerobic activity promoted by an elastic bed. works aerobic resistance and it strengthens inferior members. Of the aesthetic point of view, the mini tramp aids in the weight reduction and it strengthens legs, thighs, buttocks. Although it maintains the muscular tonus, as only activity it is insufficient for the aesthetic objectives.

b - Some Considerations on Sporting Practice and Human Aesthetics

Frequency
The frequency can include number of days a week, and number of times a day.
We advise  in our study with patients with body disharmony , that for aesthetic objectives, the ideal of activities weekly is 5 aerobic and 3 anaerobic.  A minimum of 3 aerobic activities and 2 anaerobic weekly it also presents good results, but slower. The Muscular Flaccidity was found in 87% of ours patients, appraised for clinical examination. This flaccidity is due to sedentary life, or of the practice just of light exercises (95,8% of the patients), that are efficient to obtain a good  answer cardiopulmonary , but insufficient for increase and maintenance of muscular mass. In this study, 95,8% of the patients are sedentary or they just practice light exercises. The tenuous lines that give the harmony of the feminine body are supplied in majority by the muscular tonus. The physical exercises should be important part of the treatment, to obtain tonicity increase in all the patients and for increase of muscular mass in the thin patients. However, it should be emphasized that to obtain this answer, it is necessary vigorous exercises. If the objective is an athletic body, the road should be in the direction of turning an amateur athlete. They are necessary 5 weekly sessions of 1 hour of aerobic activities (ergo metric bike, swimming or light race) and 2 to 3 weekly sessions of anaerobic activity (Lifting training or trainings of weight rising in group). Good feeding and exercises bring of pleasant the good body form, but they are justified for they be, besides methods to improve the appearance, excellent actions of preventive medicine and of well to be emotional. The vigorous exercises aid to obtain negative caloric swinging, for the loss of body fat and they increase the thin mass and the muscular tonus. The electronic muscular stimulation is useful in supplying muscular tonus, but it should not substitute the emphasis in the exercises.

Duration
The duration is related to the intensity, due the total work performed by session, Considering that many sedentary individuals can performe  a session of exercise of low intensity more easily and of long duration than the opposite and to obtain the benefits of the physical activity with a minimum risk. As the intensity of the exercise increases, the necessary duration to consume certain amount of calorie decreases.The duration of the exercise for each exercise session can be supplied as a  number of minutes of exercise, total of kilocalories (Kcal) worn-out, and total of worn-out Kcal for kilogram of body weight.

Intensity
The intensity describes the necessary overload to generate a training effect.

Walk
The exercise programs for people sedentary, young, senior or obeses, they should be initiate with activities of low intensity (walk).
The emphasis on the slow walk the moderate as the main activity in the beginning of a program, beginning slowly and progressing easily, minors will be the chances of provoking muscular lesions and of worsening old lesions.
When the individual gets to walk about 6,4 km without fatigue, the progression for a walk program / jogging will be recommended.

Jogging
The energy expense of the jogging/walk program  is about of twice the one of the walk (in slow speeds the moderate ones). The  important in the beginning of the jogging program is to performe  the transition of the program of way walk to minimize the discomfort associated to the introduction of any new activity. That is gotten beginning with a jogging/walk /jogging program, that facilitates the adaptation when mixing the jogging with the walk.The jogging, obviously, is not for all. In the obeses people's case or with ankle problems, knee or hip, it can be an avoided activity. Activities recommended for that population are the cyclism and the swimming.

Games and Sports
As the individual becomes used to with the exercise, other activities that demand higher levels of energy expense can be introduced, but without rest, as the table tennis, squash and exercises with music. Activities as walk /jogging can be introduced, in order to reduce the participant's chance not to adapt to the activity.

Training of force
It is of extreme importance that stays the thin body mass due to the maintenance of the energy swinging for a lifetime, avoiding like this, futures problems of health.The recommendation for of dynamic exercises of force they would be in ten or twelve repetitions, demanding total width of the movement in an intensity that causes fatigue and a minimum from eight to ten different exercises that include the main muscular groups, proceeding at least twice a week.
The activity maintains or it forms the thin tissue (muscle) that has the capacity to burn calories. Diet by itself takes to the loss of the muscle and the reduction in expense caloric diary, resulting in a crescent fat deposit.
The practice of physical activities also favors the sociability, the participation in group and the consequent interaction processes and social integration. The own improvement of the body aesthetics, as well as the perception of the progress of the physical condition (aptitude), it collaborates directly for a larger valorization and increase of the self-image aspects and self-esteem. Being well physically, as well as feeling healthier, the individual will be more easily prone meeting well psychologically , mainly  get even, making possible, consequently, better performance in their social relationships.

Personalized programs
Based on these studies the Naturale Clinic developed own programs of exercises, recommending the most appropriate exercises for each physical type or each patient's situation.

8 – The Beautiful , The  Art, the Medicine, the Philosophy, and the Woman
            What is the Beautiful? - Plato already recognized the existence of things that are beautiful for themselves and that supply a pure pleasure that no that of the ceasing of the pain or affliction. Socrates thought the Beautiful was an agreement observed by the eyes and ears. Kant found beautiful above all the natural, the birds, the plants. And the definitions of the Beautiful and of what it is Aesthetic, they were always present and they were enlarged in the philosophical and artistic discussions. The feminine beauty, also a manifestation of the Beautiful, is sometimes little understood by being associated to a futile behavior. Rude mistake, to work, to practice sports, to study, to frequent the aesthetics clinics is not task for futile and simple. Women intelligent, educated, that work home and has profession and that are above all strong, they are the ones that has enthusiasm to take care of the beauty and of the health.
The pure feminine beauty occupies a place in the Cosmoses, as well as the other natural and no natural beauties. A beautiful bird or animal are beautiful, as well as a picture, a city, a forest, a star, or a poetry. The beauty shows in things free from the feeling and thought humans and of them it doesn't depend. There is no evil in worshipping the Beautiful. There is no evil in worshipping the Feminine Beauty. To admire the Beautiful doesn't mean to despise what is not beautiful. It is also then beautiful the woman senior, healthy and happy, as the active man in all of the stages of life.  It is also beautiful the child playing, the work of art, the nature, is beautiful the wisdom. Clear, there is no beauty in the illness, in the sadness, in the death, in the hunger, in the destruction. The harmonic, quality of the Beautiful, is clear and shows in the life, in the health, in the happiness and in the love.  The woman, of the humans the most beautiful part, could only have been the inspiring largest of the art and of the artists, since the old times. To Victory  of Samothrace, to Venus of Milo, the Egyptian paintings, the surrealist Dalis’ s Gala , the woman's soft beauty in the Spring of Botticcelli, the woman in the poetry of Vinícius of Moraes, of Drummond, inspired wonderful works for them.
And it is clear, the beauty changed through the times. In the past the feminine beauty was only a face, privilege of little that had the genetic coincidence of having a face with harmonic lines. The habits then didn't allow to reveal the body. In the current times all the feminine forms are exposed, and that pleasant liberation of habits gave to the women the possibility of other beauty manifestations, the beauty of the body, that is much "more democratic", because accessible to most of the women. The nutrition, the sports, and also the medicine started to help in the promotion of the feminine beauty.
A new medical specialty - the Aesthetic Medicine, intends then to use the techniques, the research and the medical knowledge for the promotion of the feminine beauty of the face and of the body. The Aesthetic Medicine is the Medical Art of the Beautiful, and as the other arts, that produce a pleasure, a subjective happiness, it cannot be submitted to a judgement of value. value is determined by the good to be that it causes the to who receives their benefits. The taste, the capacity to judge what is beautiful, it is that makes the work of art to be wonderful for some and horrible for other, it is influenced by the culture, for the conditions partner economical, for the fashion, for the habits of each people. Then, it is not the Aesthetic Medicine that as science creates that basic aspects that are the taste and the aesthetics. fits to her just to assist the collective unconscious's longings and as an artistic manifestation, to create, to maintain and to improve the Human Beauty.

Part 1

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